1 STATE OF OKLAHOMA
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2 2nd Session of the 59th Legislature (2024)
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3 HOUSE BILL 3369 By: McEntire
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6 AS INTRODUCED
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7 An Act relating to state government; amending 74 O.S.
7 2021, Section 1304.1, which relates to the Oklahoma
8 Employees Insurance and Benefits Act; modifying
8 certain duties and responsibilities; adding external
9 review requirements; and providing an effective date.
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12 BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
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13 SECTION 1. AMENDATORY 74 O.S. 2021, Section 1304.1, is
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14 amended to read as follows:
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15 Section 74-1304.1 A. The State and Education Employees Group
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16 Insurance Board and the Oklahoma State Employees Benefits Council
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17 are hereby abolished. Wherever the State and Education Employees
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18 Group Insurance Board and the Oklahoma State Employees Benefits
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19 Council are referenced in law, that reference shall be construed to
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20 mean the Oklahoma Employees Insurance and Benefits Board.
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21 B. There is hereby created the Oklahoma Employees Insurance and
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22 Benefits Board.
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23 C. The chair and vice-chair shall be elected by the Board
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24 members at the first meeting of the Board and shall preside over
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 1 meetings of the Board and perform other duties as may be required by
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2 the Board. Upon the resignation or expiration of the term of the
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3 chair or vice-chair, the members shall elect a chair or vice-chair.
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4 The Board shall elect one of its members to serve as secretary.
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5 D. The Board shall consist of seven (7) members to be appointed
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6 as follows:
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7 1. The State Insurance Commissioner, or designee;
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8 2. Four members shall be appointed by the Governor;
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9 3. One member shall be appointed by the Speaker of the Oklahoma
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10 House of Representatives; and
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11 4. One member shall be appointed by the President Pro Tempore
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12 of the Oklahoma State Senate.
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13 E. The appointed members shall:
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14 1. Have demonstrated professional experience in investment or
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15 funds management, public funds management, public or private group
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16 health or pension fund management, or group health insurance
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17 management;
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18 2. Be licensed to practice law in this state and have
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19 demonstrated professional experience in commercial matters; or
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20 3. Be licensed by the Oklahoma Accountancy Board to practice in
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21 this state as a public accountant or a certified public accountant.
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22 In making appointments that conform to the requirements of this
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23 subsection, at least one but not more than three members shall be
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 1 appointed each from paragraphs 2 and 3 of this subsection by the
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2 combined appointing authorities.
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3 F. Each member of the Board shall serve a term of four (4)
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4 years from the date of appointment.
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5 G. Members of the Board shall be subject to the following:
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6 1. The appointed members shall each receive compensation of
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7 Five Hundred Dollars ($500.00) per month. Appointed members who
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8 fail to attend a regularly scheduled meeting of the Board shall not
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9 receive the related compensation;
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10 2. The appointed members shall be reimbursed for their
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11 expenses, according to the State Travel Reimbursement Act, as are
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12 incurred in the performance of their duties, which shall be paid
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13 from the Health Insurance Reserve Fund;
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14 3. In the event an appointed member does not attend at least
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15 seventy-five percent (75%) of the regularly scheduled meetings of
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16 the Board during a calendar year, the appointing authority may
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17 remove the member;
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18 4. A member may also be removed for any other cause as provided
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19 by law;
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20 5. No Board member shall be individually or personally liable
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21 for any action of the Board; and
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22 6. Participation on the Board is contingent upon maintaining
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23 all necessary annual training as may be required through the Health
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24 Insurance Portability and Accountability Act of 1996, Medicare
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 1 contracting requirements or other statutory or regulatory
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2 guidelines.
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3 H. The Board shall meet as often as necessary to conduct
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4 business but shall meet no less than four times a year, with an
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5 organizational meeting to be held prior to December 1, 2012. The
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6 organizational meeting shall be called by the Insurance
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7 Commissioner. A majority of the members of the Board shall
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8 constitute a quorum for the transaction of business, and any
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9 official action of the Board must have a favorable vote by a
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10 majority of the members of the Board present.
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11 I. Except as otherwise provided in this subsection, no member
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12 of the Board shall be a lobbyist registered in this state as
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13 provided by law, or be employed directly or indirectly by any firm
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14 or health care provider under contract to the State and Education
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15 Employees Group Insurance Board, the Oklahoma State Employees
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16 Benefits Council, or the Oklahoma Employees Insurance and Benefits
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17 Board, or any benefit program under its jurisdiction, for any goods
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18 or services whatsoever. Any physician member of the Board shall not
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19 be subject to the provisions of this subsection.
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20 J. Any vacancy occurring on the Board shall be filled for the
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21 unexpired term of office in the same manner as provided for in
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22 subsection D of this section.
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 1 K. The Board shall act in accordance with the provisions of the
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2 Oklahoma Open Meeting Act, the Oklahoma Open Records Act and the
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3 Administrative Procedures Act.
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4 L. The Administrative Director of the Courts shall designate
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5 grievance panel members as shall be necessary. The members of the
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6 grievance panel shall consist of two attorneys licensed to practice
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7 law in this state and one state-licensed health care professional or
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8 health care administrator who has at least three (3) years practical
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9 experience, has had or has admitting privileges to a hospital in
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10 this state, has a working knowledge of prescription medication, or
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11 has worked in an administrative capacity at some point in their his
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12 or her career. The state health care professional shall be
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13 appointed by the Governor. At the Governor's discretion, one or
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14 more qualified individuals may also be appointed as an alternate to
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15 serve on the grievance panel in the event the Governor's primary
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16 appointee becomes unable to serve.
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17 M. The Office of Management and Enterprise Services shall have
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18 the following duties, responsibilities and authority with respect to
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19 the administration of the flexible benefits plan authorized pursuant
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20 to the State Employees Flexible Benefits Act:
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21 1. To construe and interpret the plan, and decide all questions
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22 of eligibility in accordance with the Oklahoma State Employees
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23 Benefits Act and 26 U.S.C.A., Section 1 et seq.;
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 1 2. To select those benefits which shall be made available to
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2 participants under the plan, according to the Oklahoma State
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3 Employees Benefits Act, and other applicable laws and rules;
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4 3. To prescribe procedures to be followed by participants in
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5 making elections and filing claims under the plan;
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6 4. Beginning with the plan year which begins on January 1,
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7 2013, to select and contract with one or more providers to offer a
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8 group TRICARE Supplement product to eligible employees who are
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9 eligible TRICARE beneficiaries. Any membership dues required to
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10 participate in a group TRICARE Supplement product offered pursuant
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11 to this paragraph shall be paid by the employee. As used in this
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12 paragraph, "TRICARE" means the Department of Defense health care
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13 program for active duty and retired service members and their
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14 families;
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15 5. To prepare and distribute information communicating and
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16 explaining the plan to participating employers and participants.
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17 Health Maintenance Organizations or other third-party insurance
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18 vendors may be directly or indirectly involved in the distribution
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19 of communicated information to participating state agency employers
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20 and state employee participants subject to the following condition:
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21 the Board shall verify all marketing and communications information
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22 for factual accuracy prior to distribution;
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 1 6. To receive from participating employers and participants
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2 such information as shall be necessary for the proper administration
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3 of the plan, and any of the benefits offered thereunder;
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4 7. To furnish the participating employers and participants such
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5 annual reports with respect to the administration of the plan as are
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6 reasonable and appropriate;
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7 8. To keep reports of benefit elections, claims and
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8 disbursements for claims under the plan;
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9 9. To negotiate for best and final offer through competitive
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10 negotiation with the assistance and through the purchasing
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11 procedures adopted by the Office of Management and Enterprise
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12 Services and contract with federally qualified health maintenance
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13 organizations under the provisions of 42 U.S.C., Section 300e et
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14 seq., or with Health Maintenance Organizations granted a certificate
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15 of authority by the Insurance Commissioner pursuant to the Health
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16 Maintenance Reform Act of 2003 for consideration by participants as
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17 an alternative to the health plans offered by the Oklahoma Employees
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18 Insurance and Benefits Board, and to transfer to the health
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19 maintenance organizations such funds as may be approved for a
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20 participant electing health maintenance organization alternative
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21 services. The Board may also select and contract with a vendor to
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22 offer a point-of-service plan. An HMO may offer coverage through a
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23 point-of-service plan, subject to the guidelines established by the
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24 Board. However, if the Board chooses to offer a point-of-service
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 1 plan, then a vendor that offers both an HMO plan and a point-of-
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2 service plan may choose to offer only its point-of-service plan in
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3 lieu of offering its HMO plan. The Board may, however, renegotiate
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4 rates with successful bidders after contracts have been awarded if
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5 there is an extraordinary circumstance. An extraordinary
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6 circumstance shall be limited to insolvency of a participating
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7 health maintenance organization or point-of-service plan,
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8 dissolution of a participating health maintenance organization or
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9 point-of-service plan or withdrawal of another participating health
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10 maintenance organization or point-of-service plan at any time during
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11 the calendar year. Nothing in this section of law shall be
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12 construed to permit either party to unilaterally alter the terms of
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13 the contract;
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14 10. To retain as confidential information the initial Request
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15 For Proposal offers as well as any subsequent bid offers made by the
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16 health plans prior to final contract awards as a part of the best
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17 and final offer negotiations process for the benefit plan;
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18 11. To promulgate administrative rules for the competitive
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19 negotiation process;
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20 12. To require vendors offering coverage to provide such
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21 enrollment and claims data as is determined by the Board. The Board
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22 shall be authorized to retain as confidential any proprietary
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23 information submitted in response to the Board's Request For
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24 Proposal. Provided, however, that any such information requested by
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 1 the Board from the vendors shall only be subject to the
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2 confidentiality provision of this paragraph if it is clearly
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3 designated in the Request For Proposal as being protected under this
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4 provision. All requested information lacking such a designation in
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5 the Request For Proposal shall be subject to Section 24A.1 et seq.
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6 of Title 51 of the Oklahoma Statutes. From health maintenance
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7 organizations, data provided shall include the current Health Plan
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8 Employer Data and Information Set (HEDIS);
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9 13. To authorize the purchase of any insurance deemed necessary
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10 for providing benefits under the plan including indemnity dental
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11 plans, provided that the only indemnity health plan selected by the
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12 Board shall be the indemnity plan offered by the Board, and to
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13 transfer to the Board such funds as may be approved for a
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14 participant electing a benefit plan offered by the Board. All
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15 indemnity dental plans shall meet or exceed the following
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16 requirements:
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17 a. they shall have a statewide provider network,
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18 b. they shall provide benefits which shall reimburse the
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19 expense for the following types of dental procedures:
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20 (1) diagnostic,
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21 (2) preventative,
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22 (3) restorative,
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23 (4) endodontic,
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24 (5) periodontic,
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 1 (6) prosthodontics,
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2 (7) oral surgery,
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3 (8) dental implants,
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4 (9) dental prosthetics, and
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5 (10) orthodontics, and
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6 c. they shall provide an annual benefit of not less than
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7 One Thousand Five Hundred Dollars ($1,500.00) for all
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8 services other than orthodontic services, and a
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9 lifetime benefit of not less than One Thousand Five
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10 Hundred Dollars ($1,500.00) for orthodontic services;
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11 14. To communicate deferred compensation programs as provided
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12 in Section 1701 of Title 74 of the Oklahoma Statutes this title;
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13 15. To assess and collect reasonable fees from contracted
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14 health maintenance organizations and third-party insurance vendors
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15 to offset the costs of administration;
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16 16. To accept, modify or reject elections under the plan in
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17 accordance with the Oklahoma State Employees Benefits Act and 26
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18 U.S.C.A., Section 1 et seq.;
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19 17. To promulgate election and claim forms to be used by
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20 participants;
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21 18. To adopt rules requiring payment for medical and dental
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22 services and treatment rendered by duly licensed hospitals,
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23 physicians and dentists. Unless the Board has otherwise contracted
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24 with the out-of-state health care provider, the Board shall
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 1 reimburse for medical services and treatment rendered and charged by
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2 an out-of-state health care provider at least at the same percentage
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3 level as the network percentage level of the fee schedule
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4 established by the Oklahoma Employees Insurance and Benefits Board
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5 if the insured employee was referred to the out-of-state health care
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6 provider by a physician or it was an emergency situation and the
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7 out-of-state provider was the closest in proximity to the place of
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8 residence of the employee which offers the type of health care
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9 services needed. For pu