The
Oklahoma State and Education Employees Group Insurance Board
For
Plan Year January 1, 2010 through December 31, 2010
Copays for office visits and other services
will increase from $25 to $50.
Preferred Medication – Pharmacy copays are
being increased. For a medication costing $100 or less, you pay up to $30 or
actual cost if less. For a medication costing more than $100, you pay 25% up to
a $60 maximum.
Non-Preferred Medication – Pharmacy copays
are being increased. For a medication costing $100 or less, you pay up to $60
or actual cost if less. For a medication costing more than $120, you pay 50% up
to a $120 maximum.
Brand-name triptans, which are used to treat
migraine headaches, are non-Preferred medications. Sumatriptan, the generic
form for Imitrex, is the Preferred medication in this
category.
The HealthChoice USA Plan is
designed for members who live and work outside of Oklahoma and Arkansas. It
offers members a national provider network and benefits identical to the
HealthChoice High Option Plan.
HealthChoice USA provides
access to the ChoiceCare Network. The ChoiceCare Network is one of the largest
provider networks in the nation, with nearly 450,000 providers and 3,000
facilities.
The premiums are the same for
both current and pre-Medicare former employees.
Member $678.57
Spouse $678.57
Child $226.33
Children $339.31
This plan is only available
to current employees who receive a work assignment outside Oklahoma and
Arkansas for more than 90 consecutive days and to non-Medicare former employees
who live outside Oklahoma and Arkansas.
If you meet the above
requirements, you may enroll in HealthChoice USA during the annual Option
Period or within 30 days of your relocation outside Oklahoma and Arkansas. If
you do not request a change within 30 days of your relocation, you must wait
until the next annual Option Period to change plans.
Upon your relocation to
Oklahoma or Arkansas, you have 30 days to change your plan from HealthChoice
USA to one of the other plans offered through OSEEGIB.
For current employees, your
Insurance/Benefits Coordinator must sign the Option Period Enrollment/Change
Form certifying that you have been assigned to work outside Oklahoma and
Arkansas. HealthChoice has the right to request employer documentation of your
work assignment. You must submit the proper change form to your
Insurance/Benefits Coordinator within 30 days of your relocation.
For pre-Medicare former
employees, you can enroll during the annual Option Period, or by notifying
OSEEGIB in writing within 30 days of your relocation in order to make this
change. In your letter, be sure to include:
Your request to change your benefits to or
from the HealthChoice USA Plan
Your new address
The date of your relocation
To locate a provider who
participates in the ChoiceCare Network:
Visit the ChoiceCare Network online provider
directory at http://www.choicecarenetwork.com/
and select Physician Finder
Call the ChoiceCare Network Monday through
Friday from 8 a.m. to 5 p.m. CT at the number listed in Contact Information at the end of this
document.
Annual deductible: $500 individual / $1,500
family
Office visit copay: $50 (for lab or other
services, the deductible and 20% coinsurance will apply)
Emergency room deductible: $100 (waived if
admitted)
Annual out-of-pocket maximum: $2,800 Network
/ $3,300 non-Network, plus you are responsible for all amounts above the
Allowed Charges when you use a non-Network provider
Scheduled hospital admissions, certain
surgical procedure performed in an outpatient facility, and specific diagnostic
imaging procedures require certification; contact APS HealthCare for
certification at the number listed in Contact
Information at the end of this document
Generic mandate plan
Pharmacy benefits generally cover up to a
34-day supply or 100 units, whichever is greater, not to exceed the FDA
approved ‘usual’ dosing for a 100-day supply and subject to specific quantity
limits
Lifetime maximum pharmacy benefit:
$2,000,000
Preferred Medications:
When the cost of medication is $100 or
less: You pay up to $30 or the actual cost if less
When the cost of medication is more than
$100: You pay 25% up to a $60 maximum
Pharmacy out-of-pocket maximum: $2,500
per person using Preferred products at Network
pharmacies, then the Plan pays 100%
Non-Preferred medications:
When the cost of medication is $100 or
less: You pay up to $60, or the actual cost if less
When the cost of medication is more than
$100: You pay 50% up to a $120 maximum
The pharmacy out-of-pocket maximum does
not apply to non-Preferred medications
You will receive an ID card
imprinted with the ChoiceCare Network logo and the HealthChoice plan
administrator’s contact information. This ID card MUST be presented when using
any of the ChoiceCare Network providers and facilities, otherwise, you will
lose any available discounts and your claims will be paid as non-network.
A searchable text version of
this guide is available on the OSEEGIB website at http://www.sib.ok.gov/ or http://www.healthchoiceok.com. This
Guide is also available in CD format at the Oklahoma Library for the Blind and
Physically Handicapped (OLBPH). Contact the OLBPH at 1-405-521-3314, toll-free
1-800-523-0288, and TDD 1-405-521-4672.
Oklahoma City Area 1-405-416-1800
All Areas 1-800-782-5218
TDD Oklahoma City Area 1-405-416-1525
TDD All Areas 1-800-941-2160
All Areas 1-800-903-8113
TDD All Areas 1-800-825-1230
ChoiceCare Network
All Areas 1-877-877-0715, ext. 4059
TDD All Areas 1-800-941-2160
All Areas 1-800-848-8121
TDD All Areas 1-877-267-6367