BULLETIN NO. 2025-12

The purpose of this bulletin is to inform and clarify to all health insurers licensed in Oklahoma that offer any health insurance plans to Oklahomans, including Medicare Advantage and Medicare Supplement plans, of the Oklahoma Insurance Department’s (“OID”) perspective on unfair trade practices that could potentially lead to manipulation of the insurance market, withholding or denying access to products from Medicare-eligible consumers, and the applicability of Oklahoma Statute, 36 O.S. § 1209(A), to such practices.

It has been brought to the OID’s attention that some insurance carriers, including those offering Medicare Advantage plans, have possibly attempted to restrict access by either removing the enrollment application from their website, encouraging producers to avoid selling their products, or changing or discontinuing producer compensation.

The OID views these practices as an unfair trade practice or method of competition under 36 O.S. § 1209(A), which prohibits any method of competition or act in the business of insurance that is unfair or deceptive, even if not specifically enumerated in statute.

It is an inappropriate and unfair practice, with the potential for great harm to Oklahoma insurance consumers, for carriers to restrict access or dissuade consumers from buying a product that was filed to market in Oklahoma and priced accordingly. To maintain fair competition in these markets, it is strongly encouraged that carriers:

• make available and easily accessible their applications for enrollment in all forms, including printed, on their website, and through their appointed agents;
• not engage in convincing or suggesting their products not be sold, marketed or discouraging enrollment;
• not change compensation or commissions mid-year;
• provide compensation or commissions if the product they filed had built compensation into its rate development.

Compensation or commissions is not a buffer against a bad market or a method to bolster profits. Discontinuing commissions on any insurance products disincentivizes producers from marketing these products to those who need them. This practice is especially concerning when the carrier has appointed independent agents, has historically paid commissions for the same products, the rate development for the products included commissions, or the carrier did not provide advanced notice that the plans would be “zero commission only.”
All carriers and producers operating in Oklahoma that offer insurance products to people, including those eligible for Medicare, are to act in good faith. All products filed and approved for sale must be made similarly accessible and marketed without artificial barriers or disincentives. If such products were filed or developed with an expectation to pay commissions, they should compensate producers accordingly. Only those carriers who expressly filed plans with a clear statement that the plan would provide zero commission are permitted to avoid compensating an appointed agent. Carriers are strongly cautioned against any other artificial manipulations of the Oklahoma insurance market which would harm Oklahomans.

All producers have an ethical and legal duty to put the best interest of the consumer first and are to assist the consumer in finding and acquiring the plan that best suits the consumer. Considerations of prescription drug coverage, provider access, overall cost, and affordability should be the priority.
The OID will closely monitor compliance and may take enforcement action under 36 O.S. § 1209(A) against any carrier engaging in practices that manipulate the market or harm consumers.

This Bulletin is not new law but is an agency interpretation of existing law, except as authorized by law or as incorporated into a contract.

Questions concerning this bulletin should be directed to the Oklahoma Insurance Department’s Legal Division at 405-521-2746 or by email to Tyler.Trammell@oid.ok.gov.

BULLETIN NO. 2025-11

Disclaimer: The purpose of this bulletin is to inform ambulance service providers and all health insurers licensed in Oklahoma of specific legislative changes for 2025. The Department’s intent is to help licensees be aware of changes that establish substantive mandates or require implementation changes. This bulletin is not intended to include every legislative change made in 2025.  Please refer to the Oklahoma Supreme Court Network (OSCN) webpage to view all changes.

Senate Bill 1067 relates to ambulance service reimbursement, amending language and creating a new law found at 36 O.S. § 6050.3.

The bill authorizes, but does not mandate, local governmental entities or ambulance service providers operating on behalf of local governmental entities to annually submit to the Insurance Department the ambulance service rates set or approved, whether in contract or ordinance, by the local government entity. Ambulance service rates should be submitted on or before December 31 to okambulancedata@oid.ok.gov via the form found at https://www.oid.ok.gov/consumers/insurance-basics/health-insurance/ambulance-rate-reporting/.

Ambulance rates set or approved by the local government entity that are not submitted to the Insurance Department shall be the lesser of three hundred twenty-five percent (325%) of the current published CMS rate for ambulance services for the same services provided in the same geographic area, or the ambulance service provider’s billed charges.

The minimum allowable reimbursement rate under any health care benefit plan issued by a health care insurer to an out-of-network ambulance service provider for providing covered ambulance services shall be at the rates set or approved, whether in contract or ordinance, on May 1, 2025, submitted by a local governmental entity in the jurisdiction in which the covered ambulance services originate or ambulance service provider operating on its behalf, if the local governmental entity has submitted such rates.

All copayments, coinsurance, deductibles, and other cost-sharing feature amounts applicable to the amounts calculated and submitted to the Insurance Department shall not exceed the in-network copayment, coinsurance, deductible, and other cost-sharing features for the covered ambulance services received by the enrollee.

SB 1067 becomes effective January 1, 2026.

Questions concerning this bulletin should be directed to the Oklahoma Insurance Department’s Legal Division at 405-521-2746 or by email to Tyler.Trammell@oid.ok.gov.