IP Enrollment Process

1. IP Enrollment Process

2. Insure Oklahoma vs. SoonerCare • IO is a limited benefit package. • Applicants are responsible for a monthly premium. Premiums range from $0 - $119.62. • Applicants must pay their co-pays to receive services. • IO does not cover children. • Cannot be enrolled in any other state program. (Medicaid, SoonerCare, Family Planning, BCC) • Coverage is not immediate. (45 – 60 days from application date)

4. Participation Agreement: The Participation Agreement page is required. Please be sure applicants read this carefully and fully understand what they are agreeing to, check the I Agree button and Submit.

5. Determine Application Type • Applicants working for a qualifying employer who does participate in Insure Oklahoma. • Self-employed applicant. • Applicants applying as disabled with a Ticket-to-Work. • Applicants applying as unemployed and receiving/approved for unemployment benefits. • Full time college students.

6. Applicants working for a qualifying non-participating employer.

7. Applicants working for a qualifying non-participating employer • Proof of income is usually taxes, pay-stub or a W-2. • Spouse may be approved for benefits if he or she: • Is not employed, • works full-time for an employer that would qualify but is not participating • part-time, employed by any size employer. • All household members must be listed. • All household income must be reported when applicable.

8. Self-employed applicant

9. Self Employed • Proof of income is usually the 1040 tax return that includes one or more of the following: • Schedule C, • Schedule E. (rents, royalties, etc.), • Schedule F( farming), • K1 (from S-Corp, and partnerships), • Spouse may be approved for benefits if he or she: • is not employed, • works full-time for an employer that would qualify but is not participating • is part-time employed by any size employer. • All household members must be listed. • All household income must be reported when applicable.

10. Applicants applying as disabled with a Ticket-to-Work.

11. Applicants applying as disabled with a Ticket-to-Work. • The applicant is applying as disabled with a Ticket-to-Work. • Proof of income is usually a Pay-Stub or a W-2. • Spouse cannot be approved for benefits. • All household members must be listed. • All household income must be reported when applicable.

12. Applicants applying as unemployed and receiving/approved for unemployment benefits

13. Applicants applying as unemployed and receiving/approved for unemployment benefits • Proof of income is usually a “Monetary Determination of Unemployment Benefits” letter from the OESC. Use the weekly benefit amount listed on the letter. • Spouse may be approved for benefits if he or she: • is not employed, • works full-time for an employer that would qualify but is not participating • is part-time employed by any size employer. • All household members must be listed. • All household income must be reported when applicable.

14. Applicants applying as an independent college student.

15. Applicants applying as an independent college student. • The applicant must be: • an undergraduate between the ages of 19 and 22 • enrolled in a minimum of 12 credit hours • the income of the applicants’ parents is not on their most recentFree Application for Federal Student Aid (FAFSA). A copy of the most recent FAFSA is required to complete the approval process. • The applicant may work for any size employer, full or part-time or not work. • Spouse cannot be approved for benefits. • All household members must be listed. • All household income must be reported when applicable.

16. Applicant Contact Information (page 1 of 8)

17. Applicant Address Information (page 2 of 8)

18. Applicant Citizenship Information (page 3 of 8)See the Proof of citizenship document.

19. Applicant Other Insurance Information (page 4 of 8)

20. Applicant Employment Information (page 5 of 8)

21. Applicant Employment Information • Provide applicant’s employment information. • FEIN is required. This number is found on W-2 or 1099. • If self employed use their SSN. • Include wages. • If the applicant has more than one type of employment, click “add another employer”

22. Clicking add other employment button brings up the following screen.

23. Applicant Health Plan Information (page 6 of 8)

24. PCP’s • The Insure Oklahoma Individual plan requires persons applying for benefits to choose 3 PCPs and list them on the application. • Add PCP ID if chosen already or click “Search for Primary Care Provider”. Define your search.

25. You can copy and paste the ID # in to the application

26. After adding the PCP choices click next page

27. Applicant Other Income Information (page 6 of 8) If you have other types of income click add income. To see the types income to include see the “Income Fact Sheet”

29. Add Household Member Information (page 8 of 8) Clicking add household member brings up the following

30. Use this screen to add a spouse and children. Then click “finish household member”

31. Next, all of the information added to the application can be reviewed and edited

32. Click to sign. • View the status page.

33. Individual Plan: What to Expect Next • After completing application online you will see a status page: • Denied • Pre-approved • If pre-approved a letter will be received. Immediately send required documents: • Taxes, all schedules/pages • Paystubs • W2’s, 1099’s • Letter from OESC (Oklahoma Employment Securities Commission) explaining unemployment benefits (monetary determination letter) • Ticket to work certificate for working disabled- Social Security documentation • College students – FAFSA • A letter will be sent for citizenship and identity documentation: • See Proof of U.S. Citizenship & Identity list for acceptable documentation • All documentation should be sent to: Insure Tulsa 4545 N Lincoln Blvd. Ste 124 Oklahoma City, OK 73105

34. Individual Plan: What to Expect Next (cont.) • Monthly Premiums • Most applicants will be responsible for a monthly premium. Invoices are mailed monthly. • The first letter will contain 2 invoices for the first two (2) months of premiums. • The invoices state the due date. This is always the 5th of the month preceding eligibility start date. • Subsequent payments will always be due by the 5th of the month prior to the benefit month. Payments must be received by the 5th, not post dated. • Late payments are not accepted and will result in application being terminated. • To resume coverage applicant must go through the application process again. • Welcome Packet • ID card, Member hand book, OOP form and TPL forms will be received approximately one (1) week prior to eligibility start date.

35. IP premiums range on a sliding scale between $0 and $119.62. See the chart below for maximum premium amounts.

36. Insure Oklahoma Income Guidelines