Oklahoma Health Insurance (OK)

Oklahoma (OK)
Individual Health Insurance Regulations

Learn more about Oklahoma Individual Health Insurance

Oklahoma, like most other states, allows the insurance companies to review your health history in determining if they want to accept you for coverage. This is called medical underwriting. If you have certain pre-existing medical conditions, the insurance company may decline your application or place an elimination rider on your policy that makes them exempt from having to pay claims toward the treatment of that condition. For those that have had prior coverage, the individual health insurance carriers in Oklahoma are not required to recognize prior creditable coverage for pre-existing medical condition exclusionary periods. HMO plans are not permitted to place exclusionary periods on individual health plans, which could explain why there are currently no insurance companies in Oklahoma that offer an HMO plan. Once you are covered on an individual medical insurance policy, your coverage may not be cancelled if you become ill or have excessive claims with your insurance company.

Oklahoma (OK)
Small Group Health Insurance Regulations

Groups of 2-50 employees are guaranteed issue in Oklahoma. This means that groups of this size may not be denied health insurance because of the overall health status of the group or any employee under requesting coverage under the group plan. No individual employee may be denied acceptance on the group plan based on their personal health history. The employer may request a waiting period before a new employee is able to join the group medical plan, but that waiting period must be the same for all new employees. HMO carriers may request that the employer does not permit an employer to join the group HMO plan until that employee has been with the company for at least two months. This is referred to as an HMO affiliation period, which must apply equally to all new employees. This is because HMO plans are not permitted to place an exclusionary period on pre-existing medical conditions, so they require a brief waiting that may encourage the employee to choose a PPO plan, where exclusionary periods are allowable. For any type of health plan, other than an HMO plan, the insurance companies may exclude paying benefits on pre-existing medical conditions for a period of no more than 12 months. If a new member on the group plan has prior creditable coverage, the length of time under that prior health plan must be applied to that exclusionary period. When determining if a treated medical condition is pre-existing, the insurance may look back at the insured member's health history a maximum of 6 months from the date the employee's policy became effective. Insurance companies may charge higher rates to companies that pose a higher health risk, but that maximum allowable rate may not exceed 125% of the standard rate.

Oklahoma COBRA and Continuation Coverage

Federal COBRA regulations apply to any Oklahoma employer that has 20 or more employees. Under federal COBRA, an employee may continue on the group health insurance policy for up to 18 months after termination of employment. Qualified dependents are also eligible for COBRA, and under certain circumstances or qualifying events, may be eligible for up to 36 months of continuation coverage. Oklahoma does not have a mini-COBRA law that applies to companies with fewer than 20 employees. In lieu of this, they have an extension of benefits law that allows employees of smaller companies to remain insured under the group health plan for 30 days after they are terminated from the policy. Under this 30 day extension period, the individual is not required to make a premium payment. However, if there is a medical claim during that 30 day period, the premium amount may be deducted from the amount that the insurance company pays to the health care provider. Extension of coverage may be available for more than 30 days if the qualified person is pregnant or disabled. Conversions plans are available through some insurance carriers in Oklahoma. This allows a person that is leaving a group plan to convert their coverage into an individual health plan. The premiums for this option may be very high, as well as a potential reduction in benefits. For those that lose or exhaust their COBRA coverage, they may apply for coverage under the Oklahoma Health Insurance Risk Pool if they are not eligible for individual health insurance.

Additional Oklahoma Resources

• Oklahoma Health Insurance Risk Pool
  The state's high-risk health pool, providing medical insurance to person's ineligible for individual health insurance.
• Oklahoma Health Care Authority
  Manages the Medicaid program in Oklahoma, as well as other health care programs designed to assist low-income residents in obtaining quality health care.
• Senior Health Insurance Counseling Program
  A non-profit organization assisting Oklahoma residents with questions about Medicare and Medicaid.

OK Medical Insurance Statistics

Total Population: 3,505,000
With Health Insurance: 2,859,000 / 81.6%
Without Health Insurance: 647,000 / 18.4%
*According to 2005 CPS Reports / U.S. Census Bureau

Note: The percentage of Oklahoma residents without health insurance has decreased by 1.5% since 2004. Even with a large improvement in the past year, Oklahoma has one of the highest percentages on uninsured residents in the country.

Oklahoma Insurance Department
Phone: 800-522-0071
Provides assistance to Oklahoma residents in understanding their insurance right and options, as well as enforcing the regulations that protect the consumer.

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