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Library: Policy

317:30-5-12. Family planning

Revised 6-25-12

(a) Adults.  Payment is made for the following family planning services:

  • (1) physical examination to determine the general health of the member and most suitable method of contraception;

  • (2) complete general history of the member and pertinent history of immediate family members;

  • (3) laboratory services for the determination of pregnancy,   detection of certain sexually transmitted infections and detection of cancerous or pre-cancerous conditions of the reproductive anatomy;

  • (4) education and counseling regarding issues related to reproduction and contraception;

  • (5) annual supply of chosen contraceptive;

  • (6) insertion and removal of contraceptive devices;

  • (7) vasectomy and Tubal Ligation procedures; and

  • (8) additional visits for members experiencing difficulty with a particular contraceptive method or having concerns related to their reproductive health.

(b) Children.  Payment is made for children as set forth in this Section for adults.  However payment cannot be made for the sterilization of persons under the age of 21. 

(c) SoonerPlan Members.  Non-pregnant women and men ages 19 and older not enrolled in SoonerCare may apply for the SoonerPlan program.  Eligible members receive family planning services set forth in this Section as well as family planning related services (vaccinations for the prevention of certain sexually transmitted infections and male exams).  SoonerPlan eligibility requirements are found at OAC 317:35-7-48.

(d) Individuals eligible for Part B of Medicare.  Payment is made utilizing the Medicaid allowable for comparable services.  Claims for services which are not covered by Medicare should be filed directly with the Fiscal Agent for payment within the scope of the program.

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