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 1-888-365-3742.
Children are ineligible for enrollment in the Insure Oklahoma/O-EPIC Individual Plan, but may be covered under SoonerCare. Please visit the Oklahoma Health Care Authority's Web site or contact your local county OKDHS office to find out.
What are the income guidelines for Insure Oklahoma 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.
What is included in the Insure Oklahoma Individual Plan benefit package?
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, maternity care, and durable medical equipment. For a complete list of covered services please see the member handbook.
Will there be co-payments?
Insure Oklahoma Individual Plan members must pay co-pays for some services. Co-pays must be paid to health care providers before the member receives services. Some services that have co-pays include:
- Office Visit: $10
- Pharmacy: $5 Generic
- Pharmacy: $10 Brand
- Emergency: $30 (waived if admitted)
- Hospital Inpatient Stay: $50
- Hospital Outpatient Visit: $25
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 19-64 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 99 or fewer 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 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.
2008 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.