{"data":{"id":"us-ok/okla.-stat.-tit.-36-36-6060.42","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 36, § 36-6060.42","heading":"Shared savings incentive program","body":"A. An insurance carrier may offer a shared savings incentive\n\nprogram to provide incentives to an enrollee when the enrollee\n\nobtains a comparable health care service that is covered by the\n\ncarrier from providers that charge less than the average allowed\n\namount paid by that carrier to network providers for that,\n\ncomparable health care service.\n\nB. Incentives may be calculated as a percentage of the\n\ndifference in allowed amounts to the average, as a flat dollar\n\namount, or by any other reasonable methodology approved by the\n\nInsurance Department. The carrier shall provide the incentive as a\n\ncash payment to the enrollee or credit toward the annual in-network\n\ndeductible and out-of-pocket limit of the enrollee. Carriers may\n\nallow enrollees to select which method the enrollee prefers to\n\nreceive the incentive.\n\nC. An insurance carrier that offers a shared savings incentive\n\nprogram shall:\n\n1. Establish the program as a component part of the policy or\n\ncertificate of insurance provided by the carrier and notify the\n\nenrollees and the Insurance Department at least thirty (30) days\n\nbefore program termination;\n\n2. File a description of the program on a form prescribed by\n\nthe Insurance Commissioner. The Insurance Department shall review\n\nthe filing and determine whether the program complies with the\n\nprovisions of this section;\n\n3. Notify an enrollee, annually or at the time of renewal, of\n\nthe availability of the shared savings incentive program and the\n\nprocedures to participate in the program;\n\n4. Publish on the website of the insurance carrier, easily\n\naccessible to enrollees and applicants for insurance, a list of\n\ncomparable health care services and health care providers and the\n\nshared savings incentive amount applicable for each service. A\n\nshared savings incentive shall not be less than twenty-five percent\n\n(25%) of the savings generated by the participation of the enrollee\n\nin any shared savings incentive program offered by the insurance\n\ncarrier. The baseline for the savings calculation shall be the\n\naverage in-network amount paid for that service in the most recent\n\ntwelve-month period or any other methodology established by the\n\ninsurance carrier and approved by the Insurance Department;\n\n5. At least quarterly, credit, deposit or make a cash payment\n\nto an enrollee of the shared savings incentive amount pursuant to\n\nparticipation in the shared savings incentive program; and\n\n6. Submit an annual report to the Insurance Department within\n\nninety (90) days after the close of each health benefit plan year.\n\nAt a minimum, the report shall include the following information:\n\na. the number of enrollees who participated in the\n\nprogram during the health benefit plan year and the\n\nnumber of instances of participation,\n\nb. the total cost of services provided as a part of the\n\nprogram, and\n\nc. the total value of the shared savings incentive\n\npayments made to enrollees participating in the\n\nprogram and the values distributed as cash or credit\n\ntoward the annual in-network deductible and out-of-\n\npocket limit of an enrollee.\n\nD. An enrollee shall not be required to participate in a shared\n\nsavings incentive program.","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":"a957a6eaffdaa13d9c42aa358fbb3e8a6382c3c31b8b7f4058e4ad17bdbd7299","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-36-36-6060.41","next":"us-ok/okla.-stat.-tit.-36-36-6060.43"},"notice":"GroundRules: Original legal text. Not legal advice."}