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

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

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

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

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

Provides Premium Assistance Tobacco Tax 50,000-70,000 Governor’s Initiatives BACKGROUNDBACKGROUND

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 Employer Sponsored Insurance (ESI) Qualified Employee/ Spouse Qualified Employee/ Spouse Qualified Commercial Health Plan Qualified Commercial Health Plan Qualified Employer

Provides Premium Assistance Targets Low-Income Uninsured Adults Dedicated Funding Source Qualified Employer 50 or fewer full-time employees Business located in Oklahoma Offer a Qualified Health Plan Contribute 25% of employee premium

Must cover hospital, physician, lab, X-ray andpharmacy services Maximum out-of-pocket $3,000 Maximum office visit co-pay $50 Maximum pharmacy annual deductible $500 Qualified Health Plan

–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

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

With Employment Allowance Yearly Family Size Single Income Family (one worker household) Double Income Family(two worker household) 1 $ 23,680$ - 2 $ 30,880 $ 33,760 3 $ 38,080 $ 40,960 4 $ 45,280 $ 48,160 5 $52,480 $ 55,360 6 $ 59,680 $ 62,560 Income Levels

Example of Contributions

Family of four: (husband, wife, two children) Employer Sponsored Ins Premium: ( Individual $275/ with spouse $555) PayerIndividualSpouseTotal Employer Share$ Employee Share$41.25$42$83.25 Insure Oklahoma/ O-EPIC Subsidy$165$238$403 Premium Totals$275$280$555 Example of Premium Contributions

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

PIN Letter Insure Oklahoma/O -EPIC 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 Employees may be eligible for reimbursement of certain out-of-pocket expenses, up to $900 Employer Payments

Renewal Tied to employer Change employers Change health plans/event Automatic renewal every twelve months Change health plans EmployerEmployee

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

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

Example of IP Medical Card

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 Ages 19 through 64 Premiums based on sliding scale of income IP Qualifications

With Employment Allowance Yearly Family Size Single Income Family (one worker household) Double Income Family(two worker household) 1 $ 23,680$ - 2 $ 30,880 $ 33,760 3 $ 38,080 $ 40,960 4 $ 45,280 $ 48,160 5 $52,480 $ 55,360 6 $ 59,680 $ 62,560 Income Levels Note: Self employed individuals are not eligible for the employment allowance-please call for details

Premiums Monthly premium is based on annual household income Sliding scale –$ for an individual –$ for a couple

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

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

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

Questions For more information: Visit our web site at: Call the helpline at:

Questions Contact: Melissa Pratt Mari Kaufman

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