Oklahoma Health Insurance Guide
Oklahoma Health Insurance Information, Health Organizations and Resources and access to online health insurance quotes
As an Oklahoma resident you can choose from a variety of private health insurance plans including plans for individuals and group plans provided by an employer. Depending on your income or employment status, you may also be eligible for Oklahoma State-funded affordable health insurance for individuals and families, and federal programs such as Medicaid and COBRA.
Oklahoma is not a guarantee issue state. By law, private insurance companies that sell individual policies must medically underwrite them and are required to sell you an individual health insurance policy if you do not meet their criteria. You can be turned down for any number of reasons including your past or current health and lifestyle habits. In Oklahoma, insurers are permitted unlimited exclusionary and look-back periods for pre-existing conditions. Oklahoma does require an insurer to give you credit for prior creditable coverage. Oklahoma also permits health insurance providers to issue Elimination Riders that exclude coverage for specific health conditions. Premiums, which are not regulated by the state, can be based on your health, your age and lifestyle factors. There is no requirement for insurers to offer individuals standardized policies. Note that there are currently no HMOs offering individual plans in Oklahoma.
Oklahoma is a guarantee issue state for group health plans issued to small businesses. If your Oklahoma health insurance is provided through your employer, your coverage cannot be denied because of your past or current health. Insurance plans other than HMOs can impose a 12-month exclusionary period and a six-month look-back period for pre-existing medical conditions, but must give credit for prior creditable coverage. HMOs, which are not allowed any exclusionary or look-back period in Oklahoma, may impose a two-month waiting period, but you will not be required to pay premiums during that time. Your employer may impose a waiting period for eligibility for new hires, but it must be applied equally to all new hires. Premiums for small group health insurance may be underwritten and the insurer can charge a premium not to exceed 25% of its standard rate if your group has a history of unfavorable health.
Oklahoma is a guaranteed renewal state. Regardless of your health, your insurer must renew your individual health insurance policy as long as you’ve paid your premiums on time and haven’t defrauded the company, or in the case of some HMOs, as long as you haven’t moved out of the service area. However, your premiums can be increased to reflect your current health status. Your policy can be canceled if your insurer discontinues a plan or no longer sells insurance in the state.
Oklahoma Mandated Health Benefits
Oklahoma laws require private health insurance policies to cover several state-mandated benefits. These currently include:
- Ambulance Services
- Bone Mass Measurement
- Breast Reconstruction
- Colorectal Cancer Screening
- Contraceptives
- Dental Anesthesia
- Diabetes Supplies and Self Management
- Emergency Services
- Hair Prostheses
- Hearing Aids
- Mammography
- Mastectomy and Mastectomy Stays
- Maternity and Maternity Stays
- General and Parity Mental Health
- Newborn Sickle-Cell Testing
- Off Label Drug Use
- PKU/Formula
- Prostate Cancer Screening
- Well-Child Care
- Coverage for newborns under their parent’s policy
- Coverage for adopted children under their parent’s policy
- Coverage for continuation dependents under their parent’s policy
- Coverage for continuation/employees
Types Health Insurance Plans Available in Oklahoma
The following major medical health insurance plans are generally available in Oklahoma. Major medical plans cover illness and injury, hospitalization, prescription drugs and office visits, as well as the mandated services stated above.
Indemnity plans - Typically the most flexible and therefore highest priced choice, an indemnity plan lets you select your health providers and facilities. Depending on your plan, you will have to pay a deductible or co-insurance.
Preferred provider organization plans (PPOs) - You select from a network of preferred health care providers and facilities, and receive services at an agreed-upon discounted rate. You also have the option of going outside the network, but typically at a higher cost. You do not need a referral from a primary care physician to see a specialist. Premiums may be less than an indemnity plan but more than an HMO. You will have to pay a deductible or co-insurance.
Health maintenance organizations (HMOs) - HMOs plans require you to select a primary care physician from a prescribed network of providers, who must issue a referral before you can see a specialist. Services and covered costs are typically more comprehensive than those provided by a PPO. HMOs offer the advantage of affordable premiums and low out-of-pocket costs, with an emphasis on preventive care. Non-emergency services out of network are usually not reimbursed.
Point of Service plans (POS) - Similar to a PPO in that you will receive reimbursement for out-of-network care, but with an HMO’s requirement for a primary care physician who must provide referrals to specialists. Premiums, co-pays and co-insurance are typically higher than what you’d pay with an HMO.
Alternative Health Programs in Oklahoma
Oklahoma Health Insurance Risk Pool
OHRP provides low-cost health insurance for residents of Oklahoma who cannot obtain coverage elsewhere. Other eligibility requirements apply. You can choose from two comprehensive PPO plans, Original and Alternate. The Original Plan deductibles range from $500 to $7,500, and require 20% co-insurance for in-network, and 40% for out-of-network services. Out-of-pocket limits are $10,000 after deductible, after which all services are free. Alternate Plan deductibles range from $1,500 to $7,500, with 40% co-insurance for in-network and 50% for out-of-network. Out-of-pocket limits are $10,000, after which the plan pays 20% for eligible services. Both plans include prescription drug benefits. Enrollment is open. Premiums are factored according to your plan, age and sex, but are capped at 150% of standard rates for similar plans sold in the state. There is a 12-month waiting period for a pre-existing condition, which can be waived under certain circumstances, but only for that condition.
Sooner Care
This program provides free or low-cost comprehensive medical services for eligible resident children up to age 19, if their families meet the income requirements. Waiting periods may apply, but can be waived in certain circumstances. There are no premiums or co-payments in most instances. Enrollment, which is open, requires periodic review for renewal.
Regulating Agency
The Oklahoma Insurance Department is responsible for regulating Oklahoma’s health insurance industry.
Get access to Oklahoma health insurance quotes from http://www.einsurance.com/health-insurance.
Oklahoma Insurance Department
PO Box 53408
Oklahoma City, OK 73152-3408
(405) 521-2828 or (800) 522-0071
http://www.ok.gov/oid
Oklahoma Health Insurance High Risk Pool
PO Box 1090
Great Bend, KS 67530
(877) 793-6477
http://www.okhrp.org
Oklahoma Health Care Authority SoonerCare
4545 N Lincoln Blvd, Ste 124
Oklahoma City, OK 73105
(405) 522-7300
http://www.okhca.org/individuals.aspx?id=548
(NAIC) National Association of Insurance Commissioners
The National Association of Insurance Commissioners (NAIC) is the organization of insurance regulators from the 50 states, the District of Columbia and the five U.S. territories. The NAIC provides a forum for the development of uniform policy when uniformity is appropriate. NAIC members are the elected or appointed state government officials who along with their departments and staff regulate the conduct of insurance companies and agents in their respective state or territory.
http://www.naic.org/
Insurance Information Institute (I.I.I)
The mission of the Insurance Information Institute (I.I.I.) is to improve public understanding of insurance -- what it does and how it works.
Contact info:
110 William Street
New York, NY 10038
212-346-5500
http://www.iii.org/