BULLETIN NO. 2026-05 (Senate Bills 1443 and 1942 (2026 Session))

Disclaimer: The purpose of this bulletin is to inform all health insurers licensed in Oklahoma of specific legislative changes for 2026. The Department’s intent is to help licensees be aware of changes that establish substantive mandates or require implementation changes. This bulletin is not intended to include every legislative change made in 2026. Please refer to the Oklahoma Supreme Court Network (OSCN) webpage to view all changes.

Senate Bill 1443

According to the Act’s title, it is “[a]n Act relating to health benefit plans; defining terms; requiring certain health benefit plans to consider certain factors when determining certain payments for certain services; requiring certain payments to be made in certain situations; providing for codification; and providing an effective date.” 

SB 1443 is a new section of law to be codified at 36 O.S. § 7501 and reads as follows:

1. As used in this act:

a. “Anesthesia services” means the same as defined by the prevailing medical coding and billing standards in the professional medical billing community, including the most recent version of the Current Procedural Terminology (CPT) code books, the Medicare Claims Processing Manual, and American Society of Anesthesiologists guidance;

b. “Base unit” means the value for each anesthesia code that reflects all activities other than anesthesia time including usual preoperative and postoperative visits, the administration of fluids and blood incident to anesthesia care, and monitoring services;

c. “Health benefit plan” means any plan that provides benefits for medical or surgical expenses or disease management incurred as a result of a health condition, accident, or sickness, including an individual, group, blanket, or franchise insurance policy or insurance agreement, a group hospital service contract, or an individual or group evidence of coverage or similar coverage document that is issued by:

i. an insurance company,

ii. a group hospital service corporation,

iii. a health maintenance organization,

iv. an approved nonprofit health corporation,

v. a small employer health benefit plan, or

vi. any other health insurance company whose primary purpose is to provide benefits for medical or surgical expenses as a result of a health condition, accident, sickness, or disease.

2. Health benefit plan does not include a plan offered by a contracted entity that covers Medicaid members under the Ensuring Access to Medicaid Act; and

a. “Physical status modifiers” means classifications set forth in the American Society of Anesthesiologists (ASA) Physical Status Classification System.

3. All health benefit plans shall consider the following factors in determining necessity of services and calculation of benefit payment amounts for anesthesia services:

a. The assessment of patient physical status, including the use of physical status modifiers as determined by a participant’s treating physician or health care provider; and

b. The complexity and urgency of care, as determined by a participant’s treating physician or health care provider.

4. Physical status modifiers shall be paid according to the corresponding base unit values to the treating physician or health care provider if the patient is ranked in one of the three following categories:

a. ASA III: A patient with severe systemic disease. Modifier P3. Base Unit Value 1;

b. ASA IV: A patient with severe systemic disease that is a constant threat to life. Modifier P4. Base Unit Value 2; or

c. ASA V: A moribund patient who is not expected to survive without the operation. Modifier P5. Base Unit Value 3.

SB 1443 becomes effective November 1, 2026.

Senate Bill 1942

According to the Act’s title, it is “[a]n Act relating to dental insurance claims; amending 36 O.S. 2021, Section 7301, which relates to dental plan fee regulation; modifying definition; and providing an effective date.”

SB 1942 is an amended section of law, modifying 36 O.S. § 7301(B)(1)’s definition of “Covered services” to read as follows:

“’Covered services’ means services reimbursed under the applicable subscriber agreement, notwithstanding and without regard to the contractual limitations on subscriber benefits.”

SB 1942 becomes effective November 1, 2026.

Questions concerning this bulletin should be directed to the Oklahoma Insurance Department’s Legal Division at 405-522-8621 or by email to Robin.Murphy@oid.ok.gov.

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