Insure Oklahoma still open for business [The Oklahoman, Oklahoma City]

Sept. 22--A: Yes, Insure Oklahoma is still open for business. The state-federal program was founded in 2005 and is administered by the Oklahoma Health Care Authority. It is funded with state tobacco tax revenues matched with federal Medicaid funds. The program has two options available for low-income working Oklahomans: An employer-sponsored plan and a plan for qualified individuals. We recently negotiated a one-year extension of the federal funds that support the program. Some changes are coming to the individual plan but there are no changes to the employer-sponsored plan.

Q: What do participants typically pay?

A: Under the Employer-Sponsored Insurance (ESI) program, businesses can help provide commercial health insurance for their qualified employees. The monthly premium costs are shared by the state and federal Medicaid program (60 percent), the employer (25 percent) and the employee (15 percent).

Under the Individual Plan people who do not have access to commercial health insurance through their employer, including those who are self-employed or may be temporarily unemployed, may buy health care coverage directly through the Oklahoma Health Care Authority. The premium costs are calculated based on the individual's family income. Participants will pay $4 for doctor visits; $4 for generic prescription drugs, $30 for emergency room visits.

Q: How does someone qualify for Insure Oklahoma?

A: One way to participate is to work for a qualified Oklahoma business with 99 or fewer employees through the Employer-Sponsored Insurance program. You also have to be between the ages of 19 and 64 and have a family income at or below 200 percent of the federal poverty level (for example, $47,100 annually for a family of four).

To qualify for the Individual Plan, an employee works for a small business with 99 or fewer employees that is not participating in Insure Oklahoma or they are self-employed or temporarily unemployed. You also must be between 19 and 64 and, as of Jan. 1, have a family income at or below 100 percent of the federal poverty level (for example, $23,550 annually for a family of four).

Q: When is the deadline to buy health insurance for next year?

A: For benefits to take effect Jan. 1 participants in the Employer Sponsored Insurance program must be approved by Dec. 31 and Individual Plan applicants must be approved by Nov. 14. Applications for each program must be received at least two weeks prior to these deadlines. However, we will continue to take applications until the program reaches enrollment capacity of about 35,000 people. There are currently 29,300 people participating.

Q: Will Insure Oklahoma permanently end Dec. 31, 2014?

A: Possibly. Our federal partner, the Centers for Medicare & Medicaid Services, only committed federal funds through 2014. We will work with the OHCA board and state leaders to determine if any viable solutions are available for a long-term extension of Insure Oklahoma.</p>

Q: How do I enroll or find out more?

A: For more information, go to www.insureoklahoma.org or call (888) 365-3742.

PAULA BURKES, BUSINESS WRITER

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