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Covering IO Member's Children

• Children on IO Brochure 

Do My Children Qualify?

Not all children will qualify for Insure Oklahoma!

To Qualify:

Household income must be between 186 percent and 200 percent of the Federal Poverty Level (FPL) to sign up. A household includes: an applicant, spouse, and/or dependent children living with you and under your legal custody. The parent/legal guardian applicant MUST be qualified and approved for Insure Oklahoma. This means working for an Oklahoma small business and meeting all other qualification requirements.

Insure Oklahoma May Provide Coverage For Your Children Who Are:

• Between the ages of 0 and 19 (through age 18)
• Listed on the application
• Children of the applicant (or applicant has legal custody)
• Not covered by another health plan (private insurance, Medicare, Medicaid, SoonerCare, etc) – Some exceptions apply (see below)

317:45-9-1
(1) Children found to be eligible for SoonerCare may not receive coverage through Insure Oklahoma.
(2) Children are not eligible for Insure Oklahoma if they are a member of a family eligible for employer-sponsored dependent health insurance coverage under any Oklahoma State Employee Health Insurance Plan.
(3) Children who already have coverage through another source must undergo, or be excepted from, a six month uninsured waiting period prior to becoming eligible for Insure Oklahoma. Exceptions to the waiting period may include:
(A) the cost of covering the family under the ESI plan meets or exceeds 10 percent of the annual gross household income. The cost of coverage includes premiums, deductibles, co-insurance, and co-payments;
(B) loss of employment by a parent which made coverage available;
(C) affordable ESI is not available; “affordable” coverage is defined by the OHCA annually using actuarially sound rates established by the Oklahoma State and Education Employee Group Insurance Board (OSEEGIB); or
(D) loss of medical benefits under SoonerCare.

To Apply:

• For new applicants, the subscriber application must indicate the child is requesting coverage.
• For existing approved applicants, a subscriber change form may be used to add children.
• After the subscriber application or subscriber change form is processed, the applicant will be notified of approval or denial, effective coverage dates and changes in their overall costs.
• The earliest effective date for Individual Plan coverage is September 1, 2010. The effective dates for Employer Sponsored Insurance coverage may vary.  See the approval letter for effective coverage dates.
• The applicant is responsible for any increase in their share of the overall costs.
• If the applicant is signed up for Employer Sponsored Insurance (ESI), they must notify the insurance company they want to add their children to their policy. Delay in notifying the carrier will cause a delay in subsidy.

Other Facts You Should Know:

Children may only join the plan that the applicant has chosen. All children in the household have to be treated the same – either they are signed up for Insure Oklahoma or they are not. We cannot enroll only some of the children. For separated or divorced parents, children may be listed on the application of only one parent and counted in that parent’s household. At least 85 percent of the child premium will be covered by Insure Oklahoma. Although health care reform has extended dependent coverage to those under 26 years of age, Insure Oklahoma qualification applies only to children under 19 years, adults age 19 through 64 years, and qualified college students under 23 years.

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