1| STATE OF OKLAHOMA | | | 2| 2nd Session of the 60th Legislature (2026) | | | 3|SENATE BILL 1626 By: Frix | | | 4| | | | 5| AS INTRODUCED | | | 6| An Act relating to health insurance; defining terms; | | prohibiting certain contracts that include certain | 7| provisions; establishing violations that constitute | | an unfair or deceptive act; allowing for certain | 8| party to submit certain waiver to the Insurance | | Commissioner; creating certain waiver; requiring | 9| Commissioner to approve or deny certain waiver within | | certain time period; establishing certain | 10| requirements to approve certain waiver; establishing | | certain contracts as null and void; allowing the | 11| Attorney General to subpoena certain records; | | allowing the Attorney General to institute certain | 12| proceedings; subjecting certain records and papers to | | inspection by the Commissioner; allowing Commissioner | 13| to require certain health insurance carrier to | | produce certain list; allowing Commissioner to impose | 14| certain administrative penalty; allowing Commissioner | | to deny sale of certain health insurance plan; | 15| allowing Commissioner to refer certain contract to | | the Attorney General; prohibiting certain changes to | 16| privacy protections and standards; prohibiting | | certain limitation of network; authorizing | 17| Commissioner to promulgate rules and regulations; | | providing for codification; and providing an | 18| effective date. | | | 19| | | | 20| | | | 21|BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA: | | | 22| SECTION 1. NEW LAW A new section of law to be codified | | | 23|in the Oklahoma Statutes as Section 366 of Title 36, unless there is | | | 24|created a duplication in numbering, reads as follows: | | | Req. No. 2456 Page 1 ___________________________________________________________________________
1| A. As used in this section: | | | 2| 1. "All-or-nothing clause" means a provision of a health care | | | 3|contract that requires the health insurance carrier or health plan | | | 4|administrator to include all members of a health care provider in a | | | 5|network plan or requires the health insurance carrier or health plan | | | 6|administrator to enter into any additional contract with an | | | 7|affiliate of the health care provider as a condition of entering | | | 8|into a contract with such health care provider; | | | 9| 2. "Anti-steering clause" means a provision of a health care | | | 10|contract that restricts the ability of the health insurance carrier | | | 11|or health plan administrator to encourage an enrollee to obtain a | | | 12|health care service from a competitor of the hospital or health | | | 13|system, or the ability to offer incentives to encourage enrollees to | | | 14|utilize specific health care providers; | | | 15| 3. "Anti-tiering clause" means a provision in a health care | | | 16|contract that restricts the ability of the health insurance carrier | | | 17|or health plan administrator to introduce or modify a tiered network | | | 18|plan or assign health care providers into tiers or requires the | | | 19|health insurance carrier or health plan administrator to place all | | | 20|members of a health care provider in the same tier of a tiered | | | 21|network; | | | 22| 4. "Enrollee" means an individual who is entitled to receive | | | 23|health care services under the terms of a health benefit plan; | | | 24| | | | Req. No. 2456 Page 2 ___________________________________________________________________________
1| 5. "Gag clause" means a provision of a health care contract | | | 2|that restricts the ability of either the health insurance carrier, | | | 3|health plan administrator, or provider to disclose: | | | 4| a. any price or quality information, including the | | | 5| allowed amount, negotiated rates or discounts, any | | | 6| fees for services, or any other claim-related | | | 7| financial obligations included in the provider | | | 8| contract, to a governmental entity as authorized by | | | 9| law or its contractors or agents, any enrollee, | | | 10| treating provider, plan sponsor, or potential eligible | | | 11| enrollee and plan sponsor, or | | | 12| b. out-of-pocket costs to an enrollee; | | | 13| 6. "Health benefit plan" means the same as defined in Section | | | 14|6060.4 of Title 36 of the Oklahoma Statutes; | | | 15| 7. "Health care contract" means a contract, agreement, or | | | 16|understanding, entered into, amended, restated, or renewed either | | | 17|orally or in writing between a health care provider and a health | | | 18|insurance carrier, health plan administrator, plan sponsor, or its | | | 19|contractors or agents for the delivery of health care services to an | | | 20|enrollee of a health benefit plan; | | | 21| 8. "Health care provider" means an entity, corporation, | | | 22|organization, parent corporation, member, affiliate, subsidiary, or | | | 23|entity under common ownership, whether for-profit or nonprofit, that | | | 24|is or whose members are licensed or otherwise authorized by this | | | Req. No. 2456 Page 3 ___________________________________________________________________________
1|state to furnish, bill, or receive payment for health care service | | | 2|delivery in the normal course of business, and includes health | | | 3|systems, hospitals, hospital-based facilities, freestanding | | | 4|emergency facilities, imaging centers, large physician groups with | | | 5|eight or more physicians, physician staffing organizations, and | | | 6|urgent care clinics; | | | 7| 9. "Health insurance carrier" means the same as defined in | | | 8|Section 6592 of Title 36 of the Oklahoma Statutes; | | | 9| 10. "Health plan administrator" means a third-party | | | 10|administrator who acts on behalf of a plan sponsor to administer a | | | 11|health benefit plan; | | | 12| 11. "Most-favored-nations clause" means a provision of a health | | | 13|care contract that: | | | 14| a. prohibits or grants a health insurance carrier or | | | 15| health plan administrator an option to prohibit a | | | 16| participating health care provider from contracting | | | 17| with another contracting entity to provide health care | | | 18| services at the same or a lower price than the payment | | | 19| specified in the health care contract, | | | 20| b. requires or grants a health insurance carrier or | | | 21| health plan administrator an option to require a | | | 22| participating health care provider to accept a lower | | | 23| payment in the event the participating health care | | | 24| | | | Req. No. 2456 Page 4 ___________________________________________________________________________
1| provider agrees to provide health care services to | | | 2| another contracting entity at a lower price, | | | 3| c. requires or grants a health insurance carrier or | | | 4| health plan administrator an option to require | | | 5| termination or renegotiation of an existing health | | | 6| care contract if a participating health care provider | | | 7| agrees to provide health care services to another | | | 8| contracting entity at the same or a lower price, or | | | 9| d. restricts other health insurance carriers or health | | | 10| plan administrators not party to the contract from | | | 11| paying the same or lower rates for items or services | | | 12| than the contracting health insurance carrier or | | | 13| health plan administrator pays for such items or | | | 14| services; | | | 15| 12. "Network plan" means a health benefit plan that either | | | 16|requires enrollees to use, or creates incentives for enrollees to | | | 17|use, certain health care providers managed, owned, affiliated, under | | | 18|contract with, or employed by a health insurance carrier, a health | | | 19|plan administrator, or plan sponsor. Network plans include health | | | 20|maintenance organization (HMO) plans, preferred provider | | | 21|organization (PPO) plans, and exclusive provider organization (EPO) | | | 22|plans; and | | | 23| 13. "Tiered network plan" means a health benefit plan that | | | 24|sorts health care providers into specific groups to which different | | | Req. No. 2456 Page 5 ___________________________________________________________________________
1|provider reimbursement, enrollee cost sharing, or provider access | | | 2|requirements are applied for the same services. | | | 3| B. Except as provided in this subsection, no health insurance | | | 4|carrier, health care provider, health plan administrator, or any | | | 5|agent or other entity that contracts on behalf of a health insurance | | | 6|carrier, a health care provider, or a health plan administrator | | | 7|shall offer, solicit, request, amend, renew, or enter into a health | | | 8|care contract that would include any of the following provisions: | | | 9| 1. An all-or-nothing clause; | | | 10| 2. An anti-steering clause; | | | 11| 3. An anti-tiering clause; | | | 12| 4. A gag clause; | | | 13| 5. A most-favored-nations clause; or | | | 14| 6. Any other clause that results or intends to result in | | | 15|anticompetitive effects as specified through regulation by the | | | 16|Insurance Commissioner. | | | 17| C. Except as provided in subsection D of this section, a | | | 18|violation of this section constitutes an unfair or deceptive act | | | 19|under Section 1204 of Title 36 of the Oklahoma Statutes and shall be | | | 20|subject to enforcement by the Attorney General. | | | 21| D. 1. A party to a health care contract that contains a | | | 22|provision specified in subsection B of this section may submit the | | | 23|health care contract to the Commissioner for a waiver. The health | | | 24|care contract shall be accompanied by: | | | Req. No. 2456 Page 6 ___________________________________________________________________________
1| a. the name and business address of each party to the | | | 2| health care contract, | | | 3| b. any identification of each location at which any | | | 4| party to the agreement or policy provides health care | | | 5| services, and | | | 6| c. any information required to demonstrate that the | | | 7| proposed agreement or policy results in an improvement | | | 8| in the welfare of consumers in this state that could | | | 9| not have been accomplished through alternative means | | | 10| that are less restrictive. | | | 11| 2. The Commissioner shall approve or deny any waiver | | | 12|application in writing within sixty (60) days. The Commissioner may | | | 13|approve a waiver to allow a contract to include a provision pursuant | | | 14|to subsection B of this section if the Commissioner determines that: | | | 15| a. the agreement or policy results in an improvement in | | | 16| the welfare of consumers in this state such that the | | | 17| competitive benefit of including the provision | | | 18| outweighs the harm to competition, | | | 19| b. such improvement in the welfare could not have been | | | 20| accomplished through alternative means that are less | | | 21| restrictive, and | | | 22| c. the agreement or policy shall not otherwise | | | 23| constitute a contract, combination, or conspiracy in | | | 24| restraint of trade. | | | Req. No. 2456 Page 7 ___________________________________________________________________________
1| 3. Except for contracts granted a waiver under this subsection, | | | 2|any provision of a health care contract described in subsection B of | | | 3|this section shall be unenforceable. | | | 4| E. The Attorney General may subpoena any records necessary to | | | 5|enforce any provisions of this section or to investigate suspected | | | 6|violations of any provisions of this section. The Attorney General | | | 7|may institute proceedings on behalf of this state or as parens | | | 8|patriae of the persons residing in this state for injunctive relief | | | 9|to prevent and restrain a violation of any provision of this | | | 10|section, civil penalties for violations of the provisions of | | | 11|subsection D of this section, criminal penalties for violations of | | | 12|the provisions of subsection D of this section, and other equitable | | | 13|relief for violations of the provisions of this section including, | | | 14|without limitation, disgorgement or restitution. | | | 15| F. 1. All records and papers of health insurance carriers | | | 16|pertaining to health benefit plans or negotiations between the | | | 17|health insurance carrier and any health care provider shall be | | | 18|subject to inspection by the Commissioner or by any agent he or she | | | 19|may designate for that purpose. The Commissioner may require any | | | 20|health insurance carrier to produce a list of all health care | | | 21|contracts, transactions, or pricing agreements entered into within | | | 22|the preceding twelve (12) months. | | | 23| 2. Except for contracts granted a waiver under subsection D of | | | 24|this section, the Commissioner may impose an administrative penalty | | | Req. No. 2456 Page 8 ___________________________________________________________________________
1|of up to Five Thousand Dollars ($5,000.00) upon a health insurance | | | 2|carrier per day for each day that a contract that has been deemed | | | 3|unenforceable pursuant to subsection D of this section is in effect. | | | 4| 3. The Commissioner may deny the sale of any health insurance | | | 5|plan where the contract between the health insurance carrier and any | | | 6|health care provider is in violation of subsection D of this | | | 7|section. | | | 8| 4. The Commissioner may refer any health care contract subject | | | 9|to this section to the Attorney General to review for compliance | | | 10|with this section. The referral of any health care contract by the | | | 11|Commissioner to the Attorney General shall not constitute a | | | 12|violation any confidentiality agreement between the health insurance | | | 13|carrier and the Commissioner that may exist under Title 36 of the | | | 14|Oklahoma Statutes. The authority of the Attorney General to | | | 15|prosecute violations of antitrust or consumer protection | | | 16|requirements shall not be altered by this section. | | | 17| G. Any party that suffers a loss as a result of the violation | | | 18|of this section shall be entitled to initiate an action and seek all | | | 19|remedies, damages, costs, and fees. | | | 20| H. Nothing in this section shall be construed to limit network | | | 21|design, cost, or quality initiatives by a group health plan, health | | | 22|insurance carrier, or administrators working on behalf of a plan | | | 23|sponsor, including accountable care organizations, exclusive | | | 24|provider organizations, networks that tier providers by cost or | | | Req. No. 2456 Page 9 ___________________________________________________________________________
1|quality or steer enrollees to centers of excellence, or other | | | 2|pay-for-performance programs. | | | 3| I. The Commissioner may promulgate rules and regulations | | | 4|necessary for the provisions of this section. | | | 5| SECTION 2. This act shall become effective November 1, 2026. | | | 6| | | | 7| 60-2-2456 CAD 1/13/2026 6:08:20 PM | | | 8| | | | 9| | | | 10| | | | 11| | | | 12| | | | 13| | | | 14| | | | 15| | | | 16| | | | 17| | | | 18| | | | 19| | | | 20| | | | 21| | | | 22| | | | 23| | | | 24| | | | Req. No. 2456 Page 10