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Oklahoma High Risk Pool

The Oklahoma Health Insurance High Risk Pool is a special health insurance program created by the state to help those who have been rejected for coverage on the private market. Administered by Blue Cross and Blue Shield of Oklahoma, these health plans work similarly to an individual plan you would buy from BCBSOK or any other carrier in the state. OHRP offer two different plans, the Original Plan and the Alternate Plan.

Each plan provides comprehensive coverage with physician and hospital care and prescription benefits, as well as coverage for the condition which may have disqualified you from receiving regular coverage. Premiums vary, and though the program is not designed to be low-cost, it will likely cost less than an insurer who has increased the rates based on your condition.

 

 

Eligibility

In order to qualify for benefits through the Oklahoma Health Insurance High Risk Pool, you must either have a health condition that has made you uninsurable, exhausted your health benefits, or were quoted premiums over the OHRP rate by a private insurer. Certain individuals may be eligible under HIPAA if they do not meet any of the other criteria. Those who qualify must also be residents of Oklahoma at the time they apply, and plan to stay in the state. Depending on the applicant, eligibility criteria varies. You will not qualify for OHRP if you are eligible for Medicare or Medicaid, or you have access to employer-sponsored coverage. There are no income guidelines for OHRP.

Medical conditions

  • All applicants must have 12 months of state residency; and
  • Proof of rejection from two health insurers; or
  • Quoted a rate over the OHRP rate for a comparable plan; or
  • Accepted for health insurance subject to an underwriting restriction; or
  • Involuntary cancellation of coverage due to a reason other than not paying premiums; and
  • Is not eligible for Medicare Part A or B, Medicaid, or any other health insurance program whether public or private.

Instead of submitting two rejection letters from insurance companies, those with certain medical conditions may provide a letter from their physician in acknowledgment of the applicant’s condition. These conditions range from various types of cancers to liver problems and asthma. Click here for a list of conditions.

 

Federally Defined Eligibility

  • No residency length requirement
  • HasĀ  aggregate creditable coverage of at least 18 months
  • Most recent coverage was through an employer, government plan, church plan, or health insurance included with any such plan
  • Not eligible for Medicare or Medicaid
  • Coverage not terminated due to nonpayment or fraud

 

Federally Defined for FTAA, PBGC, or HCTC

  • No residency length requirement
  • Has aggregate creditable coverage of at least 18 months
  • Most recent coverage was through an employer, government plan, church plan, or health insurance included with any such plan
  • Not eligible for Medicare or Medicaid
  • Coverage not terminated due to nonpayment or fraud
  • Has exhausted COBRA coverage if chosen to use it
  • Eligible for credit for health insurance costs under section 35 of internal revenue code of 1986
  • FTAA: federal trade adjustment assistance under federal trade adjustment assistance reform act of 2002, public law 107-210

 

Benefits

Each plan includes pharmacy benefits, though the coverage is slightly different between the Original Plan and the Alternate Plan. Both connect you with the preferred provider organization Blue Choice from BCBSOK, which is the carrier’s largest network in the state. By choosing in-network care, you save money and have the ability to use any physician, hospital or other medical service provider for the contracted rate. Prescription coverage is managed by MaxCare Prescription Benefit Services.

Original Plan members receive 80 percent coverage after deductible when using Blue Choice providers, and 60 percent for out-of-network care. Members of the Alternate Plan have access to in-network services at 40 percent coinsurance after deductible. All health plans from OHRP cover the following services:

  • Preventive care
  • Physician office visits
  • Diagnostic testing
  • Outpatient surgery, therapies, and treatments
  • Allergy injections
  • Inpatient hospital stays
  • Skilled nursing facility care
  • Home health care
  • Hospice
  • Prescription drug card

 

 

Premiums

Rates for OHRP vary based on the applicant’s age, gender, and use of tobacco, as well as the plan for which they apply. As with a normal health plan, the higher your deductible, the lower your monthly premium. Below are the rate tables for the 2012 enrollment year. Rates cannot exceed a certain amount, and are never determined based on your health condition. Tobacco use is a controllable factor which naturally raises your rates. However, those who use tobacco and do not have access to coverage for themselves and their spouses and children as dependents. Rates for spouses and dependent children are determined separately from the primary member.

Original Plan Rates

 

Alternate Plan Rates

 

How to Apply

Visit the BCBSOK website for OHRP and print an application and attach all necessary documents to your form. Mail your application to the BCBSOK address as indicated on the form. When your application is approved, you must pay your first monthly premium in order to receive your ID card and insurance policy with your schedule of benefits and other plan documents.

Download an Application

Send to:

BCBSOK
PO Box 3283
Tulsa, OK 74102-3283

 

Resources

BCBSOK: Oklahoma Health Insurance High Risk Pool

Contact BCBSOK

877-885-3717

 

 

 

Sources:

 

1. BCBSOK. “Oklahoma Health Insurance High Risk Pool.”http://www.bcbsok.com/ohrp/index.html.

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