{"data":{"id":"us-ok/okla.-stat.-tit.-36-36-3634.11","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 36, § 36-3634.11","heading":"Coverage of vision care or medical diagnosis and","body":"treatment services – Referral to optometrists – Equal compensation.\n\nA. Any health benefit plan which offers services for vision\n\ncare or medical diagnosis and treatment for the eye shall allow\n\noptometrists to be providers of those services.\n\nB. With respect to optometric services, any health benefit plan\n\nwhich uses a gatekeeper or equivalent for referrals for services for\n\nvision care or for medical diagnosis and treatment of the eye shall\n\nrequire such covered services be provided on a referral basis within\n\nthe medical group or network at the request of an enrollee who has a\n\ncondition requiring vision care or medical diagnosis and treatment\n\nof the eye if:\n\n1. A referral is necessitated in the judgment of the primary\n\ncare physician; and\n\n2. Treatment for the condition falls within the licensed scope\n\nof practice of an optometrist.\n\nC. Each health benefit plan shall have a defined set of\n\nstandards and procedures for selecting providers, including\n\nspecialists, to serve enrollees. The standards and procedures shall\n\nbe drafted in such a manner that they are applicable to all\n\ncategories of providers and shall be utilized by the health benefit\n\nplan in a manner that is without bias for or discrimination against\n\na particular category or categories of providers.\n\nD. No health benefit plan shall require a provider to have\n\nhospital privileges if hospital privileges are not usual and\n\ncustomary for the services the provider provides.\n\nE. Health benefit plans shall provide that optometrists be\n\nequally compensated for covered services and procedures provided to\n\nan insured on the basis of charges prevailing in the same\n\ngeographical area or in similar-sized communities for similar\n\nservices and procedures as provided in the Health Care Freedom of\n\nChoice Act, if the services are within the scope of practice of\n\noptometry.\n\nF. Nothing in this section shall be construed to:\n\n1. Prohibit a health benefit plan which offers services for\n\nvision care or medical diagnosis and treatment for the eye from\n\ndetermining the adequacy of the size of its network;\n\n2. Prohibit an optometrist from agreeing to a fee schedule;\n\n3. Limit, expand, or otherwise affect the scope of practice of\n\noptometry; or\n\n4. Alter, repeal, modify or affect the laws of this state\n\nexcept where such laws are in conflict or are inconsistent with the\n\nexpress provisions of this section.\n\nG. Existing health benefit plans shall comply with the\n\nrequirements of this section upon issuance or renewal on or after\n\nthe effective date of this act.\n\nH. As used in this section, \"health benefit plan\" means\n\nindividual or group hospital or medical insurance coverage, a not-\n\nfor-profit hospital or medical service or indemnity plan, a prepaid\n\nhealth plan, a health maintenance organization plan, a preferred\n\nprovider organization plan, the State and Education Employees Group\n\nHealth Insurance Plan, any program funded under Title XIX of the\n\nSocial Security Act or such other publicly funded program, and\n\ncoverage provided by a Multiple Employer Welfare Arrangement (MEWA)\n\nor employee self-insured plan except as exempt under federal ERISA\n\nprovisions.","path":["OK Code","Title 36"],"source_url":"https://www.oklegislature.gov/OK_Statutes/CompleteTitles/os36.pdf","current_through":"2026-08-14","vintage":"open-us-law v2026.08, retrieved 2026-09-14","retrieved_at":"2026-09-14T18:32:36Z","sha256":"827bc73d4dc0e0e93f586313379632dfe214de324394bbfd3496f0e4fc23360f","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-36-36-3634.1","next":"us-ok/okla.-stat.-tit.-36-36-3634.2"},"notice":"GroundRules: Original legal text. Not legal advice."}