Okla. Stat. tit. 36 § 6060.42

Current through Laws 2024, c. 378.

Section 6060.42 - Shared savings incentive program

A. An insurance carrier may offer a shared savings incentive program to provide incentives to an enrollee when the enrollee obtains a comparable health care service that is covered by the carrier from providers that charge less than the average allowed amount paid by that carrier to network providers for that, comparable health care service.

B. Incentives may be calculated as a percentage of the difference in allowed amounts to the average, as a flat dollar amount, or by any other reasonable methodology approved by the Insurance Department. The carrier shall provide the incentive as a cash payment to the enrollee or credit toward the annual in-network deductible and out-of-pocket limit of the enrollee. Carriers may allow enrollees to select which method the enrollee prefers to receive the incentive.

C. An insurance carrier that offers a shared savings incentive program shall:

1. Establish the program as a component part of the policy or certificate of insurance provided by the carrier and notify the enrollees and the Insurance Department at least thirty (30) days before program termination;

2. File a description of the program on a form prescribed by the Insurance Commissioner. The Insurance Department shall review the filing and determine whether the program complies with the provisions of this section;

3. Notify an enrollee, annually or at the time of renewal, of the availability of the shared savings incentive program and the procedures to participate in the program;

4. Publish on the website of the insurance carrier, easily accessible to enrollees and applicants for insurance, a list of comparable health care services and health care providers and the shared savings incentive amount applicable for each service. A shared savings incentive shall not be less than twenty-five percent (25%) of the savings generated by the participation of the enrollee in any shared savings incentive program offered by the insurance carrier. The baseline for the savings calculation shall be the average in-network amount paid for that service in the most recent twelve-month period or any other methodology established by the insurance carrier and approved by the Insurance Department;

5. At least quarterly, credit, deposit or make a cash payment to an enrollee of the shared savings incentive amount pursuant to participation in the shared savings incentive program; and

6. Submit an annual report to the Insurance Department within ninety (90) days after the close of each health benefit plan year. At a minimum, the report shall include the following information:

a. the number of enrollees who participated in the program during the health benefit plan year and the number of instances of participation,

b. the total cost of services provided as a part of the program, and

c. the total value of the shared savings incentive payments made to enrollees participating in the program and the values distributed as cash or credit toward the annual in-network deductible and out-of-pocket limit of an enrollee.

D. An enrollee shall not be required to participate in a shared savings incentive program.

Okla. Stat. tit. 36, § 6060.42

Added by Laws 2022 , c. 151, s. 3, eff. 8/26/2022.