BULLETIN NO. 2025-05

Disclaimer: The purpose of this bulletin is to inform 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. 

House Bill 1389

HB 1389 relates to mammography screening and diagnostic examination, amending language found at 36 O.S. § 6060.  The bill amends 36 O.S. § 6060(A)(3) by adding “contrast-enhanced mammogram” and “molecular breast imaging” to what may be included under the definition of “diagnostic examination for breast cancer”.

HB 1389 further adds the definition of “supplemental examination” which means “a medically necessary and appropriate examination of the breast, including, but not limited

to, such an examination using contrast–enhanced mammography, breast magnetic resonance imaging, breast ultrasound, or molecular breast imaging that is: a) used to screen for breast cancer when there is no abnormality seen or suspected, and b) based on personal or family medical history or additional factors that increase the individual’s risk of breast cancer, including heterogeneously or extremely dense breasts.”

Finally, HB 1389 amends 36 O.S. § 6060(B) by adding supplemental examinations for breast cancer as a coverage that all health benefit plans shall include.

HB 1389 becomes effective November 1, 2025.

House Bill 1516

HB 1516 relates to the capacity of minors to contract for life or accident and health insurance.  The bill amends 36 O.S. § 3606 by raising the minimum age a minor can contract for a life or accident and health insurance policy from fifteen (15) to sixteen (16) years of age, so long as there is signed parental or guardian consent.

HB 1516 further creates new law to be found at 36 O.S. § 3606(D), which states that liability for failure to obtain signed parental or guardian consent shall not rest upon the insurance agent from whom the insurance policy was purchased.

HB 1516 becomes effective November 1, 2025.

Senate Bill 109

SB 109 relates to genetic testing and cancer imaging, creating new law and definitions to be found at 36 O.S. § 6060.5b.  The bill requires that any health benefit plan offered, issued, or renewed in this state provide coverage for clinical genetic testing for inherited gene mutation relating to cancer and evidence-based cancer imaging for individuals with increased cancer risk. Coverage under this law shall not be subject to any annual deductibles, copayments, or coinsurance limits; however, the bill provides that if application of those requirements would result in HSA ineligibility, they shall only apply to HSA accounts with qualified high deductible health plans.

SB 109 becomes effective November 1, 2025.

Senate Bill 176

SB 176 relates to conceptive drugs, creating new law and definitions to be found at 36 O.S. § 6060.3b.  The bill requires any health benefit plan that offers coverage for contraceptive drugs to provide coverage for a three-month supply at once, the first time the enrollee obtains the drug, and a six-month supply each subsequent time, regardless if the enrollee was in the health benefit plan the first time they obtained the drug.  An enrollee may obtain only one six-month supply during each six-month period. The bill does not prohibit an enrollee from requesting a smaller supply of a contractive drug and shall not be construed to require coverage for any medications that could be used to terminate a pregnancy.

SB 176 becomes effective November 1, 2025.

Senate Bill 1019

SB 1019 relates to anesthesia coverage, creating new law and definitions to be found at 36 O.S. § 7500. The bill prohibits an insurer from establishing, implementing, or enforcing any policy, practice, or procedure which imposes a time limit on the amount of covered anesthesia services provided during a medical or surgical procedure, or restricts or excludes coverage or payment of anesthesia time.

SB 1019 becomes effective November 1, 2025.

Senate Bill 1050

SB 1050 relates to the Unfair Claims Settlement Practices Act, amending language found at 36 O.S. § 1250.5(15). The bill reduces the amount of time insurers have to request a refund from claimants and health providers on paid claims. The time limit for claimants has been reduced from twelve (12) months to six (6) months, and for health care providers from eighteen (18) months to twelve (12) months.

SB 1050 becomes effective November 1, 2025.

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. 2025-04

Disclaimer: The purpose of this bulletin is to inform 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.

House Bill 1808

HB 1808 creates the Ensuring Transparency in Prescription Drugs Prior Authorization Act, to be found at 36 O.S. §§ 6570.50 through 6570.59.

HB 1808 requires that a utilization review entity make any current prescription drug prior authorization requirements and restrictions, including written clinical criteria, in detail but in an easily understandable language, readily accessible on its website to enrollees and health care providers.  Additionally, health plans shall make any current prescription drug plan formularies readily accessible on its website to enrollees and health care providers. “Prescription plan drug formularies”, while not defined in statute, shall include, but not be limited to, coverage of generic and brand name prescription drugs, cost sharing, and restrictions.

No later than October 1, 2026, all health benefit plans shall submit a secured webpage link for the plan’s formulary to the Insurance Commissioner and thereafter annually on or before October 1. The secured webpage link for the plan’s formulary shall be submitted via the SERFF portal found at www.SERFF.com under TOI: UR Certificate and with Filing Description as “Formulary Webpage”.  To comply with HB 1808, the Oklahoma Insurance Department will make any submitted formularies available to the public on its website beginning no later than December 31, 2025, and will update thereafter annually.  To support the intent of HB 1808, and to increase transparency, all health plans are encouraged to voluntarily submit current formularies via the SERFF portal prior to December 31, 2025.

If a utilization review entity intends to implement a new, or amend an existing, prior authorization requirement or restriction, said new or amended requirement shall not be implemented unless the utilization review entity’s website has been updated to reflect the same.  Further, notice to contracted health care providers credentialed to prescribe the drug and enrollees who have a chronic condition and are already receiving the drug shall be given notice no less than sixty (60) days before the requirement of restriction is implemented. Updating of the utilization review entity’s website solely shall not constitute proper notice to contracted health care providers or enrollees with chronic conditions.

1) Possess a current and valid license in any U.S. jurisdiction;

2) Have appropriate training, knowledge, or expertise to apply the appropriate clinical guidelines; and

3) Make the adverse determination under the clinical direction provided by the committee or board, responsible for developing policies for drug use, evaluating clinical appropriateness, and ensuring effective drug use when reviewing prescription drug prior authorizations to enrollees of Oklahoma.

The term “committee or board” shall encompass any health plan medical policy team so long as said team is responsible for the same elements of the review.

Likewise, any appeals shall be reviewed by a physician, pharmacist, or licensed mental health professional. The physician, pharmacist, or licensed mental health professional shall:

1) Possess a current and valid license in any U.S. jurisdiction;

2) Be of the same or similar specialty as a physician, pharmacist, or licensed mental health professional who typically manages the medical condition or disease, which means that the physician either maintains board certification for the same or similar specialty as the medical condition in question, or whose training and experience:

a) includes treating the condition,

b) includes treating complications that may result from the service or procedure, and

c) is sufficient for the physician, pharmacist, or licensed mental health professional to determine if the service or procedure is medically necessary or clinically appropriate, except for appeals coming from a licensed mental health professional, which may be conducted by another licensed mental health professional as opposed to a physician, or for appeals coming from a pharmacist, which may be conducted by another licensed pharmacist as opposed to a physician;

3) Not have been directly involved in making the adverse determination;

4) Not have any financial interest in the outcome of the appeal; and

5) Consider all known clinical aspects of the health care service under review, including, but not limited to, a review of those medical records which are pertinent and relevant to the active condition provided to the utilization review entity by the enrollee’s health care provider, or a health care facility, and any pertinent medical literature provided to the utilization review entity by the health care provider.

If a utilization review entity requires prior authorization of a prescription drug, the utilization review entity shall make a prior authorization or adverse determination and notify the enrollee and the enrollee’s health care provider within twenty-four (24) hours of obtaining all necessary information for urgent prescription drugs or within four (4) business days for nonurgent prescription drugs.  A utilization review entity shall not require prior authorization for prescription drugs administered as a part of the provision of emergency health care services.

If a prior authorization is required for a prescription drug for the treatment of a chronic condition of an enrollee, other than opioids or weight loss drugs, and the enrollee remains on the same health plan, then the prior authorization shall remain valid for three (3) years from the date the health care provider receives the prior authorization approval, unless clinical criteria changes, the enrollee’s health plan removes the generic prescription drug from the formulary, or moves the prescription drug to a less preferred tier status on its formulary.

On receipt of information documenting a prior authorization from the enrollee or from the enrollee’s health care provider, a utilization review entity shall honor a prior authorization granted to an enrollee from a previous utilization review entity for at least the initial sixty (60) days of an enrollee’s coverage under a new health plan. Additionally, a utilization review entity shall continue to honor a prior authorization it has granted to an enrollee when the enrollee changes products under the same health insurance company for the initial sixty (60) days of an enrollee’s coverage under the new product unless the service is no longer a covered service under the new product.

Finally, HB 1808 authorizes the Insurance Commissioner to impose a penalty of not more than Five Thousand Dollars ($5,000) for each violation of this Act.

HB 1808 becomes effective November 1, 2025.

House Bill 1811

HB 1811 relates to the treatment of chronic conditions and the validity period for prior authorization of inpatient and non-inpatient care.  The bill amends language found at 36 O.S. § 6570.9(B)(2), reducing the amount of time a health care provider has to timely submit a prior authorization request for continued inpatient care for a chronic condition from seventy-two (72) hours to twenty-four (24) hours prior to the termination of the previously approved prior authorization.

 HB 1811 becomes effective on November 1, 2025.

Questions concerning this bulletin should be directed to the Oklahoma Insurance Department’s Legal Division at 405-522-4805 or by email to Tyler.Trammell@oid.ok.gov. Any questions concerning the filing of the secured webpage link for the plan’s formulary through SERFF may be directed towards Lien Skaggs at Lien.Skaggs@oid.ok.gov.

BULLETIN NO. 2025-08

On August 7, 2025, the U.S. Departments of Labor, HHS, and Treasury (hereinafter, the “Federal Departments”) issued a statement that the Federal Departments do not intend to prioritize enforcement actions for violations related to failing to meet the definition of Short-Term Limited Duration Insurance (STLDI) related to the 2024 rules that established a three month duration, with one month renewal duration, on these policies.  Acting on this guidance, the Oklahoma Insurance Department (“OID”) is authorizing carriers and producers that sell STLDI to follow the durations set forth under Oklahoma statute as follows:

36 O.S. § 4419(A): “For the purposes of this section “short-term, limited-duration insurance or “STLDI” means individual health insurance coverage provided pursuant to a contract with an insurer that has an expiration date specified in the contract that is less than twelve (12) months after the original effective date of the contract and, taking into account renewals or extensions, has a duration of no longer than thirty-six (36) months in total.”

Effective immediately, and until further guidance from the Federal Departments, the OID will allow authorized carriers to sell STLDI plans in a manner consistent with the statutory language referenced above. However, pursuant to 36 O.S. § 4419(G), carriers must receive approval from the OID to sell these plans under the duration guidelines set out above through the SERFF filing process.

Producers who sell STLDI should check with their appointed carriers to confirm that these policies are in compliance with regulatory requirements.

Questions concerning this bulletin should be directed to Mike Rhoads, Deputy Commissioner of Life & Health, by telephone at (918) 295-3702 or by email at Mike.Rhoads@oid.ok.gov.