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

Oklahoma’s Employer/Employee Partnership for Insurance Coverage (O-EPIC). www.insureoklahoma.org 1-888-365-3742. What, Why, Who Background Overview of Insure Oklahoma program Employer Sponsored Insurance Individual Plan. Today's Agenda. Provides Premium Assistance.

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

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

  2. What, Why, Who Background Overview of Insure Oklahoma program Employer Sponsored Insurance Individual Plan Today's Agenda Provides Premium Assistance Targets Low-Income Uninsured Adults Dedicated Funding Source

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

  4. Why Insure Oklahoma Many Oklahomans cannot afford health coverage. Insure Oklahoma can help! Provides Premium Assistance Targets Low-Income Uninsured Adults Dedicated Funding Source

  5. Who Are Oklahoma's Uninsured? Working Adults Small OK Businesses Provides Premium Assistance Targets Low-Income Uninsured Adults Dedicated Funding Source Limited Access

  6. Governor’s Initiatives B A C K G R O U N D Tobacco Tax Provides Premium Assistance 50,000-70,000

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

  8. Qualified Employee/ Spouse Qualified Commercial Health Plan Employer Sponsored Insurance (ESI) Qualified Employer Provides Premium Assistance Targets Low-Income Uninsured Adults Dedicated Funding Source

  9. 50 or fewer full-time 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

  10. 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

  11. Advantage Health Plans Trust-MEWA, Financial Institutions Only Aetna Health, Inc. Allied National Companies (GTL) BlueCross BlueShield Community Care Coventry Health Care Federated Mutual Insurance Company First Health Life and Health Insurance Plan John Alden Life Insurance Co Nippon Life Insurance Company of America Oklahoma Lumbermen’s Association Oklahoma Municipal Assurance Group/OMAG Oklahoma Press Association/MEBT Oklahoma State Medical Association PacifiCare Principal Financial Group Time Insurance Trustmark Life Insurance Company Union Security Insurance United Healthcare Qualified Carriers

  12. Meet income and program guidelines Ages 19 through 64 Contribute 15% of monthly premium Employee Qualifications Targets Low-Income Uninsured Adults Dedicated Funding Source

  13. Income Levels

  14. Example of Contributions

  15. Example of Premium Contributions Family of four:(husband, wife, two children) Employer Sponsored Ins Premium: ( Individual $275/ with spouse $555)

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

  17. PIN Letter Insure Oklahoma/O-EPIC application Social Security Numbers Report all income/ household information Employee Enrollment Process

  18. Employer Payments Health plan invoice to TPA Electronic deposit to employer Employer forwards total amount to the carrier Employees may be eligible for reimbursement of certain out-of-pocket expenses, up to $900

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

  20. 50 or fewer full-time employees Qualified Health Plan Employer 25% of monthly premium Employee 15% of monthly premium Summary of ESI

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

  22. Example of IP Medical Card

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

  24. Meet income and program guidelines Ages 19 through 64 Premiums based on sliding scale of income IP Qualifications

  25. Note: Self employed individuals are not eligible for the employment allowance-please call 1-888-365-3742 for details Income Levels

  26. Premiums • Monthly premium is based on annual household income • Sliding scale • $0-51.39 for an individual • $0-68.91 for a couple

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

  28. $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

  29. 45-60 days until effective date Forward premium to TPA Application Process Individual applies No deductible, or medical underwriting and guaranteed issue

  30. For those not eligible for ESI Monthly premium Co-payments Some limitations Summary of IP

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

  32. Questions Contact: • Melissa Pratt 405-522-7333 • Melissa.pratt@okhca.org • Mari Kaufman 405-522-7098 • Mari.Kafman@okhca.org

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

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