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

www.insureoklahoma.org1-888-365-3742

What is Insure Oklahoma?

Provides Premium

Assistance

Targets Low-Income

Uninsured Adults

Dedicated

Funding Source

Employer Sponsored Insurance

(ESI)

Targets Low-Income Uninsured

Adults

Dedicated Funding Source

Individual Plan (IP)

Two Different Strategies

Insure Oklahoma

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

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

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

  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

Qualified Spouses

Qualified Children

Who Qualifies?

Qualified College Students

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

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

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

Example of Contributions

DEPENDENT(S)

EMPLOYEE

Final Rate

Schedule

Final Rate

Schedule

EFT Form EFT Form

Staff Listing

Application/Contract

Employer Enrollment Process

PIN Letter

Insure Oklahoma

application

Report all income/

household information

Social Security Numbers

Employee Enrollment Process

Health plan

invoice to TPA

Electronic deposit to employer

Employer forwards

total amount to the carrier

Employer Payments

Renewal

•Tied to employer

•Change employers

•Change health plans/event

•Automatic renewal every twelve months

•Change health plans

Employer Employee

Individual Plan (IP)

The Individual Plan is a health coverage option for qualified

Oklahomans

Example of IP Medical Card

123456789

Example--New Medical Card

123456789

Working adults without access

to Insure Oklahoma ESI

Temporarily unemployed

adults

Working adults with a

disability

Who Qualifies?

Individual Plan (IP)

Meet income and

program guidelines

Primary must be ages 19

through 64

Premiums based on

sliding scale of income

IP Qualifications

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  

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

Qualified Spouses

Qualified Children

Who Qualifies Continued?

Qualified College Students

Individual Plan (IP)

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

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

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

Premiums

• Monthly premium is based on annual household income

• Sliding scale– Premiums range– $0-$119.00

• No more than 4%

Office Visits - $10

Hospital Inpatient - $50 / Outpatient $25

ER - $30 (waived if admitted)

Pharmacy - $5 Generic / $10 Brand

Co-payments

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

Questions

For more information:• Visit our web site at:

www.insureoklahoma.org • Call the helpline at:

1-888-365-3742

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

www.insureoklahoma.org1-888-365-3742