Coverage is available to persons who meet the following general requirements:

1. Oklahoma Health Insurance High Risk Pool (OHRP) in conjunction with the State of Oklahoma offers a plan to provide health care benefits for Oklahoma residents who are unable to purchase health insurance or obtain coverage for an existing medical condition, who have exhausted their health insurance benefits, who have been quoted insurance rates more than the OHRP rate, or otherwise qualify under the Health Insurance Portability and Accountability Act (HIPAA).

2. Coverage is available for individuals and families.

3. Two plans are available and each plan has a choice of deductibles. Rate sheets with the deductible options are available on this website.

4. The OHRP program is available to individuals and their dependents who are residents of Oklahoma at the time of application and who remain residents of Oklahoma. Eligibility requirements vary according to the basis upon which application is made.

MEDICAL CONDITION ELIGIBILITY

Eligibility based on a Medical Condition, current premium rate or involuntary termination of an individual health policy. (requires 12 months of residency)

• Applicants must have applied for health insurance and been rejected by two carriers because of a health condition; or
• Applicant must have been quoted a rate more than the OHRP rate for similar coverage; or
• Applicant must have been accepted for health insurance subject to a material or permanent underwriting restriction; or
• Applicant must have had previous individual insurance coverage involuntarily terminated for a reason other than non-payment of premiums; and
• Applicant is not eligible for coverage under a group health plan, Part A or Part B of Title XVIII of the Social Security Act (Medicare) or a State plan under Title XIX of such act (Medicaid) or any other public or private program or successor program that provides or indemnifies for health services, and does not have other health insurance coverage.

Documentation required for medical condition.

One of the following documents showing your name and address proving your 12-month residency must be submitted with the OHRP application.

Documentation must be at least 12 months old prior to making your application.

• Oklahoma Driver's License; or
• Recent Oklahoma tax return proving 12-month residency; or
• Twelve-month-old utility bill showing current Oklahoma address; or
• Twelve-month-old cancelled check showing current Oklahoma address

Applicants must also provide the following documentation to prove eligibility.

• If you have been diagnosed with one of the conditions identified on the current conditions list, a letter from your physician.
• If you have been rejected for health care coverage by at least two insurance carriers, include a letter or form from authorized representatives of two Oklahoma-licensed health insurers or health plans documenting the underwriting action taken. This documentation must indicate that coverage was refused; or
• If you are being charged more than the OHRP Plan's rates for individual health care coverage, include the premium bill from your insurer; or
• If you have been accepted for health insurance coverage but are subject to an exclusion of a pre-existing condition or disease, include the policy form that indicates the exclusion of coverage for specific conditions; or
• If your individual health insurance has been involuntarily terminated for any other reason than non-payment of premiums, please include the letter from the insurance company stating termination.

Applicants (and dependents) are subject to a 12-month pre-existing condition exclusion. However, if you have continuous coverage for the preceding 6 months before the OHRP coverage effective date, under another similar policy which provided major medical expense benefits, which did cover or could have covered a pre-existing condition and you applied for OHRP coverage within 63 days of the termination of that prior coverage, the pre-existing condition limitation will be waived for that same pre-existing condition only.

CURRENT MEDICAL CONDITIONS LIST

One of several requirements for Medical Eligibility is having been rejected by two companies for similar coverage. If an applicant currently has one of the conditions listed below, he or she may submit, in lieu of the two rejection requirement, a letter from a physician verifying the applicant has the condition.

• Cancer: Bone, Brain, Breast, Colon, Liver, Lung

• Cardiovascular: Artificial Heart Valve, Cardiomyopathy, Coronary Atherosclerotic Disease - which was symptomatic with MI, Polyarteritis Nodosa

• Endocrine/Exocrine: Cystic Fibrosis, Diabetes Mellitus

• Gastrointestinal Intestinal: Crohn's Disease, Ulcerative Colitis

• Hematopoietic: Aplastic Anemia, Hemophilia, Hodgkin's Disease, Leukemia, Sickle Cell Disease

• Immunological: ADA (Adenosine deaminase deficiency), AIDS or HIV positive, Ataxia – Telangiectasia, SCID (Severe-combined immunodeficiency disease), Scleroderma, Systemic lupus erythematosus, Wegener's granulamatosis, X-linked agammaglobulinemia

• Liver-Cirrhosis (non-alcoholic): Hepatitis C, Wilson's Disease

• Musculoskeletal: Dermatomyositis or polymyositis Muscular dystrophy

• Neurological / Central Nervous System: Alzheimer's Disease, Cerebral Palsy,

• Neurological / Peripheral Nervous System (including spinal cord): Amyotrophic Lateral Sclerosis (ALS),Paraplegia or Quadriplegia, Sclerosis, Multiple, Disseminated or Postero-Lateral Syringomyelia (spina bifida)

• Pulmonary: Asthma (steroid dependent), Bronchopulmonary dysplasia, Chronic Obstructive Pulmonary insufficiency, oxygen dependent, Pulmonary Fibrosis with pulmonary insufficiency

• Renal: Chronic renal failure, with or without dialysis, Polycystic kidney

  FEDERAL DEFINED ELIGIBILITY (no length of residency required)

  • Applicant, as of the date on which the individual seeks coverage under this Plan, has aggregate creditable coverage of 18 months or more;
  • Applicant's most recent prior creditable coverage was under a group health plan, governmental plan, church plan or health insurance coverage offered in connection with any such plan;
  • Applicant is not eligible for coverage under a group health plan, Part A or Part B of Title XVIII of the Social Security Act (Medicare) or a State plan under Title XIX of such act (Medicaid) or any successor program, and does not have other health insurance coverage;
  • Applicant's most recent coverage within the period of aggregate creditable coverage was not terminated based on a factor relating to nonpayment of premiums or fraud;
  • Applicant, if offered the option of continuation coverage under a COBRA continuation provision or under a similar State program, elected such coverage; and
  • Applicant has exhausted such continuation coverage under such provision or program, if the applicant elected the continuation coverage.

  Documentation required for federally defined eligibility.

  Applicants seeking coverage based on federally defined eligibility must provide one of the following documents.

  • A certificate of creditable coverage from all previous insurers, the aggregate of which is 18 months.
  • If Applicant's most recent coverage within the period of aggregate creditable coverage was terminated for reasons other than non-payment of premiums or fraud, attach a certification of canceled coverage indicating the termination reason and termination date.

  Applications must be received within 63 days of the termination date of other insurance or applicant (and dependents) will not be eligible for coverage based on federally defined eligibility. Rather they must meet medical condition criteria. (see medical condition). In such cases, 12-month residency is required and pre-existing condition exclusions will be applied for 12 months.

  FEDERALLY DEFINED ELIGIBILITY for Federal Trade Adjustment Assistance (FTAA), Pension Benefit Guaranty Corp. (PBGC), and/or Health Care Tax Credit (HCTC). No length of residency required.

  • Applicant, as of the date on which the individual seeks coverage under this Plan, has aggregate creditable coverage of 18 months or more;
  • Applicant's most recent prior creditable coverage was under a group health plan, governmental plan, church plan or health insurance coverage offered in connection with any such plan;
  • Applicant is not eligible for coverage under a group health plan, Part A or Part B of Title XVIII of the Social Security Act (Medicare) or a State plan under Title XIX of such act (Medicaid) or any successor program, and does not have other health insurance coverage;
  • Applicant's most recent coverage within the period of aggregate creditable coverage was not terminated based on a factor relating to nonpayment of premiums or fraud;
  • Applicant, if offered the option of continuation coverage under a COBRA continuation provision or under a similar State program, elected such coverage; and
  • Applicant has exhausted such continuation coverage under such provision or program, if the applicant elected the continuation coverage.
  • Applicant must be eligible for the credit for health insurance costs under section 35 of the internal revenue code of 1986.
  • “FTAA” means federal trade adjustment assistance under the federal trade adjustment assistance reform act of 2002, public law 107-210.

  Documentation required for federally defined eligibility.

  Applicants seeking coverage based on federally defined eligibility for FTAA, PBGC, and/or HCTC must provide the following documents.

  • A certificate of creditable coverage or other proof from all previous insurers, the aggregate of which is 18 months.
  • The copy of your certification or notice that you have been certified to receive Trade Adjustment Assistance Act (TAA), PBGC and/or HCTC benefits.

  NOT ELIGIBLE FOR OHRP COVERAGE

  You are not eligible if you meet any of the criteria listed below:

  1. The person is eligible for Medicare or is eligible for Medicaid benefits;

  2. You have terminated coverage in OHRP within the last 12 months, unless you can show continuous other coverage which has been involuntarily terminated for any reason other than nonpayment of premiums, except that this provision shall not apply with respect to an applicant who is a Federally Defined Eligible Individual;

  3. The Plan has paid out $500,000 in benefits on behalf of the person;

  4. You are incarcerated in any state penal institution or confined to any narcotic detention, treatment, or rehabilitation facility;

  5. A person has access to health insurance coverage through an employer-sponsored group or self-funded plan, including coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA), except that the requirement for exhaustion of any available COBRA or state continuation is waived whenever such person:
     • Is eligible for the credit for health care costs under section 35 of the internal revenue code of 1986; and
     • Has three months of prior creditable coverage; and
     • A person may maintain other coverage for the period of time that person is satisfying any preexisting condition waiting period under a plan policy; and
     • A person may maintain Plan coverage for the period of time the person is satisfying a preexisting condition waiting period under another health insurance policy intended to replace the Plan policy.

  6. The person is eligible for any other public or private program that provides or indemnifies for health services.

  7. Any person who ceases to meet the eligibility requirements of this section will be terminated at the end of the month in which they no longer meet the eligibility requirements, except in the following cases:
     • When an insured ceases to be an eligible dependent by reason of divorce, coverage for that insured will cease on the date the divorce is granted;
     • When an insured ceases to be an eligible dependent because he or she has married, coverage for that insured will cease on the marriage date.

  8. Coverage shall cease on the date state law requires cancellation of the policy.