All policies issued or renewed in Oklahoma on or after November 1, 2025, must comply with the healthcare payment provisions of SB 515. Specifically, if an enrollee negotiates a lower-than-average fee for a covered healthcare service and chooses to pay directly out of pocket for that service to the healthcare provider, the health insurance policy must count that amount toward the enrollee’s annual deductible and out-of-pocket limits under the policy if certain conditions are met. The healthcare provider must accept the payment as payment in full and not bill the insurer or the enrollee any balance. The enrollee must submit to the insurer documentation, including details of the service, the negotiated fee from the healthcare provider, and the final bill showing the amount paid.
Insurers are responsible for bringing applicable fully insured plans into compliance. Employer plan sponsors should be aware of the changes. Considering the nature of the new law, employers may consider working with the insurer to educate participants of their new right under the plan.
Read the full legislation: SB 515.