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Legislation Signed into Law

2020

Primary Focus: Compliance; Reporting
Title/Description: An Act relating to health insurance
Citation: O.S. §§ 6060-10 — 6060-13
Summary: This law requires all in-state health plans to comply with the 2008 federal Mental Health Parity and Addiction Equity Act. Specific provisions include removing exclusion of small employers from the requirement to provide mental health/substance use disorder benefits, and prohibiting health benefit plans from imposing stricter non-quantitative limitations on mental health and substance use disorder benefits than physical benefits. The law also requires insurance companies that offer mental health or substance use disorder plans to submit annual reports demonstrating compliance with the 2008 Mental Health Parity and Addiction Equity Act, including an analysis for each non-quantitative treatment limitation in each classification of care consistent with the six-step process.  Reporting will begin April 1, 2021 and the department will make reports public starting June 1, 2021. The bill also clarifies mental health and substance use disorders to refer to all conditions listed under appropriate diagnostic guides, expanding the definition beyond the previously used “serious mental illness.”
Effective Date: 11/1/20
Notes: N/A

2015-2016

Primary Focus: Mandated Benefit; Provider
Title/Description: Coverage of Autism Spectrum Disorders
Citation: Okla. Stat. 36 § 6060.21
Summary: A health benefit plan and the Oklahoma Employees Health Insurance Plan must provide coverage for the screening, diagnosis and treatment of autism spectrum disorder in individuals less than nine (9) years of age, or if an individual is not diagnosed or treated until after three (3) years of age, coverage shall be provided for at least six (6) years, provided that the individual continually and consistently shows sufficient progress and improvement as determined by the health care provider. Additionally, no insurer can terminate coverage, or refuse to deliver, execute, issue, amend, adjust or renew coverage to an individual solely because the individual is diagnosed with or has received treatment for an autism spectrum disorder.
Effective Date: November 1, 2016
Notes: Enacted by OK. HB 2962.

2009-2010

Primary Focus: Mandated Benefit; Provider & Parity
Title/Description: Insurance Plans to Include Treatment of Severe Mental Illness
Citation: Okla. Stat. 36 § 6060.11
Summary: Any health benefit plan that is offered, issued, or renewed on or after the effective date of this act shall provide benefits for treatment of severe mental illness. Treatment limitations applicable to mental health or substance abuse disorder benefits shall be no more restrictive than the predominant treatment limitations applied to substantially all medical and surgical benefits covered by the plan. There shall be no separate treatment limitations that are applicable only with respect to mental health or substance abuse disorder benefits.
Effective Date: May 10, 2010
Notes: Amended by OK. SB 2054.

Oklahoma Parity Law

There are several sections of the state insurance law about parity. This section contains relevant definitions for the subsequent sections.

This section requires large employer fully insured plans to cover services for the following conditions that are designated as “severe mental illness”:

  • Schizophrenia
  • Bipolar disorder
  • Major depressive disorder
  • Panic disorder
  • Obsessive compulsive disorder
  • Schizoaffective disorder

Plans are not required to cover services for other mental health conditions and substance use disorders, but if they do the coverage must be the same as what is required for “severe mental illness.”

Coverage for severe mental illness, and any other covered behavioral health conditions, must “be equal to” and “no more restrictive” than what is in place for other medical services for the following:

Plans cannot use any treatment limitation for behavioral health services that is not in place for other medical services.

Plans must cover either 26 days of inpatient care or the same inpatient day limit that is used for other medical care, whichever is greater.

This section allows plans to file for an exemption if they can demonstrate that coverage of “severe mental illness” caused premiums to rise by at least 2% over the course of a year.

Common Violations

In seeking care or services, be aware of the common ways parity rights can be violated.

Common Violations

Definition

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