{"data":{"id":"us-ok/okla.-stat.-tit.-74-74-1371","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 74, § 74-1371","heading":"Election of benefit plans - Plans offered by health","body":"maintenance organizations - Default benefits.\n\nA. All participants must purchase at least the basic plan\n\nunless, to the extent that it is consistent with federal law, the\n\nparticipant is a person who has retired from a branch of the United\n\nStates military and has been provided with health coverage through a\n\nfederal plan and that participant provides proof of that coverage,\n\nor the participant has opted out of the state’s basic plan according\n\nto the provisions in Section 1308.3 of this title. On or before\n\nJanuary 1 of the plan year beginning July 1, 2001, and July 1 of any\n\nplan year beginning after January 1, 2002, the Oklahoma Employees\n\nInsurance and Benefits Board shall design the basic plan for the\n\nnext plan year to ensure that the basic plan provides adequate\n\ncoverage to all participants. All benefit plans, whether offered by\n\nthe Board, a health maintenance organization (HMO) or other vendors,\n\nshall meet the minimum requirements set by the Board for the basic\n\nplan.\n\nB. The Board shall offer health, disability, life and dental\n\ncoverage to all participants and their dependents. For health,\n\ndental, disability and life coverage, the Board shall offer plans at\n\nthe basic benefit level established by the Board, and in addition,\n\nmay offer benefit plans that provide an enhanced level of benefits.\n\nThe Board shall be responsible for determining the plan design and\n\nthe benefit price for the plans that it offers. Effective for the\n\nplan year beginning January 1, 2017, and for each plan year\n\nthereafter, in setting health insurance premiums for active\n\nemployees and for retirees under sixty-five (65) years of age, the\n\nBoard shall set the monthly premium for active employees to be equal\n\nto the monthly premium for retirees under sixty-five (65) years of\n\nage; except that the Board may offer retirees under sixty-five (65)\n\nyears of age the opportunity to voluntarily enroll in an alternative\n\nplan of insurance at a rate that is between One Hundred Dollars\n\n($100.00) less than the monthly premium for active employees and up\n\nto One Hundred Dollars ($100.00) more than the monthly premium for\n\nactive employees. Retirees under the age of sixty-five (65) who\n\nenroll in an alternative plan of insurance shall retain the right to\n\nenroll in any other health insurance plan offered by the Board for\n\nwhich they might be qualified during a subsequent open enrollment\n\nperiod.\n\nNothing in this subsection shall be construed as prohibiting the\n\nBoard from offering additional medical plans, provided that any\n\nmedical plan offered to participants shall meet or exceed the\n\nbenefits provided in the medical portion of the basic plan.\n\nC. In lieu of electing any of the preceding medical benefit\n\nplans, a participant may elect medical coverage by any health\n\nmaintenance organization made available to participants by the\n\nBoard. The benefit price of any health maintenance organization\n\nshall be determined on a competitive bid basis. Contracts for such\n\nplans shall not be subject to the provisions of the Oklahoma Central\n\nPurchasing Act. The Board shall promulgate rules establishing\n\nappropriate competitive bidding criteria and procedures for\n\ncontracts awarded for flexible benefits plans. The Board shall have\n\nthe authority to reject the bid or restrict enrollment in any health\n\nmaintenance organization for which the Board determines the benefit\n\nprice to be excessive. The Board shall have the authority to reject\n\nany plan that does not meet the bid requirements. All bidders shall\n\nsubmit along with their bid a notarized, sworn statement as provided\n\nby Section 85.22 of this title. Effective for the plan year\n\nbeginning January 1, 2007, and for each plan year thereafter, in\n\nsetting health insurance premiums for active employees and for\n\nretirees under sixty-five (65) years of age, HMOs, self-insured\n\norganizations and prepaid plans shall set the monthly premium for\ns shall\n\nsubmit along with their bid a notarized, sworn statement as provided\n\nby Section 85.22 of this title. Effective for the plan year\n\nbeginning January 1, 2007, and for each plan year thereafter, in\n\nsetting health insurance premiums for active employees and for\n\nretirees under sixty-five (65) years of age, HMOs, self-insured\n\norganizations and prepaid plans shall set the monthly premium for\n\nactive employees to be equal to the monthly premium for retirees\n\nunder sixty-five (65) years of age.\n\nD. Nothing in this section shall be construed as prohibiting\n\nthe Board from offering additional qualified benefit plans or\n\ncurrently taxable benefit plans.\n\nE. Each employee of a participating employer who meets the\n\neligibility requirements for participation in the flexible benefits\n\nplan shall make an annual election of benefits under the plan during\n\nan enrollment period to be held prior to the beginning of each plan\n\nyear. The enrollment period dates will be determined annually and\n\nwill be announced by the Board; provided, the enrollment period\n\nshall end no later than thirty (30) days before the beginning of the\n\nplan year.\n\nEach such employee shall make an irrevocable advance election\n\nfor the plan year or the remainder thereof pursuant to such\n\nprocedures as the Board shall prescribe. Any such employee who\n\nfails to make a proper election under the plan shall, nevertheless,\n\nbe a participant in the plan and shall be deemed to have purchased\n\nthe default benefits described in this section.\n\nF. The Board shall prescribe the forms that participants will\n\nbe required to use in making their elections, and may prescribe\n\ndeadlines and other procedures for filing the elections.\n\nG. Any participant who, in the first year for which he or she\n\nis eligible to participate in the plan, fails to make a proper\n\nelection under the plan in conformance with the procedures set forth\n\nin this section or as prescribed by the Board shall be deemed\n\nautomatically to have purchased the default benefits. The default\n\nbenefits shall be the same as the basic plan benefits. Any\n\nparticipant who, after having participated in the plan during the\n\nprevious plan year, fails to make a proper election under the plan\n\nin conformance with the procedures set forth in this section or\n\nprescribed by the Board, shall be deemed automatically to have\n\npurchased the same benefits which the participant purchased in the\n\nimmediately preceding plan year, except that the participant shall\n\nnot be deemed to have elected coverage under the health care\n\nreimbursement account plan or the dependent care reimbursement\n\naccount plan.\n\nH. Benefit plan contracts with the Board, health maintenance\n\norganizations, and other third-party insurance vendors shall provide\n\nfor a risk adjustment factor for adverse selection that may occur,\n\nas determined by the Board, based on generally accepted actuarial\n\nprinciples.\n\nI. 1. For the plan year ending December 31, 2004, employees\n\ncovered or eligible to be covered under the State and Education\n\nEmployees Group Insurance Act and the State Employees Flexible\n\nBenefits Act who are enrolled in a health maintenance organization\n\noffering a network in Oklahoma City, shall have the option of\n\ncontinuing care with a primary care physician for the remainder of\n\nthe plan year if:\n\na. that primary care physician was part of a provider\n\ngroup that was offered to the individual at enrollment\n\nand later removed from the network of the health\n\nmaintenance organization, for reasons other than for\n\ncause, and\n\nb. the individual submits a request in writing to the\n\nhealth maintenance organization to continue to have\n\naccess to the primary care physician.\n\n2. The primary care physician selected by the individual shall\n\nbe required to accept reimbursement for such health care services on\n\na fee-for-service basis only. The fee-for-service shall be computed\nganization, for reasons other than for\n\ncause, and\n\nb. the individual submits a request in writing to the\n\nhealth maintenance organization to continue to have\n\naccess to the primary care physician.\n\n2. The primary care physician selected by the individual shall\n\nbe required to accept reimbursement for such health care services on\n\na fee-for-service basis only. The fee-for-service shall be computed\n\nby the health maintenance organization based on the average of the\n\nother fee-for-service contracts of the health maintenance\n\norganization in the local community. The individual shall only be\n\nrequired to pay the primary care physician those co-payments,\n\ncoinsurance and any applicable deductibles in accordance with the\n\nterms of the agreement between the employer and the health\n\nmaintenance organization and the provider shall not balance bill the\n\npatient.\n\n3. Any network offered in Oklahoma City that is terminated\n\nprior to July 1, 2004, shall notify the health maintenance\n\norganization, and Oklahoma Employees Insurance and Benefits Board by\n\nJune 11, 2004, of the network’s intentions to continue providing\n\nprimary care services as described in paragraph 2 of this subsection\n\noffered by the health maintenance organization to state and public\n\nemployees.","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":"4138cd581f66a424d78912f086c2056b0f908264431bd06b05bef97e5f94e859","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-74-74-1370","next":"us-ok/okla.-stat.-tit.-74-74-1372"},"notice":"GroundRules: Original legal text. Not legal advice."}