oklahoma’s employer/employee partnership for insurance coverage (insure oklahoma/o-epic) ...
TRANSCRIPT
![Page 1: Oklahoma’s Employer/Employee Partnership for Insurance Coverage (Insure Oklahoma/O-EPIC) 1-888-365-3742](https://reader035.vdocument.in/reader035/viewer/2022062806/56649c915503460f9494bc38/html5/thumbnails/1.jpg)
Oklahoma’s Employer/Employee Partnership for Insurance Coverage (Insure Oklahoma/O-EPIC)
www.insureoklahoma.org1-888-365-3742
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What is Insure Oklahoma?
Provides Premium
Assistance
Targets Low-Income
Uninsured Adults
Dedicated
Funding Source
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Employer Sponsored Insurance
(ESI)
Targets Low-Income Uninsured
Adults
Dedicated Funding Source
Individual Plan (IP)
Two Different Strategies
Insure Oklahoma
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Provides Premium
Assistance
Targets Low-Income Uninsured
Adults
Dedicated Funding Source
Qualified Employer
99 or fewer employees
Business located in Oklahoma
Offer a Qualified Health Plan
Contribute 25% of employee premium
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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
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Targets Low-Income Uninsured
Adults
Dedicated Funding Source
Meet income and
program guidelines
Primary must be ages 19
through 64
Contribute 15% of
monthly premium
Qualified Employee
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With Employment Allowance
Yearly
Family Size
Single Income Family (one
worker household)
Double Income Family (two
workerhousehold)
1 $ 24,660 $ -
2 $ 32,300 $ 35,180
3 $ 39,940 $ 42,820
4 $ 47,580 $ 50,460
5 $55,220 $ 58,100
6 $ 62,860 $ 65,740
Income Levels
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Qualified Spouses
Qualified Children
Who Qualifies?
Qualified College Students
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Provides Premium
Assistance
Targets Low-Income Uninsured
Adults
Dedicated Funding Source
Qualified Spouses
99 or fewer employees
If 23 or less hours may work for any size employer
No Medicaid or Medicare
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Provides Premium
Assistance
Targets Low-Income Uninsured
Adults
Dedicated Funding Source
Qualified Children
Ages 0-18
Household income 186-200% of FPL
Change form or new application
Legal guardian must be approved with IO
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Provides Premium
Assistance
Targets Low-Income Uninsured
Adults
Dedicated Funding Source
Qualified College Students
Ages 19 through 22
Must attend an accredited college full time in Oklahoma
Must supply FAFSA
Must supply school schedule
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Example of Contributions
DEPENDENT(S)
EMPLOYEE
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Final Rate
Schedule
Final Rate
Schedule
EFT Form EFT Form
Staff Listing
Application/Contract
Employer Enrollment Process
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PIN Letter
Insure Oklahoma
application
Report all income/
household information
Social Security Numbers
Employee Enrollment Process
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Health plan
invoice to TPA
Electronic deposit to employer
Employer forwards
total amount to the carrier
Employer Payments
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Renewal
•Tied to employer
•Change employers
•Change health plans/event
•Automatic renewal every twelve months
•Change health plans
Employer Employee
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Individual Plan (IP)
The Individual Plan is a health coverage option for qualified
Oklahomans
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Example of IP Medical Card
123456789
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Example--New Medical Card
123456789
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Working adults without access
to Insure Oklahoma ESI
Temporarily unemployed
adults
Working adults with a
disability
Who Qualifies?
Individual Plan (IP)
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Meet income and
program guidelines
Primary must be ages 19
through 64
Premiums based on
sliding scale of income
IP Qualifications
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Income Levels
With Employment Allowance
Yearly
Family Size
Single Income Family (one
worker household)
Double Income Family(two worker
household)
1 $ 24,660 $ -
2 $ 32,300 $ 35,180
3 $ 39,940 $ 42,820
4 $ 47,580 $ 50,460
5 $ 55,220 $ 58,100
6 $ 62,860 $ 65,740
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Income Levels
Annual Income
Family Size
Self Employed* & Unemployment Income (Gross)
1 $21,780
2 $29,420
3 $37,060
4 $44,700
5 $52,340
6 $59,980
* 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
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Qualified Spouses
Qualified Children
Who Qualifies Continued?
Qualified College Students
Individual Plan (IP)
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Provides Premium
Assistance
Targets Low-Income Uninsured
Adults
Dedicated Funding Source
Qualified Spouses
99 or fewer employees
If 23 or less hours may work for any size employer
No Medicaid or Medicare
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Provides Premium
Assistance
Targets Low-Income Uninsured
Adults
Dedicated Funding Source
Qualified Children
Ages 0-18
Household income 186-200% of FPL
Change form or new application
Legal guardian must be approved with IO
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Provides Premium
Assistance
Targets Low-Income Uninsured
Adults
Dedicated Funding Source
Qualified College Students
Ages 19 through 22
Must attend an accredited college full time in Oklahoma
Must supply FAFSA
Must supply school schedule
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Premiums
• Monthly premium is based on annual household income
• Sliding scale– Premiums range– $0-$119.00
• No more than 4%
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Office Visits - $10
Hospital Inpatient - $50 / Outpatient $25
ER - $30 (waived if admitted)
Pharmacy - $5 Generic / $10 Brand
Co-payments
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Some limitations
$15,000 DME
annually
$1 million lifetime
maximum
Some services are not covered
Please refer to the member handbook for a complete listing
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Questions
For more information:• Visit our web site at:
www.insureoklahoma.org • Call the helpline at:
1-888-365-3742
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Oklahoma’s Employer/Employee Partnership for Insurance Coverage (O-EPIC)
www.insureoklahoma.org1-888-365-3742