Employer FAQ

What is a premium assistance subsidy?

Premium Assistance is a mechanism whereby small businesses, employees, and their spouses can obtain health insurance coverage at a more affordable rate. Employers choosing to participate in a premium assistance program reap savings on health insurance premiums provided to their eligible workers. As the name implies, assistance in the form of a monetary subsidy is provided to be used towards health insurance premiums.

How will premium assistance benefit my business?

  • Decreases the cost of health insurance coverage for the employer
  • Makes it more affordable for employees to pay for health insurance
  • Improves a company's business reputation by investing in employee benefits
  • Helps attract and retain valued employees - improves morale
  • Makes health insurance more accessible to all eligible employees

How does it work?

There are 2 general scenarios under which eligible, working families and their employers might participate in the premium assistance program:

  • 1. Employer already offers coverage. About 40 percent of Oklahoma small business employees do not participate in the coverage offered by their employer. This is largely due to their share of health insurance costs increasing faster than wage increases. Under this scenario qualified employees and their spouses will be eligible for a subsidy that can only be used to purchase health insurance offered by the participating employer.
    2. Employer does not offer coverage. Through the State Planning Grant we have surveyed several employers with 50 or fewer employees who have indicated an interest in offering a health plan to their employees but cannot afford to do so. With premium assistance subsidies, participating employers may purchase commercial health insurance through the private market on behalf of their eligible employees and their spouses.
  • Note: Children are not eligible for Insure Oklahoma, but may be covered under SoonerCare. Please visit http://www.okhca.org/client/client.asp or contact your local county OKDHS office for more information about SoonerCare.

Is my business eligible?

Businesses that employ 99 or fewer employees are eligible for Insure Oklahoma. If a company has multiple locations or subsidiaries under the same FEIN, the total of all its employees will be used to determine if the employer is eligible to participate in the program.

Employers must either be currently offering a qualified health plan, or at the contracting stage with a qualified health plan. Businesses not currently offering a qualified health plan must be far enough down the road of researching what health plan(s) they will offer to indicate their selection on their Insure Oklahoma application.

Employers must be Oklahoma companies whose insurance plans meet the minimum HIFA requirements (hospital, physician, lab and pharmacy services). Eligible employers must offer a health plan that meets program participation requirements. Participating small businesses will contribute at least 25 percent of the employee’s premium. Employees will contribute no more than 15 percent of their family’s premium (up to a 3 percent cap of gross income). The premium assistance subsidy will cover remaining premium costs.

 

Are my employees eligible?

Any employee, regardless of time status (full-time, part-time, etc), who is eligible for employer-sponsored insurance is eligible to apply. For employees and their spouses, the premium assistance program will initially be open to Oklahoma residents with household incomes of less than 200 percent of the federal poverty level (FPL). The 2009 schedule of family size and income breakdown is as follows:

2009 Gross Annual Household Income Guidelines

This 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 did not qualify for O-EPIC in the past, please encourage them to re-apply.

For families larger than 8 add $6,438 to the maximum income for each additional member.

How will the subsidy work?

Employee has a family of four: husband, wife, two children (children may be covered under the SoonerCare program).

The employer receives the Employee eligible letter indicating:

Applicant Name: John Smith

Health Plan Choice: H00000 Oklahoma Care

Spouse Name: Mary Smith

Health Plan Choice: H00000 Oklahoma Care

Effective on 11/01/2007 through 10/31/2008

Employee Premium Share Amount: $85.00

Employer Premium Share Amount: $83.00

State/Federal Subsidy Amount: $553.00

This example assumes:

Annual household income: $37,000
Oklahoma Care monthly premiums are: $420 for the employee, $450 for the spouse / $870 for employee & spouse.

Insure Oklahoma will calculate the following:

Payer

Employee

Spouse

Total

Employer

$83.00

$0.00

$83.00

Employee

$46.50

$46.50

$85.00

Insure Oklahoma

$206.50

$346.50

$553.00

Totals

$332.00

$389.00

$721.00

The employer share is 25 percent of the employee premium rate of $332 or $83. The employee share is 15 percent of $721, or $108.15. Since the $108.15 exceeds 3 percent of the employee family income, the employee share is capped at the 3 percent figure of $85.

The Insure Oklahoma subsidy equals the remaining balance of $553.

 

What administrative requirements will be placed on my business?

Once a year the employer is required to provide the Insure Oklahoma program with benefit and plan information on the application as well as an EFT form, voided check, contract, OES-3 report, employee listing form and final rate schedule. An annual renewal application is required for continued employer eligibility. Employees and their spouses are responsible for their own premium assistance applications and eligibility determinations. Each month the employer must send a copy of their most recent health plan invoice to Insure Oklahoma in order to receive the subsidy. The employer will collect the subsidy on behalf of eligible employees, put it together with the employee and employer share, and pay the insurance company.

Who will get the money?

Each month, premium subsidy payments are made by direct deposit to the employer for all qualified employees and their covered spouse. These payments are to be combined with the employer & employee portions and sent to the insurance companies.

Do I have to contribute to dependent coverage?

Employers will not be required to contribute to dependent coverage.

How long am I eligible?

Employers are eligible for up to a twelve month period.

How do I sign up?

Employers can obtain applications from the Insure Oklahoma website www.insureoklahoma.org or by calling 1-888-3-OK-EPIC (1-888-365-3742) and requesting an enrollment packet.

Is there a time frame I must participate after signing up?

Eligibility periods are for twelve months. Participation will continue as long as premium contributions are made and coverage is provided.

What if I'm currently offering my employees insurance?

You may still participate in the premium assistance program. By completing the application for the program we will determine if your contribution amounts as well as the insurance plan you currently offer meet the minimum HIFA requirements for eligibility.

Are there insurance plan requirements?

Yes. The insurance plan must meet minimum HIFA requirements. At a minimum there must be coverage for hospital services, physician’s services, lab and x-ray, pharmacy, and office visits. If the Health Plan offers co-payments or deductibles, those co-payments or deductibles cannot exceed the limits described below:

  • An annual out of pocket maximum cannot exceed $3,000 per individual. This amount includes any individual, annual deductible amount, except for pharmacy.
  • Office visits cannot require a co-payment exceeding $50 per visit.
  • Annual pharmacy deductibles cannot exceed $500 per individual.
  • A list of health plans qualified for Insure Oklahoma can be found on the website www.insureoklahoma.org under the health plans button.

What are the residency requirements for the program?

Employees and spouses must be Oklahoma residents. Employers must be Oklahoma companies. Employer size is determined at the corporate level, not local level.

What if an employee has multiple employers?

Assuming both employers offer insurance, the employee must choose which employer to receive primary coverage from and indicate this on their premium assistance application. The employee is required to report all employers, regardless of their participation in the program, on the application. If a worker is offered employer sponsored insurance by a participating employer, the worker must participate in the employer sponsored insurance product.

Is there a minimum number of employees that must participate?

There is no minimum number of eligible employees an employer must have before participating in the premium assistance program. Subsidies will be provided for any eligible employee.

What if an employee is currently on Medicaid or Medicare?

If the employee or spouse is currently eligible for participation in Medicaid and/or Medicare they are not eligible for an Insure Oklahoma subsidy.

What if I choose not to participate?

Premium assistance is a voluntary program. Employers choose to take advantage of this benefit.

Is there a waiting period?

If an employer decides to drop insurance coverage, they must wait six months before they can participate in Insure Oklahoma.

What is the Employer Attestation?

The Employer Attestation Employee Citizenship form was first implemented on April 1, 2008. This form is used by an employer to state that, under penalty of perjury and to the best of the employer’s knowledge, all current and future hired employees are either United States citizens or legal aliens residing in the United States for at least five years.

The Employer Attestation form only substitutes for the citizenship requirements asked of each employee. They must still provide proof of identity documentation, such as a copy of their driver’s license or state ID.

The Employer Attestation form does not cover the spouse of an employee. Any employee with approved coverage for their spouse is still required to provide citizenship and identity documentation for their spouse.