How Am I Protected?

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 In Oklahoma, as in many other states, your health insurance options are somewhat dependent on your health status.  Even if you are sick, however the laws protect you in the following ways.

  • Coverage under your group health plan (if your employer offers one) cannot be denied or limited, nor can you be required to pay more, because of your health status. This is called nondiscrimination.
  • All group health plans in Oklahoma must limit exclusion of pre-existing conditions. There are rules about what counts as a pre-existing condition and how long you must wait before a new group health plan will begin to pay for care for that condition. Generally, if you join a new group health plan, your old coverage will be credited toward the pre-existing condition exclusion period, provided you did not have a long break in coverage. If you join a fully insured group HMO, no pre-existing condition exclusion period is allowed.
  • Your health insurance cannot be canceled because you get sick. Most health insurance is guaranteed renewable.
  • If you leave your job, you may be able to remain in your old group health plan for a certain length of time. This is called COBRA continuation coverage. It can help when you are between jobs or waiting for a new health plan to cover your pre-existing condition. There are limits on what you can be charged for this coverage.
  • If your fully insured group health insurance is terminated, you will be able to remain covered for 30 days, or possibly longer, depending on your health status. This is due to an Oklahoma extension of coverage law. This law does not apply to health maintenance organizations (HMOs).
  • If you lose your group health insurance and meet other qualifications, you will be HIPAA eligible. If so, you can buy an individual health insurance policy from the Oklahoma Health Insurance High Risk Pool (High Risk Pool). You will not face a new pre-existing condition exclusion period. There are limits on what you can be charged for a High Risk Pool policy.
  • If you have had difficulty obtaining affordable individual health insurance because of your health condition, you may also be eligible for High Risk Pool coverage. In this case you may face a new pre-existing condition exclusion period. There are limits on what you can be charged for a High Risk Pool policy.
  • If you are a small employer buying a group health plan, you cannot be turned down because of the health status, age, or any factor that might predict the use of health services of those in your group. All health plans for small employers must be sold on a guaranteed issue basis. In addition, there are limits on how much you can be charged for a small group health plan.
  • If you have low or modest household income, you may be eligible for free or subsidized health coverage for yourself or members of your family. The Oklahoma Medicaid program (SoonerCare) offers free or subsidized health coverage for pregnant women, families with children, elderly and disabled individuals with very low incomes.
  • If you believe you may be at risk for breast or cervical cancer but are uninsured or underinsured, you may be eligible for screening and treatment. The Take Charge program provides free cancer screening for qualified residents. Some women with abnormal screening results may be eligible for medical care through Medicaid.
  • If you lost your health insurance and are receiving benefits from the Trade Adjustment Assistance (TAA) Program, you may be eligible for a federal income tax credit to help you pay for new health coverage. This credit is called the Health Coverage Tax Credit (HCTC), and is equal to 65% of the cost of qualified coverage, including COBRA and health insurance purchased through the High Risk Pool.
  • If you are a retiree aged 55-65 and receiving benefits from Pension Benefit Guaranty Corporation (PBGC), then you may be eligible for the HCTC.


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