Oklahomas EmployerEmployee Partnership for Insurance Coverage Insure OklahomaOEPIC

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

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

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

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

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

Income Levels With Employment Allowance Yearly 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 Family Size

Who Qualifies? Qualified Spouses Qualified Children Qualified College Students

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

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

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

Example of Contributions EMPLOYEE DEPENDENT(S)

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

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

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

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

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

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

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

Income Levels With Employment Allowance Family Size Yearly 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

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

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

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

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

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

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. org 1 -888 -365 -3742