Okla. Stat. tit. 74, § 74-1304.1

A. The State and Education Employees Group Insurance Board and

the Oklahoma State Employees Benefits Council are hereby abolished.

Wherever the State and Education Employees Group Insurance Board and

the Oklahoma State Employees Benefits Council are referenced in law,

that reference shall be construed to mean the Oklahoma Employees

Insurance and Benefits Board.

B. There is hereby created the Oklahoma Employees Insurance and

Benefits Board.

C. The chair and vice-chair shall be elected by the Board

members at the first meeting of the Board and shall preside over

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meetings of the Board and perform other duties as may be required by

the Board. Upon the resignation or expiration of the term of the

chair or vice-chair, the members shall elect a chair or vice-chair.

The Board shall elect one of its members to serve as secretary.

D. The Board shall consist of seven (7) members to be appointed

as follows:

1. The State Insurance Commissioner, or designee;

2. Four members shall be appointed by the Governor;

3. One member shall be appointed by the Speaker of the Oklahoma

House of Representatives; and

4. One member shall be appointed by the President Pro Tempore

of the Oklahoma State Senate.

E. The appointed members shall:

1. Have demonstrated professional experience in investment or

funds management, public funds management, public or private group

health or pension fund management, or group health insurance

management;

2. Be licensed to practice law in this state and have

demonstrated professional experience in commercial matters; or

3. Be licensed by the Oklahoma Accountancy Board to practice in

this state as a public accountant or a certified public accountant.

In making appointments that conform to the requirements of this

subsection, at least one but not more than three members shall be

appointed each from paragraphs 2 and 3 of this subsection by the

combined appointing authorities.

F. Each member of the Board shall serve a term of four (4)

years from the date of appointment.

G. Members of the Board shall be subject to the following:

1. The appointed members shall each receive compensation of

Five Hundred Dollars ($500.00) per month. Appointed members who

fail to attend a regularly scheduled meeting of the Board shall not

receive the related compensation;

2. The appointed members shall be reimbursed for their

expenses, according to the State Travel Reimbursement Act, as are

incurred in the performance of their duties, which shall be paid

from the Health Insurance Reserve Fund;

3. In the event an appointed member does not attend at least

seventy-five percent (75%) of the regularly scheduled meetings of

the Board during a calendar year, the appointing authority may

remove the member;

4. A member may also be removed for any other cause as provided

by law;

5. No Board member shall be individually or personally liable

for any action of the Board; and

6. Participation on the Board is contingent upon maintaining

all necessary annual training as may be required through the Health

Insurance Portability and Accountability Act of 1996, Medicare

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contracting requirements or other statutory or regulatory

guidelines.

H. The Board shall meet as often as necessary to conduct

business but shall meet no less than four times a year, with an

organizational meeting to be held prior to December 1, 2012. The

organizational meeting shall be called by the Insurance

Commissioner. A majority of the members of the Board shall

constitute a quorum for the transaction of business, and any

official action of the Board must have a favorable vote by a

majority of the members of the Board present.

I. Except as otherwise provided in this subsection, no member

of the Board shall be a lobbyist registered in this state as

provided by law, or be employed directly or indirectly by any firm
ty of the members of the Board shall

constitute a quorum for the transaction of business, and any

official action of the Board must have a favorable vote by a

majority of the members of the Board present.

I. Except as otherwise provided in this subsection, no member

of the Board shall be a lobbyist registered in this state as

provided by law, or be employed directly or indirectly by any firm

or health care provider under contract to the State and Education

Employees Group Insurance Board, the Oklahoma State Employees

Benefits Council, or the Oklahoma Employees Insurance and Benefits

Board, or any benefit program under its jurisdiction, for any goods

or services whatsoever. Any physician member of the Board shall not

be subject to the provisions of this subsection.

J. Any vacancy occurring on the Board shall be filled for the

unexpired term of office in the same manner as provided for in

subsection D of this section.

K. The Board shall act in accordance with the provisions of the

Oklahoma Open Meeting Act, the Oklahoma Open Records Act and the

Administrative Procedures Act.

L. The Administrative Director of the Courts shall designate

grievance panel members as shall be necessary. The members of the

grievance panel shall consist of two attorneys licensed to practice

law in this state and one state-licensed health care professional or

health care administrator who has at least three (3) years practical

experience, has had or has admitting privileges to a hospital in

this state, has a working knowledge of prescription medication, or

has worked in an administrative capacity at some point in his or her

career. The state health care professional shall be appointed by

the Governor. At the Governor's discretion, one or more qualified

individuals may also be appointed as an alternate to serve on the

grievance panel in the event the Governor's primary appointee

becomes unable to serve.

M. The Oklahoma Health Care Authority shall work in conjunction

with the Office of Management and Enterprise Services to determine

state employee benefit elections and eligibility, and the Oklahoma

Health Care Authority shall have the following duties,

responsibilities and authority with respect to the administration of

the flexible benefits plan authorized pursuant to the State

Employees Flexible Benefits Act and the Oklahoma State Employees

Benefits Act:

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1. To construe and interpret the plan, and decide all questions

of eligibility in accordance with 26 U.S.C.A., Section 1 et seq.;

2. To select those benefits which shall be made available to

participants under the plan, according to applicable laws and rules;

3. To prescribe procedures to be followed by participants in

making elections and filing claims under the plan;

4. Beginning with the plan year which begins on January 1,

2013, to select and contract with one or more providers to offer a

group TRICARE Supplement product to eligible employees who are

eligible TRICARE beneficiaries. Any membership dues required to

participate in a group TRICARE Supplement product offered pursuant

to this paragraph shall be paid by the employee. As used in this

paragraph, "TRICARE" means the Department of Defense health care

program for active duty and retired service members and their

families;

5. To prepare and distribute information communicating and

explaining the plan to participating employers and participants.

Health maintenance organizations or other third-party insurance

vendors may be directly or indirectly involved in the distribution

of communicated information to participating state agency employers

and state employee participants subject to the following condition:

the Board shall verify all marketing and communications information

for factual accuracy prior to distribution;

6. To receive from participating employers and participants
ird-party insurance

vendors may be directly or indirectly involved in the distribution

of communicated information to participating state agency employers

and state employee participants subject to the following condition:

the Board shall verify all marketing and communications information

for factual accuracy prior to distribution;

6. To receive from participating employers and participants

such information as shall be necessary for the proper administration

of the plan, and any of the benefits offered thereunder;

7. To furnish the participating employers and participants such

annual reports with respect to the administration of the plan as are

reasonable and appropriate;

8. To keep reports of benefit elections, claims and

disbursements for claims under the plan;

9. To negotiate for best and final offer through competitive

negotiation with the assistance and through the purchasing

procedures adopted by the Office of Management and Enterprise

Services and contract with federally qualified health maintenance

organizations under the provisions of 42 U.S.C., Section 300e et

seq., or with health maintenance organizations granted a certificate

of authority by the Insurance Commissioner pursuant to the Health

Maintenance Reform Act of 2003 for consideration by participants as

an alternative to the health plans offered by the Oklahoma Employees

Insurance and Benefits Board, and to transfer to the health

maintenance organizations such funds as may be approved for a

participant electing health maintenance organization alternative

services. The Board may also select and contract with a vendor to

offer a point-of-service plan. An HMO may offer coverage through a

point-of-service plan, subject to the guidelines established by the

Board. However, if the Board chooses to offer a point-of-service

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plan, then a vendor that offers both an HMO plan and a point-of-

service plan may choose to offer only its point-of-service plan in

lieu of offering its HMO plan. The Board may, however, renegotiate

rates with successful bidders after contracts have been awarded if

there is an extraordinary circumstance. An extraordinary

circumstance shall be limited to insolvency of a participating

health maintenance organization or point-of-service plan,

dissolution of a participating health maintenance organization or

point-of-service plan or withdrawal of another participating health

maintenance organization or point-of-service plan at any time during

the calendar year. Nothing in this section of law shall be

construed to permit either party to unilaterally alter the terms of

the contract;

10. To retain as confidential information the initial Request

For Proposal offers as well as any subsequent bid offers made by the

health plans prior to final contract awards as a part of the best

and final offer negotiations process for the benefit plan;

11. To promulgate administrative rules for the competitive

negotiation process;

12. To require vendors offering coverage to provide such

enrollment and claims data as is determined by the Board. The Board

shall be authorized to retain as confidential any proprietary

information submitted in response to the Board's Request For

Proposal. Provided, however, that any such information requested by

the Board from the vendors shall only be subject to the

confidentiality provision of this paragraph if it is clearly

designated in the Request For Proposal as being protected under this

provision. All requested information lacking such a designation in

the Request For Proposal shall be subject to Section 24A.1 et seq.

of Title 51 of the Oklahoma Statutes. From health maintenance

organizations, data provided shall include the current Health Plan

Employer Data and Information Set (HEDIS);

13. To authorize the purchase of any insurance deemed necessary

for providing benefits under the plan including indemnity dental
king such a designation in

the Request For Proposal shall be subject to Section 24A.1 et seq.

of Title 51 of the Oklahoma Statutes. From health maintenance

organizations, data provided shall include the current Health Plan

Employer Data and Information Set (HEDIS);

13. To authorize the purchase of any insurance deemed necessary

for providing benefits under the plan including indemnity dental

plans, provided that the only indemnity health plan selected by the

Board shall be the indemnity plan offered by the Board, and to

transfer to the Board such funds as may be approved for a

participant electing a benefit plan offered by the Board. All

indemnity dental plans shall meet or exceed the following

requirements:

a. they shall have a statewide provider network,

b. they shall provide benefits which shall reimburse the

expense for the following types of dental procedures:

(1) diagnostic,

(2) preventative,

(3) restorative,

(4) endodontic,

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(5) periodontic,

(6) prosthodontics,

(7) oral surgery,

(8) dental implants,

(9) dental prosthetics, and

(10) orthodontics, and

c. they shall provide an annual benefit of not less than

One Thousand Five Hundred Dollars ($1,500.00) for all

services other than orthodontic services, and a

lifetime benefit of not less than One Thousand Five

Hundred Dollars ($1,500.00) for orthodontic services;

14. To communicate deferred compensation programs as provided

in Section 1701 of this title;

15. To assess and collect reasonable fees from contracted

health maintenance organizations and third-party insurance vendors

to offset the costs of administration;

16. To accept, modify or reject elections under the plan in

accordance with the Oklahoma State Employees Benefits Act and 26

U.S.C.A., Section 1 et seq.;

17. To promulgate election and claim forms to be used by

participants;

18. To adopt rules requiring payment for medical and dental

services and treatment rendered by duly licensed hospitals,

physicians and dentists. Unless the Board has otherwise contracted

with the out-of-state health care provider, the Board shall

reimburse for medical services and treatment rendered and charged by

an out-of-state health care provider at least at the same percentage

level as the network percentage level of the fee schedule

established by the Oklahoma Employees Insurance and Benefits Board

if the insured employee was referred to the out-of-state health care

provider by a physician or it was an emergency situation and the

out-of-state provider was the closest in proximity to the place of

residence of the employee which offers the type of health care

services needed. For purposes of this paragraph, health care

providers shall include, but not be limited to, physicians,

dentists, hospitals and special care facilities;

19. To enter into a contract with out-of-state providers in

connection with any PPO or hospital or medical network plan which

shall include, but not be limited to, special care facilities and

hospitals outside the borders of the State of Oklahoma. The

contract for out-of-state providers shall be identical to the in-

state provider contracts. The Board may negotiate for discounts

from billed charges when the out-of-state provider is not a network

provider and the member sought services in an emergency situation,

when the services were not otherwise available in the State of

Oklahoma or when the Administrator appointed by the Board approved

the service as an exceptional circumstance;

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20. To create the establishment of external appeals procedures

for complaints by insured employees in the two following manners:

a. independent review organizations, accredited by a

national accrediting body, shall act as appeals bodies

for complaints by insured employees regarding adverse

benefit determinations based on:

(1) medical judgment,
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20. To create the establishment of external appeals procedures

for complaints by insured employees in the two following manners:

a. independent review organizations, accredited by a

national accrediting body, shall act as appeals bodies

for complaints by insured employees regarding adverse

benefit determinations based on:

(1) medical judgment,

(2) whether the insurer is complying with the

surprise billing and cost-sharing protections set

forth in Sections 2799A-1 and 2799A-2 of the

Public Health Services Act, 42 U.S.C. 201 et

seq., and

(3) a recission in coverage,

b. a three-member grievance panel, which shall act as an

appeals body for complaints by insured employees

regarding all other issues.

The appeals procedures provided by this paragraph shall be the

exclusive remedies available to insured employees having complaints

against the insurer. The appeals procedures of the three-member

grievance panel shall be subject to the Oklahoma Administrative

Procedures Act, including provisions thereof for review of agency

decisions by the district court. The grievance panel shall schedule

a hearing within sixty (60) days from the date the grievance panel

receives a written request for a hearing unless the panel orders a

continuance for good cause shown. Upon written request by the

insured employee to the grievance panel and received not less than

ten (10) days before the hearing date, the grievance panel shall

cause a full stenographic record of the proceedings to be made by a

competent court reporter at the insured employee's expense; and

21. To intercept monies owing to plan participants from other

state agencies, when those participants in turn owe money to the

Oklahoma Health Care Authority, and to ensure that the participants

are afforded due process of law.

N. Except for a breach of fiduciary obligation, a Board member

shall not be individually or personally responsible for any action

of the Board.

O. The Board shall operate in an advisory capacity to the

Oklahoma Health Care Authority.

P. The members of the Board shall not accept gifts or

gratuities from an individual organization with a value in excess of

Ten Dollars ($10.00) per year. The provisions of this section shall

not be construed to prevent the members of the Board from attending

educational seminars, conferences, meetings or similar functions.