Okla. Stat. tit. 74, § 74-1371

maintenance organizations - Default benefits.

A. All participants must purchase at least the basic plan

unless, to the extent that it is consistent with federal law, the

participant is a person who has retired from a branch of the United

States military and has been provided with health coverage through a

federal plan and that participant provides proof of that coverage,

or the participant has opted out of the state’s basic plan according

to the provisions in Section 1308.3 of this title. On or before

January 1 of the plan year beginning July 1, 2001, and July 1 of any

plan year beginning after January 1, 2002, the Oklahoma Employees

Insurance and Benefits Board shall design the basic plan for the

next plan year to ensure that the basic plan provides adequate

coverage to all participants. All benefit plans, whether offered by

the Board, a health maintenance organization (HMO) or other vendors,

shall meet the minimum requirements set by the Board for the basic

plan.

B. The Board shall offer health, disability, life and dental

coverage to all participants and their dependents. For health,

dental, disability and life coverage, the Board shall offer plans at

the basic benefit level established by the Board, and in addition,

may offer benefit plans that provide an enhanced level of benefits.

The Board shall be responsible for determining the plan design and

the benefit price for the plans that it offers. Effective for the

plan year beginning January 1, 2017, and for each plan year

thereafter, in setting health insurance premiums for active

employees and for retirees under sixty-five (65) years of age, the

Board shall set the monthly premium for active employees to be equal

to the monthly premium for retirees under sixty-five (65) years of

age; except that the Board may offer retirees under sixty-five (65)

years of age the opportunity to voluntarily enroll in an alternative

plan of insurance at a rate that is between One Hundred Dollars

($100.00) less than the monthly premium for active employees and up

to One Hundred Dollars ($100.00) more than the monthly premium for

active employees. Retirees under the age of sixty-five (65) who

enroll in an alternative plan of insurance shall retain the right to

enroll in any other health insurance plan offered by the Board for

which they might be qualified during a subsequent open enrollment

period.

Nothing in this subsection shall be construed as prohibiting the

Board from offering additional medical plans, provided that any

medical plan offered to participants shall meet or exceed the

benefits provided in the medical portion of the basic plan.

C. In lieu of electing any of the preceding medical benefit

plans, a participant may elect medical coverage by any health

maintenance organization made available to participants by the

Board. The benefit price of any health maintenance organization

Oklahoma Statutes - Title 74. State Government Page 851

shall be determined on a competitive bid basis. Contracts for such

plans shall not be subject to the provisions of the Oklahoma Central

Purchasing Act. The Board shall promulgate rules establishing

appropriate competitive bidding criteria and procedures for

contracts awarded for flexible benefits plans. The Board shall have

the authority to reject the bid or restrict enrollment in any health

maintenance organization for which the Board determines the benefit

price to be excessive. The Board shall have the authority to reject

any plan that does not meet the bid requirements. All bidders shall

submit along with their bid a notarized, sworn statement as provided

by Section 85.22 of this title. Effective for the plan year

beginning January 1, 2007, and for each plan year thereafter, in

setting health insurance premiums for active employees and for

retirees under sixty-five (65) years of age, HMOs, self-insured

organizations and prepaid plans shall set the monthly premium for
s shall

submit along with their bid a notarized, sworn statement as provided

by Section 85.22 of this title. Effective for the plan year

beginning January 1, 2007, and for each plan year thereafter, in

setting health insurance premiums for active employees and for

retirees under sixty-five (65) years of age, HMOs, self-insured

organizations and prepaid plans shall set the monthly premium for

active employees to be equal to the monthly premium for retirees

under sixty-five (65) years of age.

D. Nothing in this section shall be construed as prohibiting

the Board from offering additional qualified benefit plans or

currently taxable benefit plans.

E. Each employee of a participating employer who meets the

eligibility requirements for participation in the flexible benefits

plan shall make an annual election of benefits under the plan during

an enrollment period to be held prior to the beginning of each plan

year. The enrollment period dates will be determined annually and

will be announced by the Board; provided, the enrollment period

shall end no later than thirty (30) days before the beginning of the

plan year.

Each such employee shall make an irrevocable advance election

for the plan year or the remainder thereof pursuant to such

procedures as the Board shall prescribe. Any such employee who

fails to make a proper election under the plan shall, nevertheless,

be a participant in the plan and shall be deemed to have purchased

the default benefits described in this section.

F. The Board shall prescribe the forms that participants will

be required to use in making their elections, and may prescribe

deadlines and other procedures for filing the elections.

G. Any participant who, in the first year for which he or she

is eligible to participate in the plan, fails to make a proper

election under the plan in conformance with the procedures set forth

in this section or as prescribed by the Board shall be deemed

automatically to have purchased the default benefits. The default

benefits shall be the same as the basic plan benefits. Any

participant who, after having participated in the plan during the

previous plan year, fails to make a proper election under the plan

in conformance with the procedures set forth in this section or

prescribed by the Board, shall be deemed automatically to have

Oklahoma Statutes - Title 74. State Government Page 852

purchased the same benefits which the participant purchased in the

immediately preceding plan year, except that the participant shall

not be deemed to have elected coverage under the health care

reimbursement account plan or the dependent care reimbursement

account plan.

H. Benefit plan contracts with the Board, health maintenance

organizations, and other third-party insurance vendors shall provide

for a risk adjustment factor for adverse selection that may occur,

as determined by the Board, based on generally accepted actuarial

principles.

I. 1. For the plan year ending December 31, 2004, employees

covered or eligible to be covered under the State and Education

Employees Group Insurance Act and the State Employees Flexible

Benefits Act who are enrolled in a health maintenance organization

offering a network in Oklahoma City, shall have the option of

continuing care with a primary care physician for the remainder of

the plan year if:

a. that primary care physician was part of a provider

group that was offered to the individual at enrollment

and later removed from the network of the health

maintenance organization, for reasons other than for

cause, and

b. the individual submits a request in writing to the

health maintenance organization to continue to have

access to the primary care physician.

2. The primary care physician selected by the individual shall

be required to accept reimbursement for such health care services on

a fee-for-service basis only. The fee-for-service shall be computed
ganization, for reasons other than for

cause, and

b. the individual submits a request in writing to the

health maintenance organization to continue to have

access to the primary care physician.

2. The primary care physician selected by the individual shall

be required to accept reimbursement for such health care services on

a fee-for-service basis only. The fee-for-service shall be computed

by the health maintenance organization based on the average of the

other fee-for-service contracts of the health maintenance

organization in the local community. The individual shall only be

required to pay the primary care physician those co-payments,

coinsurance and any applicable deductibles in accordance with the

terms of the agreement between the employer and the health

maintenance organization and the provider shall not balance bill the

patient.

3. Any network offered in Oklahoma City that is terminated

prior to July 1, 2004, shall notify the health maintenance

organization, and Oklahoma Employees Insurance and Benefits Board by

June 11, 2004, of the network’s intentions to continue providing

primary care services as described in paragraph 2 of this subsection

offered by the health maintenance organization to state and public

employees.