The bill amends Section 7301 of Title 36 of the Oklahoma Statutes, which pertains to dental insurance claims and the regulation of dental plan fees. It modifies the definition of "covered services" by changing the term from "reimbursable" to "reimbursed" and clarifies that these services are provided "notwithstanding and without regard to the contractual limitations on subscriber benefits." This includes removing references to specific limitations such as deductibles and waiting periods. Additionally, the bill defines "dental plan" and "health benefit plan" to ensure clarity in the context of dental services.
Furthermore, the bill mandates that health benefit plans or dental plans must establish and maintain appeal procedures for claims denied due to lack of medical necessity. It requires that any denial of benefits must be based on a determination by a licensed dentist and that written communications regarding such denials must include specific identifying information about the dentist who made the determination. The bill is set to take effect on November 1, 2026.