{"data":{"id":"us-ok/okla.-stat.-tit.-74-74-1304.1","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 74, § 74-1304.1","heading":"Oklahoma Employees Insurance and Benefits Board","body":"A. The State and Education Employees Group Insurance Board and\n\nthe Oklahoma State Employees Benefits Council are hereby abolished.\n\nWherever the State and Education Employees Group Insurance Board and\n\nthe Oklahoma State Employees Benefits Council are referenced in law,\n\nthat reference shall be construed to mean the Oklahoma Employees\n\nInsurance and Benefits Board.\n\nB. There is hereby created the Oklahoma Employees Insurance and\n\nBenefits Board.\n\nC. The chair and vice-chair shall be elected by the Board\n\nmembers at the first meeting of the Board and shall preside over\n\nmeetings of the Board and perform other duties as may be required by\n\nthe Board. Upon the resignation or expiration of the term of the\n\nchair or vice-chair, the members shall elect a chair or vice-chair.\n\nThe Board shall elect one of its members to serve as secretary.\n\nD. The Board shall consist of seven (7) members to be appointed\n\nas follows:\n\n1. The State Insurance Commissioner, or designee;\n\n2. Four members shall be appointed by the Governor;\n\n3. One member shall be appointed by the Speaker of the Oklahoma\n\nHouse of Representatives; and\n\n4. One member shall be appointed by the President Pro Tempore\n\nof the Oklahoma State Senate.\n\nE. The appointed members shall:\n\n1. Have demonstrated professional experience in investment or\n\nfunds management, public funds management, public or private group\n\nhealth or pension fund management, or group health insurance\n\nmanagement;\n\n2. Be licensed to practice law in this state and have\n\ndemonstrated professional experience in commercial matters; or\n\n3. Be licensed by the Oklahoma Accountancy Board to practice in\n\nthis state as a public accountant or a certified public accountant.\n\nIn making appointments that conform to the requirements of this\n\nsubsection, at least one but not more than three members shall be\n\nappointed each from paragraphs 2 and 3 of this subsection by the\n\ncombined appointing authorities.\n\nF. Each member of the Board shall serve a term of four (4)\n\nyears from the date of appointment.\n\nG. Members of the Board shall be subject to the following:\n\n1. The appointed members shall each receive compensation of\n\nFive Hundred Dollars ($500.00) per month. Appointed members who\n\nfail to attend a regularly scheduled meeting of the Board shall not\n\nreceive the related compensation;\n\n2. The appointed members shall be reimbursed for their\n\nexpenses, according to the State Travel Reimbursement Act, as are\n\nincurred in the performance of their duties, which shall be paid\n\nfrom the Health Insurance Reserve Fund;\n\n3. In the event an appointed member does not attend at least\n\nseventy-five percent (75%) of the regularly scheduled meetings of\n\nthe Board during a calendar year, the appointing authority may\n\nremove the member;\n\n4. A member may also be removed for any other cause as provided\n\nby law;\n\n5. No Board member shall be individually or personally liable\n\nfor any action of the Board; and\n\n6. Participation on the Board is contingent upon maintaining\n\nall necessary annual training as may be required through the Health\n\nInsurance Portability and Accountability Act of 1996, Medicare\n\ncontracting requirements or other statutory or regulatory\n\nguidelines.\n\nH. The Board shall meet as often as necessary to conduct\n\nbusiness but shall meet no less than four times a year, with an\n\norganizational meeting to be held prior to December 1, 2012. The\n\norganizational meeting shall be called by the Insurance\n\nCommissioner. A majority of the members of the Board shall\n\nconstitute a quorum for the transaction of business, and any\n\nofficial action of the Board must have a favorable vote by a\n\nmajority of the members of the Board present.\n\nI. Except as otherwise provided in this subsection, no member\n\nof the Board shall be a lobbyist registered in this state as\n\nprovided by law, or be employed directly or indirectly by any firm\nty of the members of the Board shall\n\nconstitute a quorum for the transaction of business, and any\n\nofficial action of the Board must have a favorable vote by a\n\nmajority of the members of the Board present.\n\nI. Except as otherwise provided in this subsection, no member\n\nof the Board shall be a lobbyist registered in this state as\n\nprovided by law, or be employed directly or indirectly by any firm\n\nor health care provider under contract to the State and Education\n\nEmployees Group Insurance Board, the Oklahoma State Employees\n\nBenefits Council, or the Oklahoma Employees Insurance and Benefits\n\nBoard, or any benefit program under its jurisdiction, for any goods\n\nor services whatsoever. Any physician member of the Board shall not\n\nbe subject to the provisions of this subsection.\n\nJ. Any vacancy occurring on the Board shall be filled for the\n\nunexpired term of office in the same manner as provided for in\n\nsubsection D of this section.\n\nK. The Board shall act in accordance with the provisions of the\n\nOklahoma Open Meeting Act, the Oklahoma Open Records Act and the\n\nAdministrative Procedures Act.\n\nL. The Administrative Director of the Courts shall designate\n\ngrievance panel members as shall be necessary. The members of the\n\ngrievance panel shall consist of two attorneys licensed to practice\n\nlaw in this state and one state-licensed health care professional or\n\nhealth care administrator who has at least three (3) years practical\n\nexperience, has had or has admitting privileges to a hospital in\n\nthis state, has a working knowledge of prescription medication, or\n\nhas worked in an administrative capacity at some point in his or her\n\ncareer. The state health care professional shall be appointed by\n\nthe Governor. At the Governor's discretion, one or more qualified\n\nindividuals may also be appointed as an alternate to serve on the\n\ngrievance panel in the event the Governor's primary appointee\n\nbecomes unable to serve.\n\nM. The Oklahoma Health Care Authority shall work in conjunction\n\nwith the Office of Management and Enterprise Services to determine\n\nstate employee benefit elections and eligibility, and the Oklahoma\n\nHealth Care Authority shall have the following duties,\n\nresponsibilities and authority with respect to the administration of\n\nthe flexible benefits plan authorized pursuant to the State\n\nEmployees Flexible Benefits Act and the Oklahoma State Employees\n\nBenefits Act:\n\n1. To construe and interpret the plan, and decide all questions\n\nof eligibility in accordance with 26 U.S.C.A., Section 1 et seq.;\n\n2. To select those benefits which shall be made available to\n\nparticipants under the plan, according to applicable laws and rules;\n\n3. To prescribe procedures to be followed by participants in\n\nmaking elections and filing claims under the plan;\n\n4. Beginning with the plan year which begins on January 1,\n\n2013, to select and contract with one or more providers to offer a\n\ngroup TRICARE Supplement product to eligible employees who are\n\neligible TRICARE beneficiaries. Any membership dues required to\n\nparticipate in a group TRICARE Supplement product offered pursuant\n\nto this paragraph shall be paid by the employee. As used in this\n\nparagraph, \"TRICARE\" means the Department of Defense health care\n\nprogram for active duty and retired service members and their\n\nfamilies;\n\n5. To prepare and distribute information communicating and\n\nexplaining the plan to participating employers and participants.\n\nHealth maintenance organizations or other third-party insurance\n\nvendors may be directly or indirectly involved in the distribution\n\nof communicated information to participating state agency employers\n\nand state employee participants subject to the following condition:\n\nthe Board shall verify all marketing and communications information\n\nfor factual accuracy prior to distribution;\n\n6. To receive from participating employers and participants\nird-party insurance\n\nvendors may be directly or indirectly involved in the distribution\n\nof communicated information to participating state agency employers\n\nand state employee participants subject to the following condition:\n\nthe Board shall verify all marketing and communications information\n\nfor factual accuracy prior to distribution;\n\n6. To receive from participating employers and participants\n\nsuch information as shall be necessary for the proper administration\n\nof the plan, and any of the benefits offered thereunder;\n\n7. To furnish the participating employers and participants such\n\nannual reports with respect to the administration of the plan as are\n\nreasonable and appropriate;\n\n8. To keep reports of benefit elections, claims and\n\ndisbursements for claims under the plan;\n\n9. To negotiate for best and final offer through competitive\n\nnegotiation with the assistance and through the purchasing\n\nprocedures adopted by the Office of Management and Enterprise\n\nServices and contract with federally qualified health maintenance\n\norganizations under the provisions of 42 U.S.C., Section 300e et\n\nseq., or with health maintenance organizations granted a certificate\n\nof authority by the Insurance Commissioner pursuant to the Health\n\nMaintenance Reform Act of 2003 for consideration by participants as\n\nan alternative to the health plans offered by the Oklahoma Employees\n\nInsurance and Benefits Board, and to transfer to the health\n\nmaintenance organizations such funds as may be approved for a\n\nparticipant electing health maintenance organization alternative\n\nservices. The Board may also select and contract with a vendor to\n\noffer a point-of-service plan. An HMO may offer coverage through a\n\npoint-of-service plan, subject to the guidelines established by the\n\nBoard. However, if the Board chooses to offer a point-of-service\n\nplan, then a vendor that offers both an HMO plan and a point-of-\n\nservice plan may choose to offer only its point-of-service plan in\n\nlieu of offering its HMO plan. The Board may, however, renegotiate\n\nrates with successful bidders after contracts have been awarded if\n\nthere is an extraordinary circumstance. An extraordinary\n\ncircumstance shall be limited to insolvency of a participating\n\nhealth maintenance organization or point-of-service plan,\n\ndissolution of a participating health maintenance organization or\n\npoint-of-service plan or withdrawal of another participating health\n\nmaintenance organization or point-of-service plan at any time during\n\nthe calendar year. Nothing in this section of law shall be\n\nconstrued to permit either party to unilaterally alter the terms of\n\nthe contract;\n\n10. To retain as confidential information the initial Request\n\nFor Proposal offers as well as any subsequent bid offers made by the\n\nhealth plans prior to final contract awards as a part of the best\n\nand final offer negotiations process for the benefit plan;\n\n11. To promulgate administrative rules for the competitive\n\nnegotiation process;\n\n12. To require vendors offering coverage to provide such\n\nenrollment and claims data as is determined by the Board. The Board\n\nshall be authorized to retain as confidential any proprietary\n\ninformation submitted in response to the Board's Request For\n\nProposal. Provided, however, that any such information requested by\n\nthe Board from the vendors shall only be subject to the\n\nconfidentiality provision of this paragraph if it is clearly\n\ndesignated in the Request For Proposal as being protected under this\n\nprovision. All requested information lacking such a designation in\n\nthe Request For Proposal shall be subject to Section 24A.1 et seq.\n\nof Title 51 of the Oklahoma Statutes. From health maintenance\n\norganizations, data provided shall include the current Health Plan\n\nEmployer Data and Information Set (HEDIS);\n\n13. To authorize the purchase of any insurance deemed necessary\n\nfor providing benefits under the plan including indemnity dental\nking such a designation in\n\nthe Request For Proposal shall be subject to Section 24A.1 et seq.\n\nof Title 51 of the Oklahoma Statutes. From health maintenance\n\norganizations, data provided shall include the current Health Plan\n\nEmployer Data and Information Set (HEDIS);\n\n13. To authorize the purchase of any insurance deemed necessary\n\nfor providing benefits under the plan including indemnity dental\n\nplans, provided that the only indemnity health plan selected by the\n\nBoard shall be the indemnity plan offered by the Board, and to\n\ntransfer to the Board such funds as may be approved for a\n\nparticipant electing a benefit plan offered by the Board. All\n\nindemnity dental plans shall meet or exceed the following\n\nrequirements:\n\na. they shall have a statewide provider network,\n\nb. they shall provide benefits which shall reimburse the\n\nexpense for the following types of dental procedures:\n\n(1) diagnostic,\n\n(2) preventative,\n\n(3) restorative,\n\n(4) endodontic,\n\n(5) periodontic,\n\n(6) prosthodontics,\n\n(7) oral surgery,\n\n(8) dental implants,\n\n(9) dental prosthetics, and\n\n(10) orthodontics, and\n\nc. they shall provide an annual benefit of not less than\n\nOne Thousand Five Hundred Dollars ($1,500.00) for all\n\nservices other than orthodontic services, and a\n\nlifetime benefit of not less than One Thousand Five\n\nHundred Dollars ($1,500.00) for orthodontic services;\n\n14. To communicate deferred compensation programs as provided\n\nin Section 1701 of this title;\n\n15. To assess and collect reasonable fees from contracted\n\nhealth maintenance organizations and third-party insurance vendors\n\nto offset the costs of administration;\n\n16. To accept, modify or reject elections under the plan in\n\naccordance with the Oklahoma State Employees Benefits Act and 26\n\nU.S.C.A., Section 1 et seq.;\n\n17. To promulgate election and claim forms to be used by\n\nparticipants;\n\n18. To adopt rules requiring payment for medical and dental\n\nservices and treatment rendered by duly licensed hospitals,\n\nphysicians and dentists. Unless the Board has otherwise contracted\n\nwith the out-of-state health care provider, the Board shall\n\nreimburse for medical services and treatment rendered and charged by\n\nan out-of-state health care provider at least at the same percentage\n\nlevel as the network percentage level of the fee schedule\n\nestablished by the Oklahoma Employees Insurance and Benefits Board\n\nif the insured employee was referred to the out-of-state health care\n\nprovider by a physician or it was an emergency situation and the\n\nout-of-state provider was the closest in proximity to the place of\n\nresidence of the employee which offers the type of health care\n\nservices needed. For purposes of this paragraph, health care\n\nproviders shall include, but not be limited to, physicians,\n\ndentists, hospitals and special care facilities;\n\n19. To enter into a contract with out-of-state providers in\n\nconnection with any PPO or hospital or medical network plan which\n\nshall include, but not be limited to, special care facilities and\n\nhospitals outside the borders of the State of Oklahoma. The\n\ncontract for out-of-state providers shall be identical to the in-\n\nstate provider contracts. The Board may negotiate for discounts\n\nfrom billed charges when the out-of-state provider is not a network\n\nprovider and the member sought services in an emergency situation,\n\nwhen the services were not otherwise available in the State of\n\nOklahoma or when the Administrator appointed by the Board approved\n\nthe service as an exceptional circumstance;\n\n20. To create the establishment of external appeals procedures\n\nfor complaints by insured employees in the two following manners:\n\na. independent review organizations, accredited by a\n\nnational accrediting body, shall act as appeals bodies\n\nfor complaints by insured employees regarding adverse\n\nbenefit determinations based on:\n\n(1) medical judgment,\nStatutes - Title 74. State Government Page 787\n\n20. To create the establishment of external appeals procedures\n\nfor complaints by insured employees in the two following manners:\n\na. independent review organizations, accredited by a\n\nnational accrediting body, shall act as appeals bodies\n\nfor complaints by insured employees regarding adverse\n\nbenefit determinations based on:\n\n(1) medical judgment,\n\n(2) whether the insurer is complying with the\n\nsurprise billing and cost-sharing protections set\n\nforth in Sections 2799A-1 and 2799A-2 of the\n\nPublic Health Services Act, 42 U.S.C. 201 et\n\nseq., and\n\n(3) a recission in coverage,\n\nb. a three-member grievance panel, which shall act as an\n\nappeals body for complaints by insured employees\n\nregarding all other issues.\n\nThe appeals procedures provided by this paragraph shall be the\n\nexclusive remedies available to insured employees having complaints\n\nagainst the insurer. The appeals procedures of the three-member\n\ngrievance panel shall be subject to the Oklahoma Administrative\n\nProcedures Act, including provisions thereof for review of agency\n\ndecisions by the district court. The grievance panel shall schedule\n\na hearing within sixty (60) days from the date the grievance panel\n\nreceives a written request for a hearing unless the panel orders a\n\ncontinuance for good cause shown. Upon written request by the\n\ninsured employee to the grievance panel and received not less than\n\nten (10) days before the hearing date, the grievance panel shall\n\ncause a full stenographic record of the proceedings to be made by a\n\ncompetent court reporter at the insured employee's expense; and\n\n21. To intercept monies owing to plan participants from other\n\nstate agencies, when those participants in turn owe money to the\n\nOklahoma Health Care Authority, and to ensure that the participants\n\nare afforded due process of law.\n\nN. Except for a breach of fiduciary obligation, a Board member\n\nshall not be individually or personally responsible for any action\n\nof the Board.\n\nO. The Board shall operate in an advisory capacity to the\n\nOklahoma Health Care Authority.\n\nP. The members of the Board shall not accept gifts or\n\ngratuities from an individual organization with a value in excess of\n\nTen Dollars ($10.00) per year. The provisions of this section shall\n\nnot be construed to prevent the members of the Board from attending\n\neducational seminars, conferences, meetings or similar functions.","path":["OK Code","Title 74"],"source_url":"https://www.oklegislature.gov/OK_Statutes/CompleteTitles/os74.pdf","current_through":"2026-08-14","vintage":"open-us-law v2026.08, retrieved 2026-09-14","retrieved_at":"2026-09-14T18:32:36Z","sha256":"b6014b6f5924bcf9c5b91edab74884f030b541e931154af70dc172951c8fcb53","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-74-74-1303","next":"us-ok/okla.-stat.-tit.-74-74-1305.1"},"notice":"GroundRules: Original legal text. Not legal advice."}