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QUALIFIED BENEFIT PLANS


Only Insure Oklahoma-qualified plans will be eligible for the subsidy payments. Qualified benefit plans must meet certain coverage and cost guidelines. Because Insure Oklahoma is for lower-income, working adults, these guidelines help ensure quality coverage remains affordable for employees.

Contact your insurance agent to choose a qualified benefit plan and start the enrollment process. If you don’t have an agent, find one through the Qualified Agent Locator.

At a minimum, qualified benefit plans must have coverage for hospital services, physician’s services, lab and x-ray, pharmacy, and office visits. Co-payments or deductibles cannot exceed the limits described below:

  • An annual out-of-pocket maximum cannot exceed $3,000 per individual. This amount includes any individual, annual deductible amount, except for pharmacy.
  • Office visits cannot require a co-payment exceeding $50 per visit.
  • Annual pharmacy deductibles cannot exceed $500 per individual.

Yes. When changing qualified benefit plans, there is a 30-day processing time. Please plan accordingly so no coverage is lost for subsidy payments.

If rates change, employers must submit the new rates to Insure Oklahoma or subsidies will stop.

Last Modified on Nov 02, 2021
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