| OKLAHOMA EMPLOYER-EMPLOYEE PARTNERSHIP FOR
INSURANCE COVERAGE (O-EPIC) Oklahoma won federal approval in September 2005 for its Employer/Employee Partnership for Insurance Coverage (O-EPIC), a health plan premium assistance demonstration program aimed at addressing the state’s high rate of uninsured persons. Federal endorsement came after two years of work by Governor Brad Henry and the state legislature to pass measures aimed at increasing access to affordable health care coverage, particularly for small businesses and low-income workers. The state expects to enroll between 50,000 to 70,000 Oklahomans in O-EPIC. O-EPIC is open to employers with 25 or fewer workers, including companies that currently offer health insurance. Workers and spouses are eligible if their income is at or below 185 percent of the federal poverty level (FPL).1 Costs are covered by employer/employee contributions, state general fund revenues generated by the tobacco tax, and federal funds. Employers must contribute 25 percent of the monthly premium; employees pay up to 15 percent of the premium, not to exceed 3 percent of household income. Employees also pay applicable deductibles and co-payments, but out-of-pocket annual maximum requirements cannot exceed $3,000. The maximum annual deductible for pharmacy cannot exceed $500; an office visit co-payment cannot exceed $50. An employer’s plan must cover a minimum of hospitalization and physician and pharmacy services. The initiative also includes a Public Product Health Care Plan (state-sponsored insurance) for self-employed persons, unemployed persons currently seeking work, and workers not eligible to participate in their employer’s health plan or whose employer does not offer a group health plan. Another part of the plan offers coverage to low-income workers who are disabled individuals with incomes above Medicaid eligibility but no more than 200 percent of the FPL. Persons in both categories will be able to buy coverage directly from the state when the program becomes available in 2006. The state has appropriated $50 million to O-EPIC, with the state’s subsidy to be matched each year with about $100 million in federal funds. The plan was approved under the federal Health Insurance Flexibility and Accountability Demonstration initiative. The Oklahoma Health Care Authority began taking employer applications for the new program on November 1. Oklahoma has one of the highest rates of uninsured persons in the country 20.4 percent in 2003, compared to a 15.2 percent national rate. O-EPIC is the first phase of a statewide initiative, insureoklahoma, to make health insurance more affordable for persons of low income. 1 For an individual , 185% of the FPL was $17,704 in 2005; for a family of four, $35,797. 1115 Waivers Page |