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The Employees Group Insurance Division (EGID) is committed to conducting its business activities with integrity and in full compliance with the federal, state and local laws governing its business. This commitment applies to relationships with members, providers, auditors and all public and government bodies. Most importantly, it applies to employees, subcontractors and representatives of EGID. This commitment includes the policy that all such individuals have an obligation to report problems or concerns involving ethical or compliance violations related to its business.
If you suspect that EGID has been defrauded or is being defrauded or that resources have been wasted or abused, report the matter to the EGID Health Care Management Unit immediately. You can report suspicious acts or claims by:
- Sending a report in writing to:
EGID Health Care Management
4345 N. Lincoln Blvd., Ste. 100
Oklahoma City, OK 73105 - Emailing a message to EGID.antifraud@omes.ok.gov.
- Calling the EGID toll-free hotline at 866-381-3815.
- Visiting the EGID Program Integrity Unit in person.
Access the Code of Ethics.
Individuals are encouraged to provide adequate information in order to assist with further investigation of fraud. All investigations will be handled confidentially. Every attempt will be made to ensure the confidentiality of any report, but please remember that confidentiality may not be guaranteed if law enforcement becomes involved. There will be no retaliation against anyone who reports conduct that a reasonable person acting in good faith would have believed to be fraudulent or abusive.
Any employee who violates the non-retaliation policy will be subject to disciplinary action up to and including termination.
Examples of fraud, waste and abuse may include:
- An individual or organization pretends to represent HealthChoice, Medicare and/or Social Security, and asks you for your HealthChoice member ID, Medicare or Social Security number, bank account number, credit card number, money, etc.
- Someone asked you to sell your prescription drug card or the account information on the card.
- Someone asks you to get medications for them using your prescription drug card or prescription coverage.
- You are encouraged to disenroll from your plan.
- You are offered cash or a gift worth more than $15 to sign up for a Medicare prescription drug plan.
- Your pharmacy does not give you all of your medications.
- You are billed for medications or health services that you did not receive.
- You are charged more than once for your insurance premium.
- Your prescription drug plan does not pay for your covered medications.
- You receive a different medication than your doctor ordered.
You can contact EGID at 866-381-3815 to report complaints about one of these types of fraud, waste and abuse issues or a related complaint.
If you have a general question or concern related to your insurance benefits and it is not a potential fraud, waste or abuse issue, please contact HealthChoice at 405-717-8780 or toll-free 800-752-9475. TDD users call 405-949-2281 or toll-free 866-447-0436.
Title 74 Chapter 37 - State and Education Employees Group Insurance Act
| Statute # | Document | File Type |
|---|---|---|
§ 1301 |
Short Title |
|
§ 1302 |
Purpose |
|
§ 1303 |
Definitions |
|
§ 1304 |
Repealed by Laws 2012, HB 3053, c. 303, § 21, eff. November 1, 2012 |
|
§ 1304.1 |
Title 74. State Government |
|
§ 1305 |
Repealed by Laws 2012, HB 3053, c. 303, § 21, eff. November 1, 2012 |
|
§ 1305.1 |
State and Education Employees Group Insurance Board - Discharge of Duties - Investments - Insurance - Quarterly Financial Report |
|
§ 1305.2 |
Fiduciaries - Duties, Powers, and Responsibilities |
|
§ 1306 |
Repealed by Laws 2012, HB 3053, c. 303, § 21, eff. November 1, 2012 |
|
§ 1306.1 |
Right of Subrogation |
|
§ 1306.2 |
Utilization Review Plan - Annual Fee. |
|
§ 1306.3 |
Repealed by Laws 2012, HB 3053, c. 303, § 21, eff. November 1, 2012 |
|
§ 1306.4 |
Repealed by Laws 2012, HB 3053, c. 303, § 21, eff. November 1, 2012 |
|
§ 1306.5 |
Mutual Written Consent Required |
|
§ 1306.6 |
Employment of Necessary Personnel |
|
§ 1307 |
Specifications - Limitations On Benefits - Exceptions |
|
§ 1307.1 |
Right to Change Primary Care Physician |
|
§ 1307.2 |
Coverage for Gestational Diabetes |
|
§ 1307.3 |
Out-of-State Hospitals - Payments for Medical Services |
|
§ 1308 |
Enrollment In Plan |
|
§ 1308.1 |
Insurance Benefits to Education Employees |
|
§ 1308.2 |
Preexisting Condition Exclusion |
|
§ 1308.3 |
Opt-Out Option |
|
§ 1309 |
Dependents |
|
§ 1309.1 |
Coverage of Dependent up to Age Twenty-Five |
|
§ 1310 |
Payment To Funds |
|
§ 1310.1 |
Premiums for Employees of Education Entity |
|
§ 1310.2 |
School District Health Care Premiums - Percentage Paid by District |
|
§ 1311 |
Payroll Deductions |
|
§ 1311.1 |
Monthly Contributions from Persons Drawing Disability Benefits |
|
§ 1311.2 |
Repealed by Laws 2003, HB 1495, c. 8, § 9, emerg. eff. July 1, 2003 |
|
§ 1312 |
Health And Dental Insurance Reserve Fund |
|
§ 1312.1 |
Revolving Fund |
|
§ 1312.2 |
Creation of Life Insurance Reserve Fund - Investment of Funds - Payments to Reserve Fund |
|
§ 1312.3 |
Creation of State Employees Group Insurance Clearing Fund |
|
§ 1313 |
Repealed by Laws 1989, c. 322, § 11, operative July 1, 1989 |
|
§ 1314 |
Officers And Employees Exempt - Options |
|
§ 1314.1 |
Employment Security Commission - System Of Higher Education - Participation - Payroll Deductions |
|
§ 1314.2 |
Terms Defined |
|
§ 1314.3 |
Participation in State Plan - Supplemental Insurance Benefits - Payment of Premiums - Preexisting Condition Limitations |
|
§ 1314.4 |
Provisions for Supplemental Health Insurance |
|
§ 1314.5 |
Supplemental Health Insurance - Competitive Procurement |
|
§ 1315 |
Participation by Political Subdivisions, Local Service Agencies and Public Trusts |
|
§ 1315.1 |
Extension of Benefits to the Secretary of a County Election Board |
|
§ 1316 |
Repealed by Laws 1988, c. 165, § 32, eff. July 1, 1988 |
|
§ 1316.1 |
Retirement Benefits - Continuance |
|
§ 1316.2 |
Continuance of Health and Dental Insurance Benefits - Retired Employees - Dependents of Deceased Employee |
|
§ 1316.3 |
Continuance of Health and Dental Insurance Benefits - Schedule of Maximum Benefits Payable on Behalf of Retired Person - Dependents of Deceased Employee |
|
1317 |
Blind Vending Stand Operators And Managing Operators - Eligibility |
|
1318 |
Maximum for Which Reemployed Ex-Employees May be Insured |
|
1319 |
Maximum for Which Reemployed Ex-Employees May be Insured |
|
§ 1320 |
Employment of Administrator, Director of Internal Audit, Attorneys, Actuaries, Consultants and Other Personnel |
|
§ 1321 |
Determination of Rates and Benefits |
|
§ 1322 |
Confidentiality of Information - Inspection of Files |
|
§ 1323 |
Penalties for Knowingly Making False Statements |
|
§ 1324 |
Coverage for Common Side Affects of Retropubic Prostatectomy Surgery |
|
§ 1325 |
Changes in Reimbursement Rates or Methodology - Hearing |
|
§ 1326 |
Fee Schedules |
|
§ 1327 |
Optometrist's Services |
|
§ 1328 |
State and Education Employees Group Insurance Plan |
|
§ 1329 |
Health Savings Account |
|
1329.1 |
Mutual Accountability Incentive Pilot Program |
|
Title 74 Chapter 37A - State Employees Disability Program Act
| Statute # | Document | File Type |
|---|---|---|
§ 1331 |
Short Title |
|
§ 1332 |
Establishment of Disability Insurance Program for State Employees |
|
§ 1332.1 |
Collections from State Agencies - Deposits - Monthly Statements - Reports - Deduction of Premiums |
|
§ 1332.2 |
Participation in Disability Insurance Program - Retention of Disability Status |
|
§ 1333 |
Creation of State Employees Disability Insurance Reserve Fund - Investments |
|
§ 1305 |
Repealed by Laws 2012, HB 3053, c. 303, § 21, eff. November 1, 2012 |
|
§ 1305.1 |
State and Education Employees Group Insurance Board - Discharge of Duties - Investments - Insurance - Quarterly Financial Report |
|
§ 1334 |
Repealed by Laws 1989, c. 322, § 11, operative July 1, 1989 |
|
§ 1335 |
Participation in Disability Insurance Program |
|
