{"data":{"id":"us-ok/okla.-stat.-tit.-36-36-7201","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 36, § 36-7201","heading":"Definitions","body":"As used in this act:\n\n1. “Access payments” means an amount paid to the Insurance\n\nCommissioner based upon a percentage of claims paid by a health\n\ncarrier to be used to fund the state’s Medicaid program and make\n\nfull use of any federal matching funds available to the state;\n\n2. “Claims paid” means all payments made by a health carrier\n\nfor health and medical services for residents of this state.\n\n“Claims paid” shall not include:\n\na. claims-related expenses and general administrative\n\nexpenses,\n\nb. payments made to qualifying providers under a “pay-\n\nfor-performance” or other incentive compensation\n\narrangement if the payments are not reflected in the\n\nprocessing of claims submitted for services rendered\n\nto specific covered individuals,\n\nc. claims paid by health carriers with respect to\n\naccidental injury, specified disease, hospital\n\nindemnity, dental, vision, disability income, long-\n\nterm care, Medicare supplement or other limited\n\nbenefit health insurance, except claims paid for\n\ndental services covered under a medical policy,\n\nd. claims paid for services rendered to nonresidents of\n\nthis state,\n\ne. claims paid under retiree health benefit plans that\n\nare separate from and not included within benefit\n\nplans for existing employees,\n\nf. claims paid by an employee benefit excess insurance\n\ncarrier that have been counted by a third-party\n\nadministrator for determining an access payment,\n\ng. claims paid for services rendered to a person covered\n\nunder a benefit plan for federal employees,\n\nh. claims paid for services rendered outside of this\n\nstate to a person who is a resident of this state, and\n\ni. claims paid pursuant to Medicare or Medicaid;\n\n3. “Claims-related expenses” means:\n\na. payments for utilization review, care management,\n\ndisease management, risk assessment and similar\n\nadministrative services intended to reduce the claims\n\npaid for health and medical services rendered to cover\n\nindividuals for the purposes of attempting to ensure\n\nthat needed services are delivered in an efficacious\n\nmanner or by helping to maintain or improve the health\n\nof a covered individual, and\n\nb. payments made to or by organized groups of providers\n\nof health and medical services in accordance with\n\nmanaged care risk arrangements or network access\n\nagreements that are unrelated to the provision of\n\nservices to specific covered individuals;\n\n4. “Health and medical services” means, but is not limited to:\n\na. any services included in the furnishing of medical\n\ncare,\n\nb. dental care to the extent covered under a medical\n\ninsurance policy,\n\nc. pharmaceutical benefits or hospitalization, including,\n\nbut not limited to, services provided in a hospital or\n\nother medical facility,\n\nd. ancillary services, including, but not limited to,\n\nambulatory services,\n\ne. physician and other practitioner services, including,\n\nbut not limited to, services provided by an assistant\n\nto a physician, nurse practitioner or midwife, and\n\nf. behavioral health services, including, but not limited\n\nto, mental health and substance abuse services;\n\n5. “Health carrier” means any entity or insurer authorized to\n\nprovide health insurance or health benefits pursuant to the laws of\n\nthis state and any entity or person engaged in the business of\n\nmaking contracts of accident or health insurance. “Health carrier”\n\nincludes, but is not limited to:\n\na. third-party administrators as provided for in Sections\n\n1441 through 1452 of Title 36 of the Oklahoma\n\nStatutes,\n\nb. health maintenance organizations as provided for in\n\nSections 6901 through 6936 of Title 36 of the Oklahoma\n\nStatutes,\n\nc. self-insured employer welfare arrangements,\n\nd. excess carriers,\n\ne. stop loss carriers,\n\nf. multiple employer welfare arrangements (MEWA) as\n\nprovided for in Sections 633 through 650 of Title 36\n\nof the Oklahoma Statutes,\n\ng. professional employer organizations (PEO), and\nb. health maintenance organizations as provided for in\n\nSections 6901 through 6936 of Title 36 of the Oklahoma\n\nStatutes,\n\nc. self-insured employer welfare arrangements,\n\nd. excess carriers,\n\ne. stop loss carriers,\n\nf. multiple employer welfare arrangements (MEWA) as\n\nprovided for in Sections 633 through 650 of Title 36\n\nof the Oklahoma Statutes,\n\ng. professional employer organizations (PEO), and\n\nh. the Oklahoma State and Education Employees Group\n\nInsurance Board (OSEEGIB); and\n\n6. “Insurance Commissioner” or “Commissioner” means the\n\nOklahoma Insurance Commissioner.","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":"c82189d5a85fa3598a7ffa9dff3c3d23b892eeb8a2bc81f9befae4aacd3157db","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-36-36-7135","next":"us-ok/okla.-stat.-tit.-36-36-7202"},"notice":"GroundRules: Original legal text. Not legal advice."}