Oklahoma SB 515 Summary

• Allows enrollees to pay out-of-pocket for medically necessary health care services covered by their health benefit plan if they negotiate a price lower than the plan's average allowed amount.

• Requires health care providers to accept the negotiated out-of-pocket payment as payment in full and prohibits billing the enrollee or health plan for any remaining balance.

• Requires health insurance carriers to count the full out-of-pocket amount paid by the enrollee toward their deductible and annual maximum out-of-pocket expense if the service is covered and the price was negotiated below the plan's average allowed amount.

• Directs the out-of-pocket cost to be attributed to in-network or out-of-network deductibles and maximum expenses depending on provider network status, and prohibits amounts from exceeding the plan's total annual out-of-pocket limit or carrying over to new plan periods.

• Takes effect November 1, 2025.