{"data":{"id":"us-ok/okla.-stat.-tit.-36-36-6972","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 36, § 36-6972","heading":"Definitions","body":"As used in this act:\n\n1. “Contractual discount” means a reduction from a provider’s\n\nusual and customary rate for covered services and materials required\n\nunder a prepaid vision plan agreement with a provider;\n\n2. “Covered materials” means materials for which reimbursement\n\nfrom the insurer, vision plan, or vision care discount plan is\n\nprovided to a vision care provider by an enrollee’s plan contract,\n\nor for which a reimbursement would be available but for the\n\napplication of the enrollee’s contractual limitations of\n\ndeductibles, copayments, or coinsurance;\n\n3. “Covered services” means services eligible for reimbursement\n\nfrom the insurer or vision plan to a provider, or services that\n\nwould be eligible for reimbursement but for the application of the\n\nenrollee’s contractual plan limitations of deductibles, copayments,\n\nor coinsurance, regardless of how the benefits are listed in the\n\nexplanation of benefits provided in the vision plan of the enrollee;\n\n4. “Enrollee” means any individual enrolled in a health care\n\nplan, vision plan, or vision care discount plan provided by a group,\n\nemployer, or other entity that purchases or supplies coverage for a\n\nvision plan;\n\n5. “Extrapolation” means a mathematical process or technique\n\nused by a vision plan in the process of auditing a vision care\n\nprovider to estimate audit results for a larger batch of group\n\nclaims not reviewed in the audit by the plan;\n\n6. “Health benefit plan” means a health benefit plan as defined\n\npursuant to Section 6060.4 of Title 36 of the Oklahoma Statutes;\n\n7. “Materials” means ophthalmic devices including but not\n\nlimited to lenses, devices containing lenses, artificial intraocular\n\nlenses, ophthalmic frames and other lens mounting apparatus, prisms,\n\nlens treatments and coatings, contact lenses, and prosthetic devices\n\nto correct, relieve, or treat defects or abnormal conditions of the\n\nhuman eye or its adnexa, or any material allowed to be utilized by\n\nthe Board of Examiners in Optometry and optometry’s scope of\n\npractice as provided by law;\n\n8. “Net equity” means the excess of total assets over total\n\nliabilities, excluding liabilities which have been subordinated in a\n\nmanner acceptable to the Insurance Commissioner;\n\n9. “Prepaid vision plan” means any contractual agreement\n\nwhereby any prepaid vision plan organization undertakes to provide\n\nfull payment or a discount of vision services directly, to arrange\n\nfor prepaid vision services, or to pay or make reimbursement for any\n\nvision service not provided for by other insurance;\n\n10. “Prepaid vision plan organization” means any person who, or\n\norganization or entity that, undertakes to conduct one or more\n\nprepaid vision plans providing only vision services;\n\n11. “Services” means the professional work performed by a\n\nvision care provider;\n\n12. “Subcontractor” means any company, group, or third-party\n\nentity including agents, servants, partially or wholly owned\n\nsubsidiaries, and controlled organizations contracted by the\n\ninsurer, vision plan, or vision care discount plan to supply\n\nservices or materials for a vision care provider or enrollee to\n\nfulfill the benefit plan of an insurer, vision plan, or vision care\n\ndiscount plan;\n\n13. “Tangible net equity” means net equity reduced by the value\n\nassigned to intangible assets including, but not limited to,\n\ngoodwill, going concern value, organizational expenses, start-up\n\ncosts, long-term prepayments of deferred charges, nonreturnable\n\ndeposits, and obligations of officers, directors, owners, or\n\naffiliates, except short-term obligations of affiliates for goods or\n\nservices arising in the normal course of business that are payable\n\non the same term as equivalent transactions with nonaffiliates and\n\nthat are not past due;\n\n14. “Uncovered expense” means the cost of health care services\n\nthat are the obligation of a prepaid vision plan organization for\n\nwhich:\nofficers, directors, owners, or\n\naffiliates, except short-term obligations of affiliates for goods or\n\nservices arising in the normal course of business that are payable\n\non the same term as equivalent transactions with nonaffiliates and\n\nthat are not past due;\n\n14. “Uncovered expense” means the cost of health care services\n\nthat are the obligation of a prepaid vision plan organization for\n\nwhich:\n\na. an enrollee may be liable in the event of the\n\ninsolvency of the organization, and\n\nb. alternative arrangements acceptable to the\n\nCommissioner have not been made to cover the costs;\n\nand\n\n15. “Vision care provider” or “provider” means a licensed\n\ndoctor of optometry or a licensed medical or osteopathic doctor\n\npracticing under the authority of the applicable provisions of Title\n\n59 of the Oklahoma Statutes.","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":"24c377b84e2e6438ce6b443539d36c6c216a3346328baa0565ef172c82d377d4","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-36-36-6971","next":"us-ok/okla.-stat.-tit.-36-36-6973"},"notice":"GroundRules: Original legal text. Not legal advice."}