Tips for Individuals and Employer Groups:
- To lower your premium, consider a plan with a smaller network or higher deductible and out-of-pocket maximum.
- If you have children in college, check to see what student plans are available to them.
- Consider a High Deductible Health Plan and Health Savings Account option. Click here for more information on HSAs.
Tips for Individuals:
- Check to see if you qualify for a subsidy to help pay part of your individual insurance premium http://kff.org/interactive/subsidy-calculator/. If you qualify, contact our Life and Health Department to set up an appointment to enroll in an on-exchange plan.
- Consider joining your or your spouse’s employer-sponsored plan. Compare the premium and coverage offered to your current plan, to see if it makes sense to change.
- Consider an employer-group plan. As long as there are two people in your entity, you might qualify for a group plan. These two people can both be owners, or one owner and one employee (part-time employees may meet this requirement). Even if only one of you needs coverage, the group will meet participation requirements if the other waives coverage due to having coverage elsewhere.
The typical requirements for starting a group plan are:
- Proof of entity and ownership, such as articles of organization
- Proof of employees on payroll, such as OESC quarterly wage and tax reports or payroll stubs
- 75% participation of eligible employees
- 50% employer contribution to employee portion of premium
The benefits of a group plan are:
- More enrollment flexibility: You can start a new group plan at any time of year.
- Premiums are tax deductible as an employee benefit.
- In Oklahoma, there are more carriers, networks and plan options available to employer groups.
- In most cases, the premiums are lower for employer group coverage than individual coverage.
- Most group plans are subject to a minimum 50% employer contribution and 75% participation requirement. However, we can help you set up a group plan with these requirements waived during a special enrollment period between November 1 and December 15. Contact us for more information and to see if your company is eligible.
- Please be aware that offering affordable coverage to employees receiving a subsidy may disqualify them for future subsidies.
- The Insure Oklahoma Individual Plan might be an affordable option for self-employed individuals, part-time workers, individuals receiving unemployment benefits, and students age 19-22 attending an accredited college in Oklahoma, who meet IO’s Income Guidelines
Tips for Employer Groups:
- Group: Employers with fewer than 250 employees, some of whom likely meet the Employer-Sponsored Income Guidelines, may want to consider applying for a qualified plan through Insure Oklahoma. When the employer contributes at least 25% of the employee premium for a qualified plan, and the employee is responsible for no more than 15% of the premium, Insure Oklahoma subsidizes the remaining amount. Contact us for more information about this program.
- Offer multiple plans, and base your contribution on the lowest cost option. Employees can pay the premium difference if they want to buy up to higher level plans.