Transcript Slide 1

IP Enrollment Process
Insure Oklahoma vs. SoonerCare
• IO is a limited benefit package.
• Applicants are responsible for a monthly premium. Premiums range
from $0 - $119.62.
• Applicants must pay their co-pays to receive services.
• IO does not cover children.
• Cannot be enrolled in any other state program. (Medicaid,
SoonerCare, Family Planning, BCC)
• Coverage is not immediate. (45 – 60 days from application date)
Participation Agreement:
The Participation Agreement page is required. Please be sure
applicants read this carefully and fully understand what they are
agreeing to, check the I Agree button and Submit.
Determine Application Type
• Applicants working for a qualifying employer who
does participate in Insure Oklahoma.
• Self-employed applicant.
• Applicants applying as disabled with a Ticket-toWork.
• Applicants applying as unemployed and
receiving/approved for unemployment benefits.
• Full time college students.
Applicants working for a qualifying non-participating employer.
Applicants working for a qualifying nonparticipating employer
• Proof of income is usually taxes, pay-stub or a W-2.
• Spouse may be approved for benefits if he or she:
– Is not employed,
– works full-time for an employer that would qualify but is not
participating
– part-time, employed by any size employer.
• All household members must be listed.
• All household income must be reported when applicable.
Self-employed applicant
Self Employed
• Proof of income is usually the 1040 tax return that includes one or
more of the following:
–
–
–
–
Schedule C,
Schedule E. (rents, royalties, etc.),
Schedule F( farming),
K1 (from S-Corp, and partnerships),
• Spouse may be approved for benefits if he or she:
– is not employed,
– works full-time for an employer that would qualify but is not participating
– is part-time employed by any size employer.
• All household members must be listed.
• All household income must be reported when applicable.
Applicants applying as disabled with a Ticket-to-Work.
Applicants applying as disabled with a
Ticket-to-Work.
• The applicant is applying as disabled with a Ticket-toWork.
• Proof of income is usually a Pay-Stub or a W-2.
• Spouse cannot be approved for benefits.
• All household members must be listed.
• All household income must be reported when applicable.
Applicants applying as unemployed and receiving/approved for
unemployment benefits
Applicants applying as unemployed and
receiving/approved for unemployment benefits
• Proof of income is usually a “Monetary Determination of
Unemployment Benefits” letter from the OESC. Use the
weekly benefit amount listed on the letter.
• Spouse may be approved for benefits if he or she:
– is not employed,
– works full-time for an employer that would qualify but is not
participating
– is part-time employed by any size employer.
• All household members must be listed.
• All household income must be reported when applicable.
Applicants applying as an independent college student.
Applicants applying as an independent college
student.
• The applicant must be:
– an undergraduate between the ages of 19 and 22
– enrolled in a minimum of 12 credit hours
– the income of the applicants’ parents is not on their most recent Free
Application for Federal Student Aid (FAFSA). A copy of the most recent
FAFSA is required to complete the approval process.
• The applicant may work for any size employer, full or part-time or not
work.
• Spouse cannot be approved for benefits.
• All household members must be listed.
• All household income must be reported when applicable.
Applicant Contact Information
(page 1 of 8)
Applicant Address Information (page 2 of 8)
Applicant Citizenship Information (page 3 of 8)
See the Proof of citizenship document.
Applicant Other Insurance Information (page 4 of 8)
Applicant Employment Information (page 5 of 8)
Applicant Employment Information
• Provide applicant’s employment information.
• FEIN is required. This number is found on W-2
or 1099.
• If self employed use their SSN.
• Include wages.
• If the applicant has more than one type of
employment, click “add another employer”
Clicking add other employment button brings up the following screen.
Applicant Health Plan Information (page 6 of 8)
PCP’s
• The Insure Oklahoma Individual plan requires persons
applying for benefits to choose 3 PCPs and list them on
the application.
• Add PCP ID if chosen already or click “Search for
Primary Care Provider”. Define your search.
You can copy and paste the ID # in to the application
After adding the PCP choices click next page
Applicant Other Income Information (page 6 of 8)
If you have other types of income click add income. To see the types
income to include see the “Income Fact Sheet”
Add Household Member Information (page 8 of 8)
Clicking add household member brings up the following
Use this screen to add a spouse and children. Then click “finish household
member”
Next, all of the information added to the application can be reviewed and
edited
• Click to sign.
• View the status page.
Individual Plan:
What to Expect Next
•
After completing application online you will see a status page:
– Denied
– Pre-approved
•
If pre-approved a letter will be received. Immediately send required documents:
–
–
–
–
Taxes, all schedules/pages
Paystubs
W2’s, 1099’s
Letter from OESC (Oklahoma Employment Securities Commission) explaining
unemployment benefits (monetary determination letter)
– Ticket to work certificate for working disabled- Social Security documentation
– College students – FAFSA
•
A letter will be sent for citizenship and identity documentation:
– See Proof of U.S. Citizenship & Identity list for acceptable documentation
•
All documentation should be sent to:
Insure Tulsa
4545 N Lincoln Blvd. Ste 124
Oklahoma City, OK 73105
Individual Plan:
What to Expect Next (cont.)
•
Monthly Premiums
– Most applicants will be responsible for a monthly premium. Invoices are mailed
monthly.
– The first letter will contain 2 invoices for the first two (2) months of premiums.
• The invoices state the due date. This is always the 5th of the month preceding eligibility
start date.
– Subsequent payments will always be due by the 5th of the month prior to the
benefit month. Payments must be received by the 5th, not post dated.
• Late payments are not accepted and will result in application being terminated.
• To resume coverage applicant must go through the application process again.
•
Welcome Packet
– ID card, Member hand book, OOP form and TPL forms will be received
approximately one (1) week prior to eligibility start date.
IP premiums range on a sliding scale between $0 and $119.62. See the
chart below for maximum premium amounts.
Family Size
Monthly IP Maximum
Premium
1
$
59.81
1 person covered
2
$
116.33
2 people covered
3
$
119.62
2 people covered
4
$
119.62
2 people covered
5
$
119.62
2 people covered
6
$
119.62
2 people covered
7
$
119.62
2 people covered
8
$
119.62
2 people covered
9
$
119.62
2 people covered
Insure Oklahoma
Income Guidelines
Annual
Effective: April 2009
Single or two worker
family all self
employed
One worker self
employed and
one employed
1
$
21,660
$
-
$
24,540
$
2
$
29,140
$
32,020
$
32,020
$ 34,900
3
$
36,620
$
39,500
$
39,500
$ 42,380
4
$
44,100
$
46,980
$
46,980
$ 49,860
5
$
51,580
$
54,460
$
54,460
$ 57,340
6
$
59,060
$
61,940
$
61,940
$ 64,820
7
$
66,540
$
69,420
$
69,420
$ 72,300
8
$
74,020
$
76,900
$
76,900
$ 79,780
9
$
81,500
$
84,380
$
84,380
$ 87,260
Family Size
Single worker
family not self
employed
Two worker
family-not self
employed
-