1| SENATE FLOOR VERSION |
| April 2, 2024 |
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3|ENGROSSED HOUSE |
|BILL NO. 3369 By: McEntire of the House |
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| Garvin of the Senate |
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8| An Act relating to state government; amending 74 O.S. |
| 2021, Section 1304.1, which relates to the Oklahoma |
9| Employees Insurance and Benefits Act; modifying |
| certain duties and responsibilities; adding external |
10| review requirements; and providing an effective date. |
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13|BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA: |
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14| SECTION 1. AMENDATORY 74 O.S. 2021, Section 1304.1, is |
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15|amended to read as follows: |
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16| Section 1304.1 A. The State and Education Employees Group |
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17|Insurance Board and the Oklahoma State Employees Benefits Council |
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18|are hereby abolished. Wherever the State and Education Employees |
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19|Group Insurance Board and the Oklahoma State Employees Benefits |
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20|Council are referenced in law, that reference shall be construed to |
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21|mean the Oklahoma Employees Insurance and Benefits Board. |
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22| B. There is hereby created the Oklahoma Employees Insurance and |
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23|Benefits Board. |
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1| C. The chair and vice-chair shall be elected by the Board |
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2|members at the first meeting of the Board and shall preside over |
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3|meetings of the Board and perform other duties as may be required by |
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4|the Board. Upon the resignation or expiration of the term of the |
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5|chair or vice-chair, the members shall elect a chair or vice-chair. |
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6|The Board shall elect one of its members to serve as secretary. |
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7| D. The Board shall consist of seven (7) members to be appointed |
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8|as follows: |
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9| 1. The State Insurance Commissioner, or designee; |
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10| 2. Four members shall be appointed by the Governor; |
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11| 3. One member shall be appointed by the Speaker of the Oklahoma |
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12|House of Representatives; and |
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13| 4. One member shall be appointed by the President Pro Tempore |
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14|of the Oklahoma State Senate. |
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15| E. The appointed members shall: |
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16| 1. Have demonstrated professional experience in investment or |
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17|funds management, public funds management, public or private group |
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18|health or pension fund management, or group health insurance |
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19|management; |
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20| 2. Be licensed to practice law in this state and have |
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21|demonstrated professional experience in commercial matters; or |
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22| 3. Be licensed by the Oklahoma Accountancy Board to practice in |
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23|this state as a public accountant or a certified public accountant. |
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1| In making appointments that conform to the requirements of this |
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2|subsection, at least one but not more than three members shall be |
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3|appointed each from paragraphs 2 and 3 of this subsection by the |
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4|combined appointing authorities. |
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5| F. Each member of the Board shall serve a term of four (4) |
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6|years from the date of appointment. |
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7| G. Members of the Board shall be subject to the following: |
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8| 1. The appointed members shall each receive compensation of |
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9|Five Hundred Dollars ($500.00) per month. Appointed members who |
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10|fail to attend a regularly scheduled meeting of the Board shall not |
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11|receive the related compensation; |
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12| 2. The appointed members shall be reimbursed for their |
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13|expenses, according to the State Travel Reimbursement Act, as are |
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14|incurred in the performance of their duties, which shall be paid |
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15|from the Health Insurance Reserve Fund; |
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16| 3. In the event an appointed member does not attend at least |
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17|seventy-five percent (75%) of the regularly scheduled meetings of |
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18|the Board during a calendar year, the appointing authority may |
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19|remove the member; |
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20| 4. A member may also be removed for any other cause as provided |
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21|by law; |
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22| 5. No Board member shall be individually or personally liable |
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23|for any action of the Board; and |
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1| 6. Participation on the Board is contingent upon maintaining |
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2|all necessary annual training as may be required through the Health |
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3|Insurance Portability and Accountability Act of 1996, Medicare |
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4|contracting requirements or other statutory or regulatory |
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5|guidelines. |
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6| H. The Board shall meet as often as necessary to conduct |
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7|business but shall meet no less than four times a year, with an |
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8|organizational meeting to be held prior to December 1, 2012. The |
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9|organizational meeting shall be called by the Insurance |
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10|Commissioner. A majority of the members of the Board shall |
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11|constitute a quorum for the transaction of business, and any |
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12|official action of the Board must have a favorable vote by a |
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13|majority of the members of the Board present. |
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14| I. Except as otherwise provided in this subsection, no member |
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15|of the Board shall be a lobbyist registered in this state as |
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16|provided by law, or be employed directly or indirectly by any firm |
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17|or health care provider under contract to the State and Education |
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18|Employees Group Insurance Board, the Oklahoma State Employees |
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19|Benefits Council, or the Oklahoma Employees Insurance and Benefits |
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20|Board, or any benefit program under its jurisdiction, for any goods |
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21|or services whatsoever. Any physician member of the Board shall not |
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22|be subject to the provisions of this subsection. |
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1| J. Any vacancy occurring on the Board shall be filled for the |
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2|unexpired term of office in the same manner as provided for in |
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3|subsection D of this section. |
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4| K. The Board shall act in accordance with the provisions of the |
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5|Oklahoma Open Meeting Act, the Oklahoma Open Records Act and the |
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6|Administrative Procedures Act. |
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7| L. The Administrative Director of the Courts shall designate |
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8|grievance panel members as shall be necessary. The members of the |
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9|grievance panel shall consist of two attorneys licensed to practice |
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10|law in this state and one state-licensed health care professional or |
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11|health care administrator who has at least three (3) years practical |
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12|experience, has had or has admitting privileges to a hospital in |
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13|this state, has a working knowledge of prescription medication, or |
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14|has worked in an administrative capacity at some point in their his |
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15|or her career. The state health care professional shall be |
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16|appointed by the Governor. At the Governor's discretion, one or |
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17|more qualified individuals may also be appointed as an alternate to |
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18|serve on the grievance panel in the event the Governor's primary |
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19|appointee becomes unable to serve. |
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20| M. The Office of Management and Enterprise Services shall have |
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21|the following duties, responsibilities and authority with respect to |
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22|the administration of the flexible benefits plan authorized pursuant |
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23|to the State Employees Flexible Benefits Act: |
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1| 1. To construe and interpret the plan, and decide all questions |
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2|of eligibility in accordance with the Oklahoma State Employees |
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3|Benefits Act and 26 U.S.C.A., Section 1 et seq.; |
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4| 2. To select those benefits which shall be made available to |
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5|participants under the plan, according to the Oklahoma State |
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6|Employees Benefits Act, and other applicable laws and rules; |
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7| 3. To prescribe procedures to be followed by participants in |
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8|making elections and filing claims under the plan; |
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9| 4. Beginning with the plan year which begins on January 1, |
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10|2013, to select and contract with one or more providers to offer a |
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11|group TRICARE Supplement product to eligible employees who are |
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12|eligible TRICARE beneficiaries. Any membership dues required to |
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13|participate in a group TRICARE Supplement product offered pursuant |
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14|to this paragraph shall be paid by the employee. As used in this |
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15|paragraph, "TRICARE" means the Department of Defense health care |
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16|program for active duty and retired service members and their |
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17|families; |
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18| 5. To prepare and distribute information communicating and |
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19|explaining the plan to participating employers and participants. |
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20|Health Maintenance Organizations or other third-party insurance |
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21|vendors may be directly or indirectly involved in the distribution |
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22|of communicated information to participating state agency employers |
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23|and state employee participants subject to the following condition: |
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1|the Board shall verify all marketing and communications information |
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2|for factual accuracy prior to distribution; |
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3| 6. To receive from participating employers and participants |
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4|such information as shall be necessary for the proper administration |
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5|of the plan, and any of the benefits offered thereunder; |
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6| 7. To furnish the participating employers and participants such |
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7|annual reports with respect to the administration of the plan as are |
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8|reasonable and appropriate; |
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9| 8. To keep reports of benefit elections, claims and |
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10|disbursements for claims under the plan; |
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11| 9. To negotiate for best and final offer through competitive |
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12|negotiation with the assistance and through the purchasing |
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13|procedures adopted by the Office of Management and Enterprise |
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14|Services and contract with federally qualified health maintenance |
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15|organizations under the provisions of 42 U.S.C., Section 300e et |
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16|seq., or with Health Maintenance Organizations granted a certificate |
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17|of authority by the Insurance Commissioner pursuant to the Health |
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18|Maintenance Reform Act of 2003 for consideration by participants as |
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19|an alternative to the health plans offered by the Oklahoma Employees |
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20|Insurance and Benefits Board, and to transfer to the health |
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21|maintenance organizations such funds as may be approved for a |
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22|participant electing health maintenance organization alternative |
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23|services. The Board may also select and contract with a vendor to |
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24|offer a point-of-service plan. An HMO may offer coverage through a |
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1|point-of-service plan, subject to the guidelines established by the |
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2|Board. However, if the Board chooses to offer a point-of-service |
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3|plan, then a vendor that offers both an HMO plan and a |
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4|point-of-service plan may choose to offer only its point-of-service |
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5|plan in lieu of offering its HMO plan. The Board may, however, |
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6|renegotiate rates with successful bidders after contracts have been |
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7|awarded if there is an extraordinary circumstance. An extraordinary |
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8|circumstance shall be limited to insolvency of a participating |
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9|health maintenance organization or point-of-service plan, |
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10|dissolution of a participating health maintenance organization or |
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11|point-of-service plan or withdrawal of another participating health |
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12|maintenance organization or point-of-service plan at any time during |
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13|the calendar year. Nothing in this section of law shall be |
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14|construed to permit either party to unilaterally alter the terms of |
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15|the contract; |
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16| 10. To retain as confidential information the initial Request |
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17|For Proposal offers as well as any subsequent bid offers made by the |
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18|health plans prior to final contract awards as a part of the best |
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19|and final offer negotiations process for the benefit plan; |
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20| 11. To promulgate administrative rules for the competitive |
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21|negotiation process; |
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22| 12. To require vendors offering coverage to provide such |
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23|enrollment and claims data as is determined by the Board. The Board |
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24|shall be authorized to retain as confidential any proprietary |
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1|information submitted in response to the Board's Request For |
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2|Proposal. Provided, however, that any such information requested by |
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3|the Board from the vendors shall only be subject to the |
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4|confidentiality provision of this paragraph if it is clearly |
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5|designated in the Request For Proposal as being protected under this |
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6|provision. All requested information lacking such a designation in |
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7|the Request For Proposal shall be subject to Section 24A.1 et seq. |
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8|of Title 51 of the Oklahoma Statutes. From health maintenance |
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9|organizations, data provided shall include the current Health Plan |
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10|Employer Data and Information Set (HEDIS); |
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11| 13. To authorize the purchase of any insurance deemed necessary |
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12|for providing benefits under the plan including indemnity dental |
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13|plans, provided that the only indemnity health plan selected by the |
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14|Board shall be the indemnity plan offered by the Board, and to |
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15|transfer to the Board such funds as may be approved for a |
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16|participant electing a benefit plan offered by the Board. All |
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17|indemnity dental plans shall meet or exceed the following |
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18|requirements: |
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19| a. they shall have a statewide provider network, |
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20| b. they shall provide benefits which shall reimburse the |
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21| expense for the following types of dental procedures: |
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22| (1) diagnostic, |
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23| (2) preventative, |
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24| (3) restorative, |
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1| (4) endodontic, |
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2| (5) periodontic, |
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3| (6) prosthodontics, |
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4| (7) oral surgery, |
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5| (8) dental implants, |
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6| (9) dental prosthetics, and |
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7| (10) orthodontics, and |
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8| c. they shall provide an annual benefit of not less than |
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9| One Thousand Five Hundred Dollars ($1,500.00) for all |
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10| services other than orthodontic services, and a |
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11| lifetime benefit of not less than One Thousand Five |
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12| Hundred Dollars ($1,500.00) for orthodontic services; |
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13| 14. To communicate deferred compensation programs as provided |
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14|in Section 1701 of Title 74 of the Oklahoma Statutes this title; |
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15| 15. To assess and collect reasonable fees from contracted |
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16|health maintenance organizations and third-party insurance vendors |
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17|to offset the costs of administration; |
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18| 16. To accept, modify or reject elections under the plan in |
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19|accordance with the Oklahoma State Employees Benefits Act and 26 |
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20|U.S.C.A., Section 1 et seq.; |
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21| 17. To promulgate election and claim forms to be used by |
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22|participants; |
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23| 18. To adopt rules requiring payment for medical and dental |
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24|services and treatment rendered by duly licensed hospitals, |
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1|physicians and dentists. Unless the Board has otherwise contracted |
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2|with the out-of-state health care provider, the Board shall |
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3|reimburse for medical services and treatment rendered and charged by |
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4|an out-of-state health care provider at least at the same percentage |
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5|level as the network percentage level of the fee schedule |
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6|established by the Oklahoma Employees Insurance and Benefits Board |
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7|if the insured employee was referred to the out-of-state health care |
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8|provider by a physician or it was an emergency situation and the |
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9|out-of-state provider was the closest in proximity to the place of |
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10|residence of the employee which offers the type of health care |
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11|services needed. For purposes of this paragraph, health care |
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12|providers shall include, but not be limited to, physicians, |
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13|dentists, hospitals and special care facilities; |
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14| 19. To enter into a contract with out-of-state providers in |
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15|connection with any PPO or hospital or medical network plan which |
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16|shall include, but not be limited to, special care facilities and |
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17|hospitals outside the borders of the State of Oklahoma. The |
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18|contract for out-of-state providers shall be identical to the |
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19|in-state provider contracts. The Board may negotiate for discounts |
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20|from billed charges when the out-of-state provider is not a network |
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21|provider and the member sought services in an emergency situation, |
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22|when the services were not otherwise available in the State of |
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23|Oklahoma or when the Administrator appointed by the Board approved |
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24|the service as an exceptional circumstance; |
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1| 20. To create the establishment of a grievance procedure by |
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2|which a three-member grievance panel external appeals procedures for |
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3|complaints by insured employees in the two following manners: |
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4| a. independent review organizations, accredited by a |
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5| national accrediting body, shall act as an appeals |
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6| body bodies for complaints by insured employees |
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7| regarding the allowance and payment of claims, |
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8| eligibility, and other matters. Except for grievances |
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9| settled to the satisfaction of both parties prior to a |
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10| hearing, any person who requests in writing a hearing |
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11| before the grievance panel shall receive a hearing |
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12| before the panel. adverse benefit determinations based |
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13| on: |
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14| (1) medical judgment, |
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15| (2) whether the insurer is complying with the |
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16| surprise billing and cost-sharing protections set |
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17| forth in Sections 2799A-1 and 2799A-2 of the |
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18| Public Health Services Act, 42 U.S.C. 201 et |
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19| seq., and |
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20| (3) a recission in coverage, |
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21| b. a three-member grievance panel, which shall act as an |
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22| appeals body for complaints by insured employees |
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23| regarding all other issues. |
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1|The grievance procedure appeals procedures provided by this |
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2|paragraph shall be the exclusive remedy remedies available to |
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3|insured employees having complaints against the insurer. Such |
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4|grievance procedure The appeals procedures of the three-member |
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5|grievance panel shall be subject to the Oklahoma Administrative |
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6|Procedures Act, including provisions thereof for review of agency |
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7|decisions by the district court. The grievance panel shall schedule |
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8|a hearing regarding the allowance and payment of claims, eligibility |
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9|and other matters within sixty (60) days from the date the grievance |
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10|panel receives a written request for a hearing unless the panel |
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11|orders a continuance for good cause shown. Upon written request by |
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12|the insured employee to the grievance panel and received not less |
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13|than ten (10) days before the hearing date, the grievance panel |
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14|shall cause a full stenographic record of the proceedings to be made |
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15|by a competent court reporter at the insured employee's expense; and |
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16| 21. To intercept monies owing to plan participants from other |
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17|state agencies, when those participants in turn owe money to the |
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18|Office of Management and Enterprise Services, and to ensure that the |
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19|participants are afforded due process of law. |
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20| N. Except for a breach of fiduciary obligation, a Board member |
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21|shall not be individually or personally responsible for any action |
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22|of the Board. |
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23| O. The Board shall operate in an advisory capacity to the |
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24|Office of Management and Enterprise Services. |
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1| P. The members of the Board shall not accept gifts or |
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2|gratuities from an individual organization with a value in excess of |
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3|Ten Dollars ($10.00) per year. The provisions of this section shall |
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4|not be construed to prevent the members of the Board from attending |
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5|educational seminars, conferences, meetings or similar functions. |
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6| SECTION 2. This act shall become effective November 1, 2024. |
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7|COMMITTEE REPORT BY: COMMITTEE ON RETIREMENT AND INSURANCE |
|April 2, 2024 - DO PASS |
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