Oklahoma Health Insurance(Original)
Oklahoma is a great state to live in, but unfortunately, the worst in the country when it comes to health
care, according to a report published recently in Newsweek magazine. The state was ranked low
because of its restrictive access to medical coverage, the low quality of health care, and the large
amount of “avoidable hospital use and costs.”
Your Oklahoma health insurance rights:
•Your insurance cannot be cancelled if you fall ill after A pre-existing condition can affect your
coverage has begun. health insurance coverage. If you are
applying for insurance, some health
•You are HIPAA-eligible if you have lost your group health insurance companies may accept you
conditionally by providing a pre-existing
insurance and meet a few other criteria. You will then be condition exclusion period.
able to join Oklahoma’s high-risk pool.
Rights of health insurance carriers in OK: Although the health plan has accepted
you and you are paying your monthly
•Carriers can deny you coverage if you have a medical premiums, you may not have coverage
problem. for any care or services related to your
pre-existing condition. Depending on the
•Insurance companies can set no-limit exclusion periods for policy and your state’s insurance
regulations, this exclusion period can
those with preexisting health conditions. range from six to 18 months.
•Creditable coverage is not available in Oklahoma.
•The state does not limit the costs of policies. Carriers can If you are getting insurance at your job,
depending on your employer and the
also increase costs when you renew your health plan. health plans offered, you may have a pre-
existing exclusion period. However, the
Oklahoma Medical Plans for Families (OK) exclusion period is limited to 12 months
(18 months if you enrolled late in the
Group health plans in Oklahoma are subject to more health plan) and only applies to health
regulations than individual plans, so if you’re looking to conditions for which you sought treatment
take out a policy for your family, you’re in luck. You can in the 6 months before you enrolled in the
choose from group networks, such as HMOs, PPOs, POSs,
and HSAs, or spend more money and purchase an individual
plan more tailored to your needs. Below, some information we’ve gathered to help you decide:
•Nondiscrimination — Group health insurers cannot bar you and your family from taking out a policy on
the basis of a health problem. They also cannot charge you higher rates because of that problem.
•Certain family changes related to marriage, job transition, and children will affect your opportunities
•HMOs in Oklahoma cannot require exclusion periods.
•However, other carriers can impose exclusion periods of up to one year.
•Creditable coverage — If you do not have gaps in coverage of more than 63 days, you will receive
credit toward exclusion periods.
Preexisting Health Conditions and Health Insurance Challenges
Unfortunately, if you have a preexisting condition, it will most likely be very difficult for you to find good
health care plans in Oklahoma. The state has few regulations governing how insurance companies
approach applicants with conditions such as cancer and diabetes. For example:
•State law in Oklahoma does not prohibit a private insurance company from neglecting coverage to any
•Insurance companies can freely apply elimination riders to applicants’ policies, meaning their
preexisting conditions will not be covered under the policy.
•There are no legal policies on how long a preexisting condition exclusion can last. The exclusion period
is based solely on the insurance company.
•In addition, there is no standard definition for a preexisting condition in Oklahoma insurance law,
meaning that insurance companies do not have to apply a standard in determining whether a
preexisting condition exists.
•In Oklahoma, insurance companies can refer to pregnancy as a preexisting condition, and genetic
information cannot be used in determining a condition, without a diagnosis.
•Insurance companies also are not required to credit prior health coverage, no matter how long an
applicant’s previous policy was in place, for a preexisting condition exclusion period.
There is still some hope for those with major medical issues. There are companies in Oklahoma that will
accept preexisting coverage after an exclusion period. Also, it is possible to get temporary coverage for
your preexisting condition during your exclusion period. Just make sure your policy states when the
inclusion period will end, so that you can avoid being charged double premiums.
If you have been turned down or offered a policy with restrictions and reductions, you may qualify for
coverage in the Oklahoma Health Insurance High Risk Pool. The high-risk pool is a need-based, first-
come, first-served organization so not every resident will be granted coverage.
Switching Health Plans in Oklahoma (OK)
Certain big changes in your life, such as a marriage or divorce, getting a new job in Oklahoma or
transitioning between jobs, will make it necessary for you to purchase a new medical plan.
•If you’ve just left your job and are worried about losing your employee health benefits, check to see if
you are eligible for COBRA, which can help you to keep some of those benefits temporarily.
•Oklahoma Extension of Coverage Law— If you lose group health insurance due to changes in your
working or marriage conditions, or for other reasons, you have a 30-day grace period where you will
maintain coverage. This does not, however, apply to HMO plans, and is dependent on health status.
•Certain non-government employers do not follow the same group health insurance regulations, so
check with your employer to see what your benefits are.
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The Affordable Care Act: Immediate Benefits for Oklahoma(Original)
•Small business tax credits. 54,400 small businesses in Oklahoma could be helped by a new small
business tax credit that makes it easier for businesses to provide coverage to their workers and makes
premiums more affordable.1 Small businesses pay, on average, 18 percent more than large businesses
for the same coverage, and health insurance premiums have gone up three times faster than wages in
the past 10 years. This tax credit is just the first step towards bringing those costs down and making
coverage affordable for small businesses.
•Closing the Medicare Part D donut hole. Last year, roughly 49,100 Medicare beneficiaries in Oklahoma
hit the donut hole, or gap in Medicare Part D drug coverage, and received no extra help to defray the
cost of their prescription drugs.2 Medicare beneficiaries in Oklahoma who hit the gap this year will
automatically be mailed a one-time $250 rebate check. These checks will begin to be mailed to
beneficiaries in mid-June and will be mailed monthly throughout the year as new beneficiaries hit the
donut hole. The new law continues to provide additional discounts for seniors on Medicare in the years
ahead and completely closes the donut hole by 2020.
•Support for health coverage for early retirees. An estimated 25,800 people from Oklahoma retired
before they were eligible for Medicare and have health coverage through their former employers.
Unfortunately, the number of firms that provide health coverage to their retirees has decreased over
time.3 Beginning June 1, 2010, a $5 billion temporary early retiree reinsurance program will help
stabilize early retiree coverage and help ensure that firms continue to provide health coverage to their
early retirees. Companies, unions, and state and local governments are eligible for these benefits.
•New consumer protections in the insurance market beginning on or after September 23, 2010.
◦ Insurance companies will no longer be able to place lifetime limits on the coverage they provide,
ensuring that the 1.7 million Oklahoma residents with private insurance coverage never have to worry
about their coverage running out and facing catastrophic out-of-pocket costs.
◦ Insurance companies will be banned from dropping people from coverage when they get sick,
protecting the 142,000 individuals who purchase insurance in the individual market from dishonest
◦ Insurance companies will not be able to exclude children from coverage because of a pre-existing
condition, giving parents across Oklahoma peace of mind.
◦ Insurance plans’ use of annual limits will be tightly regulated to ensure access to needed care. This will
protect the 1.6 million residents of Oklahoma with health insurance from their employer, along with
anyone who signs up with a new insurance plan in Oklahoma.
◦ Health insurers offering new plans will have to develop an appeals process to make it easy for enrollees
to dispute the denial of a medical claim.
◦ Patients’ choice of doctors will be protected by allowing plan members in new plans to pick any
participating primary care provider, prohibiting insurers from requiring prior authorization before a
woman sees an ob-gyn, and ensuring access to emergency care.
•Extending coverage to young adults. Beginning on or after September 23, 2010, plans and issuers that
offer coverage to children on their parents’ policy must allow children to remain on their parents’ policy
until they turn 26, unless the adult child has another offer of job-based coverage in some cases. This
provision will bring relief to roughly 14,500 individuals in Oklahoma who could now have quality
affordable coverage through their parents.4 Some employers and the vast majority of insurers have
agreed to cover adult children immediately.
•Affordable insurance for uninsured with pre-existing conditions. $59.7 million federal dollars are
available to Oklahoma starting July 1 to provide coverage for uninsured residents with pre-existing
medical conditions through a new transitional high-risk pool program, funded entirely by the Federal
government. The program is a bridge to 2014 when Americans will have access to affordable coverage
options in the new health insurance exchanges and insurance companies will be prohibited from
denying coverage to Americans with pre-existing conditions. If states choose not to run the program, the
Federal government will administer the program for those residents.
•Strengthening community health centers. Beginning October 1, 2010, increased funding for Community
Health Centers will help nearly double the number of patients seen by the centers over the next five
years. The funding could not only help the 45 Community Health Centers in Oklahoma but also support
the construction of new centers.
•More doctors where people need them. Beginning October 1, 2010, the Act will provide funding for the
National Health Service Corps ($1.5 billion over five years) for scholarships and loan repayments for
doctors, nurses and other health care providers who work in areas with a shortage of health
professionals. This will help the 15% of Oklahoma’s population who live in an underserved area.
•New Medicaid options for states. For the first time, Oklahoma has the option of Federal Medicaid
funding for coverage for all low-income populations, irrespective of age, disability, or family status.
What the New Health Care Reform Bill Means For People With Pre-Existing
What the Patient Protection and Affordable Care Act says The Patient Protection and
What the Health Care Bill Means For People With Pre- Affordable Care Act(Original)includes
Existing Conditions: immediate changes to the way health insurance
companies do business to protect consumers from
According to the new health car bill, a short summary on discriminatory practices and provide Americans with
pre-existing conditions gives us this: better preventive coverage and the information
they need to make informed decisions about their
In 2010, the bill will provide immediate assistance for health insurance.
patients who are uninsured because of pre-existing
Uninsured Americans with a pre-
conditions. It will also prohibit pre-existing condition
exclusion for children. In 2014, the bill will ban pre-existing existing condition will have access to
condition exclusion for all patients in the U.S. an immediate insurance program to
help them avoid medical bankruptcy
“Insurers will be prohibited from denying coverage or
setting rates based on gender, health status, medical and retirees will have greater
condition, claims experience, genetic information, evidence certainty due to reinsurance
of domestic violence, or other health-related factors,” provisions to help maintain coverage.
according to the summary. “Premiums will vary only by
family structure, geography, actuarial value, tobacco use, New health insurance Exchanges will make coverage
affordable and accessible for individuals and small
participation in a health promotion program, and age (by businesses. Premium tax credits and cost-sharing
not more than three to one). assistance will help those who need assistance.
”The Patient Protection and Affordable Care Act will ensure
Insurance companies will be barred
that ALL Americans have access to quality, affordable
health care and will create the transformation within the from discriminating based on pre-
health care system necessary to contain costs". existing conditions, health status, and
Coverage Denied: How the Current Health
Insurance System Leaves Millions
In 45 states across the country, insurance companies can discriminate against people based on their pre-
existing conditions when they try to purchase health insurance directly from insurance companies in the
individual insurance market.4 Insurers can deny them coverage, charge higher premiums, and/or refuse
to cover that particular medical condition.
High-risk pools, which have been used by states to cover the “medically uninsurable,” do not work.
Thirty-five states offer a high-risk pool for people who have been denied coverage in the individual
insurance market or otherwise cannot obtain insurance. However, high-risk pools generally charge
significantly higher rates than they charge for a healthy individual in the individual insurance market,14
meaning that only relatively high-income people can afford the coverage. One study estimated that only
eight percent of the uninsurable population is able to enroll in high-risk pools, mainly because of high
Benefits through a high-risk pool are also not guaranteed. Some state high-risk pools have annual caps
on enrollment, or limit eligibility only to people who had prior group health coverage in the preceding
63 days. And one state high-risk pool has been closed to new beneficiaries since 1991.16
All high-risk pools also impose pre-existing condition exclusions for six months to one year, during which
time care for the very condition that made someone uninsurable is not covered.17
Health Insurance Reform Will Provide Stability and Security for All Americans
Under health insurance reform, insurance companies will be prohibited from refusing coverage
because of someone’s medical history or health risk.
Insurance companies will be required to renew any policy as long as the policyholder pays their
premium in full. Insurance companies will not be allowed to refuse renewal because someone became
And insurance companies will be prohibited from dropping or watering down insurance coverage for
those who are or become ill.