OK| Oklahoma Insurance Department Bulletin No. 2025-10 announces substantive changes from Senate Bill 515, effective November 1, 2025, impacting health insurers and related entities in Oklahoma. The bill clarifies what qualifies as a “health benefit plan” and “health care service,” excludes specific coverages from the law’s scope, and introduces a new option for enrollees to pay out-of-pocket for medically necessary services at negotiated rates and have these costs counted toward their deductibles and out-of-pocket maximums under certain conditions.
Main Points:
- Senate Bill 515 establishes and defines terms for “health benefit plan” and “health care service,” setting boundaries for included and excluded coverage types.
- Enrollees can now pay out-of-pocket for certain medically necessary healthcare services at negotiated lower prices, and these payments may be applied to their deductibles and out-of-pocket limits if properly documented.
- The bill takes effect November 1, 2025, and outlines compliance requirements for both insurers and providers in the state of Oklahoma.