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Ellis Health Insurance

Facts and Figures

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State Government Insurance Programs Offered

Medicaid SoonerCare (Search: SoonerCare)

SoonerCare: Family planning, Home health inpatient, Laboratory and x-ray, Nurse-midwife, Nursing facility outpatient, Physician, Ambulatory surgical center, Hearing, Durable medical equipment, Prescription drugs, Prosthetics, Mental health, Rehabilitative services, Transportation services, Dental and vision for some people, and more. SoonerPlan: Office visits and physical exams related to family planning. Pregnancy tests, birth control education and supplies, Pap smears, STD screening. For patients age 21 and older, tubal ligations for women and vasectomies for men are offered. Fertility services are not covered. Eligibility: Both: Must be an Oklahoma resident and a U.S. citizen or legal alien who has been in the U.S. at least five years. SoonerCare: Aged, blind and disabled: Singles earning $715/ month with asset limit of $2,000. Couples earning $1,052/month for an eligible individual with an ineligible spouse; couples with both individuals eligible earning $1,093/month. Asset limit of $3,000 for both kinds of couples. Parents/caretakers living with children ages 0–18: 32% FPL. Pregnant women and children ages 0–18: 185% FPL SoonerPlan: Must be over 18 years old, uninsured, not enrolled in SoonerCare, and did not already have surgery that prevents pregnancy. Income limit of 185% FPL.

Insure Oklahoma (IO)

Insure Oklahoma: Limited health services subject to medical necessity, such as inpatient hospital services (acute care only), outpatient hospital services, prescription drugs, physician services, etc.

Child and Adolescent Health Clinical Services (CAHCS) (Search: Clinical Services)

Eligibility: CAHCS: Must be age 0–21 years old, uninsured or underinsured for health care services. Income limit of 185% FPL. Services will not be refused based on patient’s inability to pay.


Medicare offers Part A, inpatient care in hospitals and rehabilitative centers; Part B, doctor and some preventive services and outpatient care; Part C allows Medicare benefits through private insurance (Medicare Advantage); Part C includes Parts A, B, and C not covered by Medicare. Part D covers prescription drugs. SHIP is a Medicare counseling service. Eligibility: Both: Must be U.S. citizen or permanent U.S. resident, and: 1) If 65 years or older, you or your spouse worked for at least 10 years in Medicare-covered employment, or 2) You have a disability or end-stage renal disease (permanent kidney failure requiring dialysis or transplant) at any age

Women-Infant-Children (WIC) (Search: WIC)

WIC: Must reside in Oklahoma. Must be a pregnant or recently pregnant woman, or child up to age 5, and determined to be at nutritional risk. Income limit of 185% FPL.

Heath Care Reform

Small business tax credits. 54,400 small businesses in Oklahoma could be helped by a new small business tax credit that makes it easier for businesses to provide coverage to their workers and makes premiums more affordable.1 Small businesses pay, on average, 18 percent more than large businesses for the same coverage, and health insurance premiums have gone up three times faster than wages in the past 10 years. This tax credit is just the first step towards bringing those costs down and making coverage affordable for small businesses.
Closing the Medicare Part D donut hole. Last year, roughly 49,100 Medicare beneficiaries in Oklahoma hit the donut hole, or gap in Medicare Part D drug coverage, and received no extra help to defray the cost of their prescription drugs.2 Medicare beneficiaries in Oklahoma who hit the gap this year will automatically be mailed a one-time $250 rebate check. These checks will begin to be mailed to beneficiaries in mid-June and will be mailed monthly throughout the year as new beneficiaries hit the donut hole. The new law continues to provide additional discounts for seniors on Medicare in the years ahead and completely closes the donut hole by 2020.
Support for health coverage for early retirees. An estimated 25,800 people from Oklahoma retired before they were eligible for Medicare and have health coverage through their former employers. Unfortunately, the number of firms that provide health coverage to their retirees has decreased over time.3 Beginning June 1, 2010, a $5 billion temporary early retiree reinsurance program will help stabilize early retiree coverage and help ensure that firms continue to provide health coverage to their early retirees. Companies, unions, and state and local governments are eligible for these benefits.
New consumer protections in the insurance market beginning on or after September 23, 2010.
Insurance companies will no longer be able to place lifetime limits on the coverage they provide, ensuring that the 1.7 million Oklahoma residents with private insurance coverage never have to worry about their coverage running out and facing catastrophic out-of-pocket costs.
Insurance companies will be banned from dropping people from coverage when they get sick, protecting the 142,000 individuals who purchase insurance in the individual market from dishonest insurance practices.
Insurance companies will not be able to exclude children from coverage because of a pre-existing condition, giving parents across Oklahoma peace of mind.
Insurance plans’ use of annual limits will be tightly regulated to ensure access to needed care. This will protect the 1.6 million residents of Oklahoma with health insurance from their employer, along with anyone who signs up with a new insurance plan in Oklahoma.
Health insurers offering new plans will have to develop an appeals process to make it easy for enrollees to dispute the denial of a medical claim.
Patients’ choice of doctors will be protected by allowing plan members in new plans to pick any participating primary care provider, prohibiting insurers from requiring prior authorization before a woman sees an ob-gyn, and ensuring access to emergency care.
Extending coverage to young adults. Beginning on or after September 23, 2010, plans and issuers that offer coverage to children on their parents’ policy must allow children to remain on their parents’ policy until they turn 26, unless the adult child has another offer of job-based coverage in some cases. This provision will bring relief to roughly 14,500 individuals in Oklahoma who could now have quality affordable coverage through their parents.4 Some employers and the vast majority of insurers have agreed to cover adult children immediately.
Affordable insurance for uninsured with pre-existing conditions. $59.7 million federal dollars are available to Oklahoma starting July 1 to provide coverage for uninsured residents with pre-existing medical conditions through a new transitional high-risk pool program, funded entirely by the Federal government. The program is a bridge to 2014 when Americans will have access to affordable coverage options in the new health insurance exchanges and insurance companies will be prohibited from denying coverage to Americans with pre-existing conditions. If states choose not to run the program, the Federal government will administer the program for those residents.
Strengthening community health centers. Beginning October 1, 2010, increased funding for Community Health Centers will help nearly double the number of patients seen by the centers over the next five years. The funding could not only help the 45 Community Health Centers in Oklahoma but also support the construction of new centers.
More doctors where people need them. Beginning October 1, 2010, the Act will provide funding for the National Health Service Corps ($1.5 billion over five years) for scholarships and loan repayments for doctors, nurses and other health care providers who work in areas with a shortage of health professionals. This will help the 15% of Oklahoma’s population who live in an underserved area.
New Medicaid options for states. For the first time, Oklahoma has the option of Federal Medicaid funding for coverage for all low-income populations, irrespective of age, disability, or family status.

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