OK SB1048

Insurance carriers are required to offer shared savings incentive programs to enrollees who obtain covered health care services from providers charging less than the average allowed amount.

Shared savings incentives must be at least 25% of the savings generated and can be calculated as a percentage of the difference in allowed amounts, a flat dollar amount, or other Insurance Department-approved methodology.

Enrollees using out-of-network providers must have financial liability capped at in-network deductible, copay, and coinsurance amounts, with coinsurance calculated based on the negotiated amount if less than the average allowed amount.

Insurance carriers must publish comparable health care services and incentive amounts on their websites, notify enrollees annually of program availability, and submit annual reports to the Insurance Department containing participation data and total incentive payments made.

Participation in shared savings incentive programs is voluntary and optional for enrollees; the act becomes effective November 1, 2025.