BULLETIN NO. 6-1-2022

To: All Health Insurance Companies, Health Maintenance Organizations, PBMs and Other Interested Parties
Re: Unfair Claims Settlement Practice: Pharmacy Benefit Calculations
From: Glen Mulready, Insurance Commissioner
Date: June 13, 2022

 

The Oklahoma Insurance Department (“Department”) is releasing this bulletin with the purpose of providing information to issuers of health benefit plans as defined by 36 O.S. § 1250.2(5) regarding HB 3495, a bill enacted during the 2022 Regular Session of the Oklahoma Legislature amending 36 O.S. § 1250.5. HB 3495 took effect on May 16, 2022.

Prior to the enactment of HB 3495, the Department released guidance in Bulletin No. LH 2021-05 regarding a conflict between federal requirements governing health savings account (“HSA”) eligibility and the language in 36 O.S. § 1250.5(18) requiring a health benefit plan issuer to combine all payments made toward a prescription when calculating an enrollee’s total contribution.

Section 1(18) of HB 3495, now codified as 36 O.S. § 1250.5(18), addresses the previous conflict and provides the following clarification:

However, if, under federal law, application of this paragraph would result in health savings account ineligibility under Section 223 of the federal Internal Revenue Code, as amended, this requirement shall apply only for health savings accounts with qualified high-deductible health plans with respect to the deductible of such plan after the enrollee has satisfied the minimum deductible, except with respect to items or services that are preventive care pursuant to Section 223(c)(2)(C) of the federal Internal Revenue Code, as amended, in which case the requirements of this paragraph shall apply regardless of whether the minimum deductible has been satisfied.

The Department understands this clarification to mean that in the case of an enrollee with a qualified high-deductible health plan (“HDHP”) and correlating HSA, the requirement to calculate any third-party payment toward a prescription as part of the enrollee’s total contribution will apply only after the enrollee’s deductible under their HDHP is satisfied. This understanding is subject to change if differing guidance is issued by the Internal Revenue Service.

As previously advised in Bulletin No. LH 2021-05, health benefit plan issuers are strongly encouraged to continue to communicate the effects of applying funds from third parties when making payments for prescriptions to members enrolled in an HDHP with an associated HSA.

 

Questions applicable to this bulletin should be directed to:

Kim Hunter, General Counsel, at kim.hunter@oid.ok.gov or Molly Clinkscales, Assistant General Counsel at molly.clinkscales@oid.ok.gov.