Oklahoma’s Employer/Employee Partnership for Insurance Coverage (Insure Oklahoma/O-EPIC) - PowerPoint PPT Presentation

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Oklahoma’s Employer/Employee Partnership for Insurance Coverage (Insure Oklahoma/O-EPIC) PowerPoint Presentation
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Oklahoma’s Employer/Employee Partnership for Insurance Coverage (Insure Oklahoma/O-EPIC)

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  1. Oklahoma’s Employer/Employee Partnership for Insurance Coverage (Insure Oklahoma/O-EPIC) www.insureoklahoma.org 1-888-365-3742

  2. What is Insure Oklahoma? Provides Premium Assistance Targets Low-Income Uninsured Adults Dedicated Funding Source

  3. Insure Oklahoma Two Different Strategies Targets Low-Income Uninsured Adults Dedicated Funding Source Individual Plan (IP) Employer Sponsored Insurance (ESI)

  4. 99 or fewer employees Business located in Oklahoma Offer a Qualified Health Plan Contribute 25% of employee premium Qualified Employer Provides Premium Assistance Targets Low-Income Uninsured Adults Dedicated Funding Source

  5. Must cover hospital, physician, lab, X-ray and pharmacy services Maximum out-of-pocket $3,000 Maximum office visit co-pay $50 Maximum pharmacy annual deductible $500 Qualified Health Plan


  6. Qualified Employee Meet income and program guidelines Primary must be ages 19 through 64 Contribute 15% of monthly premium Targets Low-Income Uninsured Adults Dedicated Funding Source

  7. Income Levels

  8. Who Qualifies? Qualified Spouses Qualified Children Qualified College Students

  9. Qualified Spouses 99 or fewer employees Provides Premium Assistance Targets Low-Income Uninsured Adults If 23 or less hours may work for any size employer Dedicated Funding Source No Medicaid or Medicare

  10. Qualified Children Ages 0-18 Household income 186-200% of FPL Provides Premium Assistance Targets Low-Income Uninsured Adults Dedicated Funding Source Legal guardian must be approved with IO Change form or new application

  11. Qualified College Students Ages 19 through 22 Must attend an accredited college full time in Oklahoma Must supply FAFSA Must supply school schedule Provides Premium Assistance Targets Low-Income Uninsured Adults Dedicated Funding Source

  12. Example of Contributions EMPLOYEE DEPENDENT(S)

  13. Employer Enrollment Process Application/Contract Staff Listing Final Rate Schedule EFT Form

  14. PIN Letter Employee Enrollment Process Insure Oklahoma application Social Security Numbers Report all income/ household information

  15. Employer Payments Health plan invoice to TPA Electronic deposit to employer Employer forwards total amount to the carrier

  16. Renewal Employer Employee • Automatic renewal every twelve months • Change health plans • Tied to employer • Change employers • Change health plans/event

  17. Individual Plan (IP) The Individual Plan is a health coverage option for qualified Oklahomans

  18. Example of IP Medical Card 123456789

  19. Example--New Medical Card 123456789

  20. Who Qualifies? Working adults without access to Insure Oklahoma ESI Temporarily unemployed adults Working adults with a disability Individual Plan (IP)

  21. Meet income and program guidelines Primary must be ages 19 through 64 Premiums based on sliding scale of income IP Qualifications

  22. Income Levels

  23. Income Levels * For Self-employed households we require your most recent tax return, including all schedules (Schedule C, Schedule F, etc). If you are apply as self-employed, please send all of your recent tax documents. For more information please call 1-888-365-3742 or refer to our income fact sheet found at www.insureoklahoma.org

  24. Individual Plan (IP) Who Qualifies Continued? Qualified Spouses Qualified Children Qualified College Students

  25. Qualified Spouses 99 or fewer employees Provides Premium Assistance Targets Low-Income Uninsured Adults If 23 or less hours may work for any size employer Dedicated Funding Source No Medicaid or Medicare

  26. Qualified Children Ages 0-18 Household income 186-200% of FPL Provides Premium Assistance Targets Low-Income Uninsured Adults Dedicated Funding Source Legal guardian must be approved with IO Change form or new application

  27. Qualified College Students Ages 19 through 22 Must attend an accredited college full time in Oklahoma Must supply FAFSA Must supply school schedule Provides Premium Assistance Targets Low-Income Uninsured Adults Dedicated Funding Source

  28. Premiums • Monthly premium is based on annual household income • Sliding scale • Premiums range • $0-$119.00 • No more than 4%

  29. Office Visits - $10 Hospital Inpatient - $50 / Outpatient $25 ER - $30 (waived if admitted) Pharmacy - $5 Generic / $10 Brand Co-payments

  30. $15,000 DME annually $1 million lifetime maximum Some services are not covered Some limitations Please refer to the member handbook for a complete listing

  31. Questions For more information: • Visit our web site at: www.insureoklahoma.org • Call the helpline at: 1-888-365-3742

  32. Oklahoma’s Employer/Employee Partnership for Insurance Coverage (O-EPIC) www.insureoklahoma.org 1-888-365-3742