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Introduction

HealthChoice is a managed health care program providing comprehensive health and dental benefits to over 186,000 state, education and local government employees, former employees, survivors and their covered dependents.

HealthChoice is administered by the Office of Management and Enterprise Services Employees Group Insurance Division (EGID). The HealthChoice plans are a partnership between providers, members and EGID in the delivery of health and dental care services and products that helps control costs, assists in the provision of high-quality health and dental care, and enhances provider-patient relationships. The HealthChoice benefit structure offers financial incentives to encourage plan members to utilize HealthChoice network providers.

EGID provides health and dental care benefits in accordance with the provisions of Oklahoma Statutes, (74 O.S. 2012, §§ 1301, et seq.). The information provided in this manual is a summary of the benefits, conditions, limitations and exclusions of the HealthChoice High, High Alternative, Basic and Basic Alternative health plans, High Deductible Health Plan (HDHP) and the HealthChoice Dental Plan. It should not be considered an all-inclusive listing.

While the HealthChoice Network Provider Manual is a summary only and is not intended to be all-inclusive, its contents should offer providers and their staff vital information regarding the most important aspects of the provider network.

Plan benefits are subject to conditions, limitations and exclusions described and located in Oklahoma Statutes, Administrative Rules, and Administrative Procedures adopted by the plan administrator. You can obtain a copy of the official rules from the office of the Oklahoma Secretary of State. An unofficial copy of the rules is available on the EGID website. On the home page under Resources, select About EGID. Then on this page under Resources, select Administrative Rules.

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