{"data":{"id":"us-ok/okla.-stat.-tit.-36-36-6060.11","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 36, § 36-6060.11","heading":"Benefits required","body":"A. Subject to the limitations set forth in this section and\n\nSections 6060.12 and 6060.13 of this title, any health benefit plan\n\nthat is offered, issued, or renewed in this state on or after\n\nJanuary 1, 2000, shall provide benefits for treatment of mental\n\nhealth and substance use disorders.\n\nB. 1. Benefits for mental health and substance use disorders\n\nshall be equal to benefits for treatment of and shall be subject to\n\nthe same preauthorization and utilization review mechanisms and\n\nother terms and conditions as all other physical diseases and\n\ndisorders including, but not limited to:\n\na. coverage of inpatient hospital services for either\n\ntwenty-six (26) days or the limit for other covered\n\nillnesses, whichever is greater,\n\nb. coverage of outpatient services,\n\nc. coverage of medication,\n\nd. maximum lifetime benefits,\n\ne. copayments,\n\nf. coverage of home health visits,\n\ng. individual and family deductibles, and\n\nh. coinsurance.\n\n2. Treatment limitations applicable to mental health or\n\nsubstance use disorder benefits shall be no more restrictive than\n\nthe predominant treatment limitations applied to substantially all\n\nmedical and surgical benefits covered by the plan. There shall be\n\nno separate treatment limitations that are applicable only with\n\nrespect to mental health or substance abuse disorder benefits.\n\nC. A health benefit plan shall not impose a nonquantitative\n\ntreatment limitation with respect to mental health and substance use\n\ndisorders in any classification of benefits unless, under the terms\n\nof the health benefit plan as written and in operation, any\n\nprocesses, strategies, evidentiary standards or other factors used\n\nin applying the nonquantitative treatment limitation to mental\n\nhealth disorders in the classification are comparable to and applied\n\nno more stringently than to medical and surgical benefits in the\n\nsame classification.\n\nD. All health benefit plans must meet the requirements of the\n\nfederal Paul Wellstone and Pete Domenici Mental Health Parity and\n\nAddiction Equity Act of 2008, as amended, and federal guidance or\n\nregulations issued under these acts including 45 CFR 146.136, 45 CFR\n\n147.160, 45 CFR 156.115(a)(3), 42 U.S.C. 300gg-26(a), 29 U.S.C.\n\n1185a(a), and 26 U.S.C. 9812.\n\nE. Beginning on or after January 1, 2000, each insurer that\n\noffers, issues or renews any individual or group health benefit plan\n\nproviding mental health or substance use disorder benefits shall\n\nsubmit an annual report to the Insurance Commissioner on or before\n\nApril 1 of each year that contains the following:\n\n1. A description of the process used to develop or select the\n\nmedical necessity criteria for mental health and substance use\n\ndisorder benefits and the process used to develop or select the\n\nmedical necessity criteria for medical and surgical benefits;\n\n2. Identification of all nonquantitative treatment limitations\n\napplied to both mental health and substance use disorder benefits\n\nand medical and surgical benefits within each classification of\n\nbenefits; and\n\n3. The results of an analysis that demonstrates that for the\n\nmedical necessity criteria described in paragraph 1 of this\n\nsubsection and for each nonquantitative treatment limitation\n\nidentified in paragraph 2 of this subsection, as written and in\n\noperation, the processes, strategies, evidentiary standards or other\n\nfactors used in applying the medical necessity criteria and each\n\nnonquantitative treatment limitation to mental health and substance\n\nuse disorder benefits within each classification of benefits are\n\ncomparable to and are applied no more stringently than to medical\n\nand surgical benefits in the same classification of benefits. At a\n\nminimum, the results of the analysis shall:\n\na. identify and clearly define the factors and terms used\n\nto determine that a nonquantitative treatment\n\nlimitation will apply to a benefit,\n\nb. identify and clearly define the specific evidentiary\ntion of benefits are\n\ncomparable to and are applied no more stringently than to medical\n\nand surgical benefits in the same classification of benefits. At a\n\nminimum, the results of the analysis shall:\n\na. identify and clearly define the factors and terms used\n\nto determine that a nonquantitative treatment\n\nlimitation will apply to a benefit,\n\nb. identify and clearly define the specific evidentiary\n\nstandards used to define the factors and any other\n\nevidence relied upon in designing each nonquantitative\n\ntreatment limitation,\n\nc. provide the detailed, written, and reasoned\n\ncomparative analyses including the results of the\n\nanalyses performed to determine that the processes and\n\nstrategies used to design each nonquantitative\n\ntreatment limitation, as written, and the as written\n\nprocesses and strategies used to apply the\n\nnonquantitative treatment limitation to mental health\n\nand substance use disorder benefits are comparable to\n\nand applied no more stringently than the processes and\n\nstrategies used to design each nonquantitative\n\ntreatment limitation, as written, and the as written\n\nprocesses and strategies used to apply the\n\nnonquantitative treatment limitation to medical and\n\nsurgical benefits,\n\nd. provide the detailed, written, and reasoned\n\ncomparative analyses including the results of the\n\nanalyses performed to determine that the processes and\n\nstrategies used to apply each nonquantitative\n\ntreatment limitation, in operation, for mental health\n\nand substance use disorder benefits are comparable to\n\nand applied no more stringently than the processes or\n\nstrategies used to apply each nonquantitative\n\ntreatment limitation for medical and surgical benefits\n\nin the same classification of benefits, and\n\ne. disclose the specific findings and conclusions reached\n\nby the insurer that the results of the analyses\n\nrequired by this subsection indicate whether the\n\ninsurer is in compliance with this section and the\n\nPaul Wellstone and Pete Domenici Mental Health Parity\n\nand Addiction Equity Act of 2008, as amended, and its\n\nimplementing and related regulations including 45 CFR\n\n146.136, 45 CFR 147.160, 45 CFR 156.115(a)(3), 42\n\nU.S.C. 300gg-26(a), 29 U.S.C. 1185a(a), and 26 U.S.C.\n\n9812.\n\nF. The findings and conclusions shall include sufficient detail\n\nto fully explain such findings including methodologies for the\n\nanalyses, detailed descriptions of each treatment limitation for\n\nmental health and substance use disorder benefits compared to each\n\ntreatment limitation for medical and surgical benefits, and detailed\n\ndescriptions of all criteria involved for approving mental health\n\nand substance use disorder benefits as compared to the criteria\n\ninvolved for approving medical and surgical benefits.\n\nG. The Commissioner shall implement and enforce any applicable\n\nprovisions of the Paul Wellstone and Pete Domenici Mental Health\n\nParity and Addiction Equity Act of 2008, as amended, and federal\n\nguidance or regulations issued under these acts including 45 CFR\n\n146.136, 45 CFR 147.136, 45 CFR 147.160, 45 CFR 156.115(a)(3), 42\n\nU.S.C. 300gg-26(a), 29 U.S.C. 1185a(a), and 26 U.S.C. 9812.\n\nH. The Commissioner shall issue guidance and standardized\n\nreporting templates to ensure compliance with the provisions of this\n\nsection. Guidance shall include examples of non-quantitative\n\ntreatment limitations as identified by the Centers for Medicare and\n\nMedicaid Services, the Department of Labor, and the Employee\n\nBenefits Security Administration.\n\nI. No later than December 31, 2021, and by December 31 of each\n\nyear thereafter, the Commissioner shall make available to the public\n\nthe reports submitted by insurers, as required in subsection E of\n\nthis section, during the most recent annual cycle.\n\n1. The Commissioner shall identify insurers that have failed in\n\nwhole or in part to comply with the full extent of reporting\nInsurance Page 1107\n\nI. No later than December 31, 2021, and by December 31 of each\n\nyear thereafter, the Commissioner shall make available to the public\n\nthe reports submitted by insurers, as required in subsection E of\n\nthis section, during the most recent annual cycle.\n\n1. The Commissioner shall identify insurers that have failed in\n\nwhole or in part to comply with the full extent of reporting\n\nrequired in this section and shall make a reasonable attempt to\n\nobtain missing reports or information by June 1 of the following\n\nyear.\n\n2. The reports submitted by insurers and the identification by\n\nthe Commissioner of noncompliant insurers shall be made available to\n\nthe public by posting on the Internet website of the Insurance\n\nDepartment. Any information that is confidential or a trade secret\n\nshall be redacted prior to the public posting.\n\nJ. The Commissioner may promulgate rules pursuant to the\n\nprovisions of this section and any provisions of the Paul Wellstone\n\nand Pete Domenici Mental Health Parity and Addiction Equity Act of\n\n2008, as amended, that relate to the business of insurance.","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":"916952a23ffd119d5223965cbd5ce8d37d9380acea1b628468d333d84e8cd617","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-36-36-6060.10a","next":"us-ok/okla.-stat.-tit.-36-36-6060.11a"},"notice":"GroundRules: Original legal text. Not legal advice."}