The Oklahoma Employeremployee Partnership for Insurance Coverage 11212020

The Oklahoma Employer/employee Partnership for Insurance Coverage 11/21/2020 1

Today's Agenda ¡ Oklahoma’s Uninsured ¡ Background ¡ Overview of O-EPIC program Employer Sponsored Insurance l Individual Plan l ¡ Questions and answers 11/21/2020 2

Who Are Oklahoma's Uninsured? Working Adults Small OK Businesses Limited Access 11/21/2020 3

B A C K G R O U N D 11/21/2020 Governor’s Initiatives Tobacco Tax 50, 000 -70, 000 4

Why O-EPIC? Many Oklahomans cannot afford health coverage. O-EPIC can help! 11/21/2020 5

O-EPIC Two Different Strategies Employer Sponsored Insurance (ESI) 11/21/2020 Individual Plan (IP) 6

Employer Sponsored Insurance (ESI) Qualified Employee/ Spouse Qualified Employer Qualified Commercial Health Plan 11/21/2020 7

Qualified Employer 50 or fewer full time employees Business located in Oklahoma Offer an O-EPIC Qualified Health Plan Contribute 25% of employee premium 11/21/2020 8

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 11/21/2020 9

Qualified Employee/Spouse Meet O-EPIC income and program guidelines Ages 19 through 64 Contribute 15% of monthly premium Note: Children may be eligible for coverage under Sooner. Care 11/21/2020 10

Initial 2007 O-EPIC Income Levels 11/21/2020 Family Size Annual Household Income 1 $18, 888. 50 2 $25, 326. 50 3 $31, 764. 50 4 $38, 202. 50 5 $44, 640. 50 6 $51, 078. 50 11

Updated Income Levels With Employment Allowance Yearly Family Size Single Income Double Income Family (one person Family working) (two people working) 11/21/2020 1 $ 21, 769 $ - 2 $ 28, 207 $ 31, 087 3 $ 34, 645 $ 37, 525 4 $ 41, 083 $ 43, 963 5 $ 47, 521 $ 50, 401 6 $ 53, 959 $ 56, 839 12

Who Contributes What? Employee 25% 60% 15% Spouse 85% 11/21/2020 13

Example of Premium Contributions Family of four: (husband, wife, two children) Annual household income: ($34, 000 annually or $2833. 33 monthly) Employer Sponsored Ins Premium: ( Individual $332/ with spouse $721) Payer Individual Spouse Total Employer Share $83 0 $83 Employee Share $42. 50 $85 O-EPIC Subsidy $206. 50 $346. 50 $553 Premium Totals $332 $389 $721 11/21/2020 14

Employer Enrollment Process Staff Listing O-EPIC Application /Contract EFT Form Final Rate Schedule 11/21/2020 15

Employee Enrollment Process PIN Letter O-EPIC application 11/21/2020 Report all income/ household information Social Security Numbers 16

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 11/21/2020 17

Renewal Employer • Automatic renewal every twelve months • Change health plans 11/21/2020 Employee • Tied to employer • Change employers • Change health plans/event 18

Summary of ESI 50 or fewer full-time employees Qualified Health Plan Employer 25% of monthly premium Employee 15% of monthly premium 11/21/2020 19

Individual Plan (IP) The Individual Plan is a health insurance option for qualified Oklahomans ¡ Available to working Oklahomans not otherwise eligible to participate in an O-EPIC employer sponsored Qualified Health Plan ¡ 11/21/2020 20

Who Qualifies? O-EPIC IP Working adults without access to O -EPIC ESI Temporarily unemployed adults Working adults with a disability (self-employed) 11/21/2020 21

IP Qualifications Meet O-EPIC income levels Meet program guidelines Ages 19 through 64 Sliding scale of income 11/21/2020 22

Initial 2007 O-EPIC Income Levels 11/21/2020 Family Size Annual Household Income 1 $18, 888. 50 2 $25, 326. 50 3 $31, 764. 50 4 $38, 202. 50 5 $44, 640. 50 6 $51, 078. 50 23

Updated Income Levels With Employment Allowance Yearly Family Size 11/21/2020 Single Income Family (one person working) Double Income Family (two people working) - 1 $ 21, 769 $ 28, 207 $ 31, 087 3 $ 34, 645 $ 37, 525 4 $ 41, 083 $ 43, 963 5 $ 47, 521 $ 50, 401 6 $ 53, 959 $ 56, 839 24

Premiums ¡ Monthly premium is based on annual household income ¡ Sliding scale $0 -51. 39 for an individual l $0 -68. 91 for a couple l 11/21/2020 25

Example of IP Medical Card 11/21/2020 26

Co-payments Office visit $10 Hospital $25 OP/ $50 IP/ $30 ER waived if admitted Pharmacy $5 generic/ $10 brand All services must be medical necessary /PCP 11/21/2020 27

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 11/21/2020 28

Summary of IP For those not eligible for ESI Monthly premium Co-payments Some limitations 11/21/2020 29

Questions ¡ For more information: Visit our web site at www. oepic. us l Call the O-EPIC Helpline at 1 -888 -365 -3742 l Contact: ¡ Melissa Pratt 405 -522 -7333 l Melissa. pratt@okhca. org ¡ Dene’ Alford 405 -522 -7243 l Dene. alford@okhca. org l 11/21/2020 30