Individuals

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Insure Oklahoma Individual Plan

Individual Plan is a premium assistance program under Insure Oklahoma. This program provides health care to adults ages 19-64. Each qualifying member enrolls with a primary care provider that provides or otherwise assures the provision of medically necessary primary care and case management services for making specialty care referrals. The primary care provider receives a monthly care coordination payment for members enrolled on the provider panel in accordance with the following schedule:



Rate Category Age Case Management Fee
Male/Female <1 $3.00
Male/Female 1 $3.00
Male/Female 2-5 $3.00
Male/Female 6-14 $3.00
Male/Female 15-20 $3.00
Male/Female 21-44 $3.00
Male/Female 45+ $3.00



Primary Care Providers may be physicians, advanced practice registered nurses, physician assistants, federally qualified health centers, rural health clinics, clinics, and Indian Health Service, Tribal or Urban Indian Clinics. Payments for health care services are reimbursed on a Fee-For-Service basis using the Individual Plan fee schedule and cost sharing provisions. I/T/Us are eligible for reimbursement at the Office of Management and Budget rate as outlined in their provider agreement.

For questions about Insure Oklahoma, call 1-888-365-3742.

To become an enrolled primary care provider, review the Insure Oklahoma Individual Plan Primary Care Provider Addendum in the Special Provisions of the applicable contract type with the Oklahoma Health Care Authority, and select Insure Oklahoma under the Managed Care Programs page of your application. To access provider contracts, please use this link:
http://www.okhca.org/providers.aspx?id=105