Health plans - Oklahoma

Summary of differences between federal and state regulations

Employee health plans are generally covered under the federal jurisdiction of the Employee Retirement Income Security Act (ERISA).

Federal ERISA plans generally do not have to comply with state laws. ERISA rules preempt or block state laws that relate to ERISA plans. State insurance laws, however, do apply. Oklahoma laws include the following provisions:

• Covered practitioners include podiatrists, psychologists, clinical social workers, dentists, and chiropractors.
• Newborns are covered from moment of birth, and coverage includes diagnosed congenital defects and birth abnormalities. It does not matter if the child was born out of wedlock, is not claimed as a dependent on the parent's federal income tax return; or does not reside with the parent or in the insurer's service area. Adopted children are covered from the date of placement.
• Coverage for diabetes equipment, supplies, and related services.
• Immunizations for children up to 18 years old.
• Coverage for dental procedures requiring hospitalization or general anesthesia for dental care for certain minor (eight years old or younger) and severely disabled persons.
• Audiological services and hearing aids for children.
• Coverage for child health supervision services up to age 18.
• Optional prostate cancer screening coverage.
• Colorectal cancer screening coverage for asymptomatic people who are at least 50 years of age; or those less than 50 years of age and at high risk.
• Coverage for wigs or other scalp prostheses.
• Coverage for treatment of severe mental illness for employers with 50 or more employees.
• Services and procedures may be performed at any hospital, home care agency or ambulatory surgical center where a practitioner is authorized to practice.
• If the plan covers prescriptions, the employer cannot require employees or retirees to obtain drugs from a mail order pharmacy as a condition of obtaining the employer's payment for such prescription drugs.
• Plans are prohibited from discriminating against applicants or participants based on genetic information.
• Plans that provide medical and surgical benefits must provide the same coverage and benefits to any individual under the age of 18 who has been diagnosed with an autistic disorder as it would provide coverage and benefits to such an individual who has not been diagnosed with an autistic disorder. (§6060.20)
• Effective November 1, 2016, plans must cover screening, diagnosis, and treatment of autism spectrum disorder in children less than nine years old. Coverage must not be subject to any limits on the number of visits for treatment.

State

Contact

Oklahoma Insurance Department

Regulations

Oklahoma Statutes

Title 36 Insurance

§§36.3203, 36.3634, 36.4511, 36.6055, 36.6051, 36.6056, 36.6058, 36.6060.2, 36.6060.4, 36.6060.6, 36.6060.7, 36.6060.8, 36.6060.6a, 36.6060.9, 36.6060.20.

Federal

Contact

Employee Benefits Security Administration (EBSA)

Regulations

29 CFR chapter XXV (Parts 2509 – 2590)