Insure Oklahoma helps some pay premiums
Insure Oklahoma helps some pay premiums

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By Mary Steichen

Published: June 19, 2008

Perhaps you are one of the many parents who are giving financial assistance to an adult child. Besides raising grandchildren, many Oklahomans are trying to pay for adult children's medical care. Unfortunately, many of those grown children have no insurance. An individual insurance policy simply isn't possible due to the high premiums and an already stretched budget.

Insure Oklahoma may be an affordable option. In November 2004, the Insure Oklahoma/O-EPIC program was born. Funded by revenues made possible by the passage of State Question 713, the program is designed to be twofold in assisting lower-income employees and self-employed people.

Part One is the O-EPIC Individual Plan. A working adult must meet the low-income guidelines and also fall within one of the following categories. With those criteria met, they will most likely qualify for the O-EPIC individual plan. The three groups are:

•Working adults who are not eligible for an employer-sponsored qualified health plan and who work for an Oklahoma business with 50 or fewer employees.

•Temporarily unemployed adults who are eligible to receive unemployment benefits through the Oklahoma Employment Security Commission.

•Working adults with a disability.

Part Two is the Employer Plan. With this program, employers can be reimbursed as much as 60 percent of the premiums paid toward health insurance for those employees who meet the income guidelines. The reimbursement program for employers requires that the health plan in place at the worksite be one that is approved by the O-EPIC program.

The income guidelines for the O-EPIC program were increased in November, and again in April. So, if you or someone you are assisting did not qualify earlier, you or he may be able to qualify with the higher-income limitations. For instance, a family of three with a single household income now can make up to $38,080 annually. The complete income guideline chart is on the Web site.

A brief summary of the benefits on the Individual O-EPIC (not group) plan follows:

•Cost of plan: Will not exceed 4 percent of monthly household gross income.

•Doctor office: $10 co-pay.

•Generic drugs: $5 co-pay.

•Brand drugs: $10 co-pay.

•Hospital stay: $50 co-pay.

•Providers: Must use a list of network providers, but it is extensive.

•Limits: Office visits and prescriptions have monthly limits.

Children do not qualify for enrollment, as they may be eligible for the state's SoonerCare program. However, spouses of a qualified employee may be eligible through either the individual or employer plans.

For more information, the Insure Oklahoma/O-EPIC Web site, www.insureoklahoma.org, is the best bet. It is user friendly and thorough. It explains in detail the qualifying criteria for employers and individuals. The "Eligibility Wizard” on the site is often helpful for those who are unsure when figuring what their annual income actually is. For instance, alimony and child support may be considered. There is a question-and-answer section. Individuals and employers will find invaluable information and tools. Online applications are included, too.

For those who would rather call or who have questions, the toll-free number is (888) 365-3742 (TDD: 416-6848). The office is open 7:30 a.m. to 5:30 p.m. Monday to Friday, excluding holidays.

Mary Steichen is founder of Insurance Care Associates Inc. Call her at 286-1022 or go online to www.insurancecare.net.

Related Topics: Law, Family Law