Oklahoma § 74-1307 Specifications - Limitations on benefits - Exceptions.

Oklahoma Statutes

§ 74-1307 — Specifications - Limitations on benefits - Exceptions.

Oklahoma·Title 74 State Government

A.The specifications drawn by the Oklahoma Health Care Authority for the health insurance plan shall provide for comprehensive hospital medical and surgical benefits. The health insurance plan may limit coverage for a particular illness, disease, injury or condition; but, except for such limits, shall not exclude or limit particular services or procedures that can be provided for the diagnosis and treatment of an illness, disease, injury or condition, so long as the services and procedures provided are of sound efficacy, are medically necessary, and fall within the licensed scope of practice of the practitioner providing same. The health insurance plan may contract with providers for specific services based on levels of outcomes defined by the Authority and achieved by the provider. The h

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A. The specifications drawn by the Oklahoma Health Care Authority for the health insurance plan shall provide for comprehensive hospital medical and surgical benefits. The health insurance plan may limit coverage for a particular illness, disease, injury or condition; but, except for such limits, shall not exclude or limit particular services or procedures that can be provided for the diagnosis and treatment of an illness, disease, injury or condition, so long as the services and procedures provided are of sound efficacy, are medically necessary, and fall within the licensed scope of practice of the practitioner providing same. The health insurance plan may contract with providers for specific services based on levels of outcomes defined by the Authority and achieved by the provider. The health insurance plan may provide for the application of deductibles and copayment or coinsurance provisions that are based on contracts with providers for specific services based on levels of outcomes or cost. B. The life insurance plan shall include Accidental Death and Dismemberment Benefits and additional optional life insurance coverage.

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Legislative History

Added by Laws 1967, c. 374, § 7, emerg. eff. May 23, 1967. Amended by Laws 1970, c. 70, § 6, emerg. eff. March 17, 1970; Laws 1977, c. 261, § 6, emerg. eff. June 17, 1977; Laws 1982, c. 333, § 6, emerg. eff. June 1, 1982; Laws 1990, c. 244, § 5, emerg. eff. May 21, 1990; Laws 1991, c. 171, § 1, eff. July 1, 1991; Laws 2011, c. 326, § 1, eff. Nov. 1, 2011; Laws 2012, c. 304, § 941; Laws 2015, c. 58, § 1, eff. Nov. 1, 2015; Laws 2025, c. 379, § 5, eff. Nov. 1, 2025.