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Oklahoma Health Insurance
Health insurance is the safety net for the physical wellness of your family and the security of your finances. Although, buying appropriate health insurance coverage for your family can be expensive, you must consider all future risks and its influence on your overall financial standing. Nevertheless, more than 47 million Americans are uninsured, majority of whom are the working families. The ever-increasing healthcare costs and the lack of proper health coverage render these families, especially children, helpless to the medical injuries and financial disasters. However, for those families who are not covered by their employers’ health group plan, there are low-priced state sponsored health insurance programs.
In 2008, Oklahoma was ranked at the 43rd spot in the healthiest state list released by the United Health Foundation. The state climbed four places from its 47th position in 2007; however, it was placed on the 44th spot in 2006. Despite strong public funding, the decreasing percentage of children under 18 in poverty and low prevalence of binge drinking, the state continues to deal with increasing pollution levels and high prevalence of smoking. Oklahoma, having the population of more than three million people, offers both private-market and public health insurance alternatives. The private-market health insurance consists of various types of health plans including family, Medicare supplemental, short-term, student, group and dental. Additionally, the state and federal government sponsored programs provide subsidized health coverage to the uninsurable residents of Oklahoma who meet specific eligibility requirements.
The Oklahoma Insurance Department protects the insurance consumers against unfair practices by regulating all kinds of insurance sold through private-market health insurers as well as public health coverage programs. However, nearly 18.5% of the residents remain uninsured as the Oklahoma lawmaker attempt to tackle the issue of limited access to primary care. Approximately, 33.7% uninsured Oklahoma citizens come under the above 200% FPL bracket, according to the Censor Bureau’s 2007 and 2008 Current Population Survey.
Health insurance is a crucial component that you cannot afford to live without. When shopping for health coverage, make sure to get in touch with a licensed health insurance agent/broker to avail the suitable health insurance alternatives.
Individual/Family Health Insurance
Below is the guidelines for applying for and obtaining individual health insurance in the state of Oklahoma. These regulations apply to all insurance companies offering individual or family health insurance in Oklahoma:
| Medical Underwriting | Yes |
Pre-Existing Condition Exclusion Period | No limit |
Look Back Period | No limit |
Look Back Standard | No definition |
Mandatory Benefits | Cancer screening for women including breast cancer screening and cervical cancer screening, IP mastectomy stay of 48 hours, reconstructive surgery after mastectomy, osteoporosis screening |
Market Rate Restrictions | None |
Guaranteed Issue Options | None |
Small Group Health Insurance
Below is the guidelines for small group health insurance in the state of Oklahoma. These regulations apply to all insurance companies offering small group health insurance in Oklahoma:
| Small Group Size | 2-50 |
Employee Qualifications | Two employees must work for at least 6 months out of the year, and work 20 hours per week |
Guaranteed Issue | Yes |
Premium Rating Factors | Rate bands |
Rate Adjustment Factors | 25% |
Look-Back Period | 6 months |
Pre-existing condition exclusionary period | 12 months |
Mandatory Benefits | Same as Individual |
State Cobra Variations for Small Groups
Below are the COBRA guidelines for small groups in the state of Oklahoma. For employer groups of more than 20 employees, refer to the federal COBRA guidelines:
| Mini-Cobra Option | Yes |
Eligible Group Sizes | 2-19 |
Extension of Benefits Period - Standard | 6 months |
Extension of Benefits Period - Disabled | 6 months |
Maximum Premium Increase | 100% |
State Legislation Reference | Oklahoma Statute Title 36, Chapter 1, Article 45 |
Additional Notes |
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State Sponsored Health Insurance Programs
There are several state sponsored health insurance programs in the State of Oklahoma to assist those without insurance in obtaining adequate coverage.
High-Risk Pools
Some states offer special state sponsored health insurance plans for qualified persons that are not eligible for individual health insurance due to pre-existing medical conditions. The guidelines for enrollment in these programs vary by state. The high-risk pool in the State of Oklahoma is summarized in the chart below:
| Plan Name | Oklahoma Health Insurance High Risk Pool (OHRP) |
Website | |
Phone Number | 877-793-6477 |
HIPPA Eligibility Required? | Yes |
Available Carriers | First Health |
Pre-Existing Condition Waiting Period | 12 months |
Enrollment Periods | Open to new enrollment |
Premium Limits | No more than 150% of standard rate |
Lifetime Maximum Benefit | $1 million |
Special Notes | To be eligible, the individual must be a resident of Oklahoma for at least one year and turned down by at least two carriers |
Children’s Health Insurance Program
Through shared funding from the federal government, the State of Oklahoma provides health insurance for uninsured children that meet certain eligibility guidelines. A summary of this program is outlined in the chart below:
| Program Name | SoonerCare |
Website | |
Phone Number | 800-987-7767 |
Apply Online | Yes |
Age Limits | Under 19 |
Insurance Carrier | NA |
Length of Coverage | Subject to Periodic Eligibility Review |
Residency Requirements | Oklahoma residents and U.S. citizen |
Other Eligibility Requirements | To be eligible, the children should not have any other insurance |
Pre-Existing Condition Exclusions | None |
Cost | $0 or minimal share of cost |
Medicaid
Medicaid is a state program partially funded through the federal government. Qualification guidelines, as well as the types of people that are eligible, will vary by state. The chart below provides a summary of the Medicaid programs in the State of Oklahoma.
| Governing Agency | Oklahoma Department of Human Services |
Website | |
Phone Number | 800-987-7767 |
Residency Requirements | Oklahoma resident and U.S. citizen |
Federal Poverty Line Income Limits | Pregnant women and children ages 0-19: 185% FPL |
Additional Resources
Oklahoma Health Care Options Matrix™ Guide
Provided by the Foundation for Health Coverage Education, the guide is a quick reference guide prepared by the non-profit Foundation for Health Coverage Education that outlines Oklahoma’s public and private health care choices for individuals and groups with various demographic profiles.
Family Health Insurance Guide by HealthInsuranceFinders.com
The guide created by HealthInsuranceFinders.com provides useful information regarding health insurance coverage such as individual/family health insurance, group health insurance, separate child health insurance and state-sponsored programs that are available for low to middle income families.
Oklahoma: At-A-Glance
Provides exclusive health data of the Oklahoma state. Statehealthfacts.org, a project of the Henry J. Kaiser Family Foundation, is designed to provide free, up-to-date, and easy-to-use health data on all 50 states.
