Who is eligible for the Insure Oklahoma/O-EPIC Individual Plan? What are the income guidelines for the Insure Oklahoma/O-EPIC Individual Plan?

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1 Individual FAQ Who is eligible for the Insure Oklahoma/O-EPIC Individual Plan? The Insure Oklahoma/O-EPIC program provides a health coverage option to uninsured adults between years of age whose household is no more than 200% of federal poverty level (FPL), who are not receiving Medicaid or Medicare. The Individual Plan is available to those persons who meet the definition in one of the following groups:1) Working adults who do not qualify for Insure Oklahoma/O-EPIC employer-sponsored Qualified Health Plan, and work for an Oklahoma business with 50 or fewer full-time employees, 2) Temporarily unemployed adults who qualify to receive unemployment benefits through the Oklahoma Employment Security Commission (OESC), 3) Working adults with disability who work for any size employer and have a ticket to work, or 4) Self employed. What are the income guidelines for the Insure Oklahoma/O-EPIC Individual Plan? The income guidelines for the Insure Oklahoma/O-EPIC Individual Plan are based on an applicants annual GROSS household income and family size. Can I get coverage for my spouse and children? Coverage is available for spouses of working and temporarily unemployed adults. Spouses of members with disabilities must apply for membership separately due to income guidelines. For more information call Children are ineligible for enrollment in the Insure Oklahoma/O-EPIC Individual Plan, but may be covered under SoonerCare. Please visit or contact your local county OKDHS office to find out. What if I am on Medicaid or Medicare? Can I also participate in the Insure Oklahoma/O- EPIC Individual Plan? No. If you are currently receiving Medicaid or Medicare, you are not eligible for the Insure Oklahoma/O-EPIC Individual Plan Gross Annual Household Income Guidelines An employment allowance can be up to $240 per month for the employee and also for the spouse (if employed). It will be automatically calculated when the application is submitted. If employees/individuals did not qualify in for Insure Oklahoma/O-EPIC Individual Plan in the past, please encourage them to re-apply.

2 Family Size Annual Income Guidelines Single Income Household Dual Income Household Self Employed* & Unemploymen t Income 1 $ 23,680 $ - $ 20,800 2 $ 30,880 $ 33,760 $ 28,000 3 $ 38,080 $ 40,960 $ 35,200 4 $ 45,280 $ 48,160 $ 42,400 5 $ 52,480 $ $ 49,600 6 $ 59,680 $ 62,560 $ 56,800 7 $ 66,880 $ 69,760 $ 64,000 8 $ 74,080 $ 76,960 $ 71,200 For families larger than 8 members add $6,438 to the maximum income for each additional member. For Self-employed households we require your most recent tax return, including all schedules (Schedule C, Schedule F, etc) If you are applying as self-employed, please send all of your recent tax documents. For more information please call or refer to our income fact sheet found at Will I have to pay for my insurance? Monthly premiums are based on annual household income. Monthly premiums will not exceed four percent of the monthly gross household income. Non-payment of premiums will result in loss of coverage by the Insure Oklahoma/O-EPIC Individual Plan program. What is the policy on late payments? When does an individual get terminated from the plan? Individuals will be required to make a payment for their monthly premium. Each month an individual is sent an invoice for coverage, for the upcoming month. The payment of premium is due by the 5th of the month. If an individual does not make a payment, coverage is terminated. Example of payment: If John applies for the program and is responsible for paying $37.00 a month he will be sent an invoice for the month of January in November. He is responsible for paying the premium of $37.00 by December 5th to insure coverage. What is included in the Insure Oklahoma/O-EPIC Individual Plan benefit package?

3 The Insure Oklahoma/O-EPIC Individual Plan benefit package includes, but is not limited to, office visits, emergency care, inpatient and outpatient hospital benefits, pharmacy, X-rays,

4 maternity care, and durable medical equipment. For a complete list of covered services please see the member handbook.

5 Are individuals with medical conditions or pre-existing conditions eligible for the Insure Oklahoma/O-EPIC plan? Yes. On the Insure Oklahoma/O-EPIC application we don t ask any health or medical related questions. If an individual meets the qualifications for the program they are eligible and they don t pay extra fees if they have what is considered a high risk condition or pre-existing conditions. What happens if I become pregnant while enrolled on the Insure Oklahoma/O-EPIC Individual Plan? Pregnant women and maternity services and care are covered on the Insure Oklahoma/O- EPIC Individual Plan. Are mental health services covered? Yes. For information please refer to the member handbook. Are vision and/or dental care covered? No. Will there be co-payments? Insure Oklahoma/O-EPIC Individual Plan members must pay co-pays for some services. Copays must be paid to the health care providers before the member receives services. Some services that have co-pays include: Office Visits: $10 Pharmacy: $5 Generic Pharmacy: $10 Brand Emergency: $30 (waived if admitted) Hospital Inpatient Stay: $50 Hospital Outpatient Visit: $25