Oklahoma Health Insurance Risk Pool - Health Insurance for the Uninsurable
Risk Pool Name / Acronym
Oklahoma Health Insurance Risk Pool
Insurance Regulation Establishing Risk Pool
Oklahoma Insurance Department
1995
Oklahoma Health Insurance Risk Pool
The Oklahoma High Risk Pool provides health insurance to Oklahoma residents who have been denied coverage.To be eligible, applicants must have applied for health insurance and been rejected by two carriers because of a health condition and should not have be eligible for group coverage or government programs and should have exhausted COBRA option.
Funding
The risk pool is funded by insurance premiums collected from plan members and subsidized by association members that are assessed for net losses in proportion to their share of the total health insurance premiums received in the state during the year.
Plans Offered
OHRP offers two comprehensive preferred provider plans, Original Plan and Alternate Plan, with a choice of calendar year deductibles.
Plan Benefits
The deductible options for the Original Plan are: $500; $1,500; $2,000; $5,000 and $7,500. Original plan requires you to pay 20% co-insurance for in-network expenses and 40% co-insurance for out-of-network expenses. The out-of-pocket limit is $10,000 after the deductible following which the plan pays 100% of the eligible expenses.
Deductible options for the Alternate Plan are: $1,500; $3,000; $5,000 and $7,500. Alternate plan requires you to pay 40% co-insurance for in-network expenses and 50% co-insurance for out-of-network expenses. The out-of-pocket limit is $10,000 after the deductible following which the plan pays 20% of the eligible expenses.
All of the plans include pharmacy benefits.
Maximum Benefit Limits
The lifetime maximum is $1 million (effective from July 1, 2009).
Eligibility
- You must be a resident of Oklahoma for at least one year
- You must have been rejected by two different insurance companies or you were quoted premiums higher than the premiums offered by the risk pool
- You must not be in prison or a drug or alcohol facility
- You must have one of the specified medical condition
- You must have been accepted for health insurance coverage but are subject to an exclusion of a pre-existing condition or disease, include the policy form that indicates the exclusion of coverage for specific conditions.
- Your individual health insurance has been involuntarily terminated for any other reason than non-payment of premiums.
- If offered the option of continuation coverage under a COBRA continuation provision or under a similar State program, you must have elected such coverage
- You must has exhausted such continuation coverage under such provision or program, if you have elected the continuation coverage.
Enrollment Periods
Applications are accepted at anytime. Upon approval, your coverage will begin on the first day of the month following your approval if it complete prior to the cut-off date.
Premium Payments
Premium rates are determined according to the OHRP plan you select, your age and gender.
Premium Calculations
Oklahoma risk pool premiums are capped at a maximum of 150% of the standard rate that would be charged to residents of Oklahoma that are eligible for standard issue comprehensive health insurance coverage similar in benefits to the plans offered through the risk pool.
Pre-Existing Condition Waiting Periods
Applicants are subject to 12-month pre-existing condition exclusion. However, if you have continuous coverage for the preceding 6 months before the OHRP coverage effective date, and you applied for OHRP coverage within 63 days of the termination of that prior coverage, the pre-existing condition limitation will be waived for that same pre-existing condition only.
Oklahoma Health Insurance High Risk Pool Contact Information
Oklahoma High Risk Pool Administrator
P.O. Box 1090
2015 - 16th Street
Great Bend, KS 67530
Phone: 877-793-6477
Oklahoma High Risk Pool Website
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