QUALIFIED BENEFIT PLANS
Only Insure Oklahoma-qualified plans will be eligible for the subsidy payments. Qualified benefit plans must meet certain coverage and cost guidelines. Because Insure Oklahoma is for lower-income, working adults, these guidelines help ensure quality coverage remains affordable for employees.
At a minimum, qualified benefit plans must have coverage for hospital services, physician’s services, lab and x-ray, pharmacy, and office visits. 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.
Yes. When changing qualified benefit plans, there is a 30-day processing time. Please plan accordingly so no coverage is lost for subsidy payments.
If rates change, employers must submit the new rates to Insure Oklahoma or subsidies will stop.