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Provider update: December 15, 2020

To: ALL ADvantage Providers

Subject: Co-Pay on SoonerCare Services

Date: December 16, 2020

As a reminder, some SoonerCare services may have a copay in which the Member is responsible.

Below is a link to the OHCA site where you can find the Comparison Chart of SoonerCare Benefits and related co-pay Amounts.

*Note: Now that many DME items are covered under Members’ SoonerCare Benefits, they may be responsible for a co-pay per claim on these items. Please also note all ADvantage Members are covered under the ADvantage Traditional section of the document.

What is Covered?

There are some out-of-pocket cost exemptions for certain population groups, such as individuals receiving hospice care. Those exemptions may also be found on the link above.

Members may also receive a letter from OHCA letting them know their monthly co-pay limit. The limit is based on a percentage of monthly income. This is not an amount the Member will automatically pay, it is the most they would pay for the month. After the limit is met the Member would not be charged any additional copays for the remainder of that month.

Please submit any questions regarding this information through the Provider Question chapter in Harmony.

ADvantage Administration | State Plan Personal Care
Office: 918-933-4900 | CareLine: 800-435-471

Last Modified on Jan 14, 2021
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