1. Oklahoma’s Employer/Employee Partnership for Insurance Coverage (Insure Oklahoma/O-EPIC) www.insureoklahoma.org 1-888-365-3742

2. What is Insure Oklahoma? Provides Premium Assistance Targets Low- Income Uninsured Adults Dedicated Funding Source

3. Employer Sponsored Insurance (ESI) Targets Low-Income Uninsured Adults Dedicated Funding Source Individual Plan (IP) Two Different Strategies Insure Oklahoma

4. Provides Premium Assistance Targets Low-Income Uninsured Adults Dedicated Funding Source Qualified Employer 99 or fewer employees Business located in Oklahoma Offer a Qualified Health Plan Contribute 25% of employee premium

5. Must cover hospital, physician, lab, X-ray andpharmacy services Maximum out-of-pocket $3,000 Maximum office visit co-pay $50 Maximum pharmacy annual deductible $500 Qualified Health Plan

6. Targets Low-Income Uninsured Adults Dedicated Funding Source Meet income and program guidelines Primary must be ages 19 through 64 Contribute 15% of monthly premium Qualified Employee

7. With Employment Allowance Yearly Family Size Single Income Family (one worker household) Double Income Family (two worker household) 1 $ 24,660$ - 2 $ 32,300 $ 35,180 3 $ 39,940 $ 42,820 4 $ 47,580 $ 50,460 5 $55,220 $ 58,100 6 $ 62,860 $ 65,740 Income Levels

8. Qualified Spouses Qualified Children Who Qualifies? Qualified College Students

9. Provides Premium Assistance Targets Low-Income Uninsured Adults Dedicated Funding Source Qualified Spouses 99 or fewer employees If 23 or less hours may work for any size employer No Medicaid or Medicare

10. Provides Premium Assistance Targets Low-Income Uninsured Adults Dedicated Funding Source Qualified Children Ages 0-18 Household income 186-200% of FPL Change form or new application Legal guardian must be approved with IO

11. Provides Premium Assistance Targets Low-Income Uninsured Adults Dedicated Funding Source Qualified College Students Ages 19 through 22 Must attend an accredited college full time in Oklahoma Must supply FAFSA Must supply school schedule

12. Example of Contributions DEPENDENT(S) EMPLOYEE

13. Final Rate Schedule EFT Form Staff Listing Application/ Contract Employer Enrollment Process

14. PIN Letter Insure Oklahoma application Report all income/ household information Social Security Numbers Employee Enrollment Process

15. Health plan invoice to TPA Electronic deposit to employer Employer forwards total amount to the carrier Employer Payments

16. Renewal Tied to employer Change employers Change health plans/event Automatic renewal every twelve months Change health plans EmployerEmployee

17. Individual Plan (IP) The Individual Plan is a health coverage option for qualified Oklahomans

18. Example of IP Medical Card 123456789

19. Example--New Medical Card 123456789

20. Working adults without access to Insure Oklahoma ESI Temporarily unemployed adults Working adults with a disability Who Qualifies? Individual Plan (IP)

21. Meet income and program guidelines Primary must be ages 19 through 64 Premiums based on sliding scale of income IP Qualifications

22. Income Levels With Employment Allowance Yearly Family Size Single Income Family (one worker household) Double Income Family(two worker household) 1 $ 24,660$ - 2 $ 32,300 $ 35,180 3 $ 39,940 $ 42,820 4 $ 47,580 $ 50,460 5 $ 55,220 $ 58,100 6 $ 62,860 $ 65,740

23. Income Levels Annual Income Family Size Self Employed* & Unemployment Income (Gross) 1$21,780 2$29,420 3$37,060 4$44,700 5$52,340 6$59,980 * For Self-employed households we require your most recent tax return, including all schedules (Schedule C, Schedule F, etc). If you are apply as self-employed, please send all of your recent tax documents. For more information please call 1-888-365-3742 or refer to our income fact sheet found at www.insureoklahoma.orgwww.insureoklahoma.org

24. Qualified Spouses Qualified Children Who Qualifies Continued? Qualified College Students Individual Plan (IP)

25. Provides Premium Assistance Targets Low-Income Uninsured Adults Dedicated Funding Source Qualified Spouses 99 or fewer employees If 23 or less hours may work for any size employer No Medicaid or Medicare

26. Provides Premium Assistance Targets Low-Income Uninsured Adults Dedicated Funding Source Qualified Children Ages 0-18 Household income 186-200% of FPL Change form or new application Legal guardian must be approved with IO

27. Provides Premium Assistance Targets Low-Income Uninsured Adults Dedicated Funding Source Qualified College Students Ages 19 through 22 Must attend an accredited college full time in Oklahoma Must supply FAFSA Must supply school schedule

28. Premiums Monthly premium is based on annual household income Sliding scale –Premiums range –$0-$119.00 No more than 4%

29. Office Visits - $10 Hospital Inpatient - $50 / Outpatient $25 ER - $30 (waived if admitted) Pharmacy - $5 Generic / $10 Brand Co-payments

30. Some limitations $15,000 DME annually $1 million lifetime maximum Some services are not covered Please refer to the member handbook for a complete listing

31. Questions For more information: Visit our web site at: www.insureoklahoma.org Call the helpline at: 1-888-365-3742

32. Oklahoma’s Employer/Employee Partnership for Insurance Coverage (O-EPIC) www.insureoklahoma.org 1-888-365-3742