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Insure Oklahoma

Administered by the Oklahoma Health Care Authority, Insure Oklahoma gives Oklahomans who cannot pay for a regular health plan an outlet for affordable health insurance. Those who do not qualify for SoonerCare may be eligible for Insure Oklahoma, as the income limits are higher and allow more residents to apply. Plans are available for employers to offer their workers a low-cost health plan, or to purchase personally if you are uninsured.

This program offers a full set of medical insurance benefits to employees, Oklahoma college students, and other uninsured individuals. As the eligibility guidelines are for income over the Medicaid limits, a monthly premium and copays are required for individuals. Benefits covered through Insure Oklahoma are similar to a private health plan or SoonerCare, and include a limited amount of physician and hospital care, prescriptions, and preventive services.

 

Insure Oklahoma Eligibility

An individual applying for IO must be an Oklahoma resident and U.S. citizen or legal immigrant between age 19 and 64, who has no access to coverage and meets the employment criteria below. Spouses may also qualify if they are unemployed, working full-time for an employer that would qualify for IO but does not offer benefits, or works part-time for any size employer.

  • Works for a business with under 99 employees that does not offer IO Employer-Sponsored Insurance
  • Unemployed and eligible to receive unemployment benefits
  • Disabled with a Federal Ticket to Work certificate
  • Self-employed

If you qualify for SoonerCare, or any other state program such as Family Planning or Breast and Cervical Cancer Program, or a private health insurance plan, you will not be eligible for IO’s Individual Plan.

Uninsured children up to age 19 also may be eligible for Insure Oklahoma if their parent or legal guardian is eligible for IO coverage. The child must be listed on the primary member’s application, and without insurance for at least six months prior to enrollment. Children who already have coverage are subject to a six month waiting period until IO benefits are available, though there are several exceptions.

 

Income Guidelines

The Insure Oklahoma Individual Plan also has income guidelines, which include any qualifying resident with earnings at or below 200 percent of the federal poverty level. These vary based on the size of your household and employment status.

 

 

Covered Services

Benefits vary based on a member’s specific medical needs and age, as more services are available to members under age 19. If there is a service you require, the Insure Oklahoma program is likely to cover it. Not all programs are listed here, though you can get a general idea of what they provide for people with certain medical needs or health conditions. Healthy individuals have access to regular services such as physician care and emergency room visits, if needed. For more information on coverage, call the IO helpline and ask if they cover a certain service you need at 888 365 3742.

The following services are covered for adults:

  • Ambulatory surgery centers
  • Anesthesia
  • Blood work
  • Chelation for heavy metal poisoning
  • Chemotherapy and radiation
  • Clinic services
  • Dental care
  • Diabetes supplies
  • Diagnostic lab and X-ray
  • Dialysis
  • Durable medical equipment and supplies
  • Early & Periodic Screening, Diagnosis and Treatment (not covered for adults)
  • Emergency care
  • Eye care and glasses (not covered for adults)
  • Family planning
  • Federally Qualified Health Centers
  • Hearing aids (not covered for adults)
  • Home health care (not covered for adults)
  • Hospice (not covered for adults)
  • Immunizations
  • Inpatient hospital care
  • Maternity
  • Mammograms
  • MRI, MRA, PET, CT
  • Mental health and substance abuse care
  • Nurse midwife services
  • Oral surgery (does not include wisdom teeth)
  • Orthodontics (not covered for adults)
  • Outpatient hospital care
  • PCP office visits, physician services, preventive care, specialists (limit of 4 per month combined)
  • Prenatal dental care (limited)
  • Physical, occupational, and speech therapy
  • Prescriptions(limited to six per month)
  • Private duty nursing (not covered for adults)
  • Prosthetics (not covered for adults)
  • Smoking cessation (limited to 90 day supply without pre-authorization)
  • Transplants (not covered for adults)
  • Transportation (not covered for adults)
  • Tuberculosis services

 

How to Apply

Insure Oklahoma applicants can fill our a form online or download and print an application. Make sure when you are applying you report all earned and unearned income, list your social security number, and provide other requested information. Paper applications can take up to 30 days to process.

If you qualify for IO, your benefits will begin 45 to 60 days from the date you applied with all requested documentation received by the deadlines given. The IO website provides an enrollment guide to help you through the application process, and an income fact sheet to clarify what income needs to be recorded. You should also select your primary care provider before you begin your application.

Apply Online

Print an Application

 

Resources

Insure Oklahoma

How to Apply

Contact Insure Oklahoma

888-365-3742

P.O. BOX 54200
Oklahoma City, OK 73154-1200
insureoklahoma@hp.com

 

 

Sources:

 

1. Insure Oklahoma. “How do I qualify?” https://www.insureoklahoma.org:444/IOindividuals.aspx?id=3900

2. 2012. Insure Oklahoma. “Insure Oklahoma Member Handbook.” PDF.

3. Insure Oklahoma. “Application Process.” https://www.insureoklahoma.org:444/IOindividuals.aspx?id=3902.

 

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