The covered benefits list provided is not all-inclusive. g) Supplemental: A SoonerCare plan that provides medical benefits to supplement those services covered by Medicare (sometimes called “crossover”). However, there are limitations that apply to ensure that only medically necessary services are provided. SoonerCare Choice is a comprehensive medical benefit plan featuring a “medical home” or a Primary Care Provider (PCP) for each member. The medical home provider will coordinate all health care services to qualifying Oklahomans. This newsletter is for SoonerCare Choice members. It provides medical benefits that supplement those services covered by Medicare. If an eligible person has other medical insurance, that insurance company must be billed before SoonerCare is billed. SoonerCare is a collection of Oklahoma health care benefit packages including Traditional (Fee-For-Service Medicaid), Choice (Medical Home), Insure Oklahoma, Supplemental (Medicare Crossover), SoonerPlan (Family Planning) and others. SoonerCare Choice is a Primary Care Case Management (PCCM) program in which each member has a medical home. It will tell you about any changes or updates to your SoonerCare benefits. Your Primary Care Provider Both SoonerCare packages have health care providers called Primary Care Providers (PCPs) to take care of you and/ or your family’s basic health care needs. SoonerCare Choice is Oklahoma’s statewide managed care model in which each member is linked to a primary care provider who serves as their 'medical home'. It provides medical benefits to supplement Medicare Part A, Part … It will also give you other useful news to help keep you healthy. Please verify coverage or consult with a SoonerCare or Insure Please visit our Qualification Guidelines page to find out if you qualify. Please visit our Qualification Guidelines page to find out if you qualify. Click here to view proper procedures when visiting the Oklahoma Health Care Authority. Some of our greatest enhancements have come from members calling or e-mailing their ideas to staff members. benefits, pharmacy, X-rays, maternity care, durable medical equipment, transplants and non-emergency transportation services. All other insurances must be used before SoonerCare pays. SoonerCare Choice. Ultrasound benefits * Not covered under SoonerCare CHOICE. SoonerCare Choice is a Primary Care Case Management (PCCM) program in which each member has a medical home. SoonerCare Tobacco Cessation Benefit Research indicates that no other clinical intervention can reduce illness, prevent death, or increase quality of life more effectively than tobacco cessation. Some members also have a provider that is part of a HAN and therefore have access to increased care coordination. The Oklahoma Health Care Authority Board Retreat … SoonerCare also offers several critical but optional benefits to help members maintain or increase their health status and quality of life. Coverage of above benefits is dependent upon meeting requirements provided in accordance with various state and federal regulations. OHCA also pays the monthly Medicare Part B premium for SoonerCare members age 65 or older and for certain blind or disabled persons. To find out what insurance your SoonerCare Choice medical home may take, call your medical home's office. You do not reside in an institution such as a nursing facility; You are not receiving SoonerCare services through a home- and community-based waiver program; You are not in a health maintenance organization. Health care coverage for pregnant and postpartum women eligible for SoonerCare Coverage for the pregnant woman limited to pregnancy-related health care services for the benefit of the baby. •All SoonerCare Choice members will establish a patient-centered medical home. If you are experiencing difficulties, please try a different Internet browser (Chrome, Firefox, Edge or Safari). SoonerCare Supplemental. This plan is partially capitated in that primary care physicians/practitioners are paid a capitated rate for a fixed set of services. For more information on SoonerCare Choice, you can download a SoonerCare Member Handbook which will provide complete enrollment and coverage details. The Oklahoma Health Care Authority collects the personally identifiable data submitted and received in regard to applications for services, renewals, appeals, provision of health care and processing of claims. Chemotherapy … SoonerCare Traditional covers members who are institutionalized, in state or tribal custody or enrolled under a Home and Community-Based Waiver. SoonerCare Supplemental is a plan that may help pay for Medicare cost sharing requirements if you meet low income and limited resources requirements. In the SoonerCare Choice program every member has a primary care provider whose office is considered their medical home. This data is treated as confidential and is stored securely in accordance with applicable law and regulations. Please check Chapter 30 of the OHCA Rules for the most up to date information. This website is not compatible with Internet Explorer. Waivers give states flexibility to SoonerCare Choice is a program run by the Oklahoma Health Care Authority (OHCA). Additionally, the OHCA will provide a prescriptio n drug benefit in accordance with section 1927 of the SSA. The benefits and coverage outlined here may change. Even if you have benefits in addition to SoonerCare, you are obligated to follow the rules of theprimary policy and SoonerCare. Possible covered services. However, if you have specific questions about your health, please talk to your doctor. e) SoonerCare: All OHCA medical benefit packages including Traditional, Choice, Insure Oklahoma, SoonerPlan, and Supplemental. Keep up with your SoonerCare benefits online Family planning Spring is for the birds M is for Medical Home The Oklahoma Health Care Authority appreciates ideas and thoughts from families who receive services through SoonerCare Choice. SoonerCare Helpline (800) 987-7767 (800) 757-5979 (TDD) FAX: (405) 530-3426 www.OKHCA.org. The medical home provider will coordinate all health care services to qualifying Oklahomans. Some services are for children only. You may be a SoonerCare Choice member if: The Oklahoma Health Care Authority collects the personally identifiable data submitted and received in regard to applications for services, renewals, appeals, provision of health care and processing of claims. •SoonerCare Choice is a managed care model in which each member is linked to a primary care provider who serves as the medical home. SoonerCare Traditional, a comprehensive medical benefit plan that purchases benefits for members on a fee-for-service basis. In some cases though, SoonerCare may not pay for all or any of your medical care. SoonerCare Supplemental, a plan for people who are covered by Medicare. OHCA Contact: Jo Kilgore, Public Information Manager, (405) 522-7474. 2020 SoonerCare and Insure Oklahoma Income Guidelines SoonerCare Children and Soon-To-Be-Sooners (STBS) may qualify for SoonerCare Services* if their tax household's Modified Adjusted Gross Income* (MAGI) is within the following guidelines. Oklahoma's SoonerCare Choice program offers a managed care delivery system of enhanced primary care case management to qualified populations statewide. The SoonerCare Choice benefits plan does provide the enhanced benefit of unlimited physician visits (as medically necessary) as compared to the State plan which limits physician services to four visits per month, including specialty visits. SoonerCare will pay for most of your medical care. •PCMHs manage the basic health care needs, including after hours care and specialty ref You may be a SoonerCare Choice member if: Ambulance. In SoonerCare CHOICE, you select a Primary Care Provider/Case Manager(PCP/ CM). OHCA may share this personally identifiable data with its authorized business associates, government agencies with jurisdiction over the OHCA, or as otherwise required or permitted by applicable law. All covered benefits must be medically necessary. When you have questions, please call the SoonerCare Helpline at 800-987-7767 or 711 (TDD). September 20, 2010. Electronic Health Record Incentive Program, SoonerCare Out-of-State Services Rule Changes, Comparison Chart of SoonerCare Benefits and Co-pay Amounts, Cost Sharing/Out-of-Pocket Cost Exemptions, Behavioral health and substance abuse services, Mental Health and Substance Abuse Services, Prenatal, delivery and postpartum services (maternity services), Incontinence Supplies for certain children ages 4-20, Clinic services including renal dialysis services, Dentures for adults residing in nursing facilities, Federally Qualified Health Center (FQHC) services, Inpatient hospital services in an institution for mental disease for people who are 65 years of age or older *, Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) *, Medical supplies and equipment, including diabetic supplies, Transportation to obtain covered medical care (, Inpatient hospital services for patients in institutions for mental disease, Optometric or optical services, including eyeglasses, Speech, hearing and language disorder services, Breast and Cervical Cancer Treatment Services (, Home and community-based services authorized under a waiver (. If you are experiencing difficulties, please try a different Internet browser (Chrome, Firefox, Edge or Safari). SoonerCare Choice is a primary care case management program. SoonerCare pays only the deductibles and a portion of the co-insurance when any of the above items are covered by Medicare. SoonerCare (Oklahoma Medicaid) covers many health care services. SoonerCare (Family Caregiver Support Program) Printer-friendly version. Part A - hospital related premium Part B - physician related premium What is a Managed Care Plan? This website is not compatible with Internet Explorer. PCPs manage the basic health care needs, including after hours care and specialty referral of the members on their panel. SoonerCare Qualification Guidelines (En español) In addition to the citizenship and the state residency requirements, an applicant must meet categorical and financial requirements. f) SoonerPlan: A limited package of family planning benefits. SoonerCare Supplemental is a plan that may help pay for Medicare cost sharing requirements if you have low income and limited resources. SoonerCare (Oklahoma Medicaid) covers many health care services. The following programs may provide additional services or more restrictions to the services covered above for enrollees. Insure Oklahoma provides premium assistance to small business employees and individuals. Eligibility. The SoonerCare CHOICE program is located in the rest of the state. When you have questions, please call the SoonerCare Helpline at 800-987-7767 or 711 (TDD). This handbook is designed to do that. In some cases though, SoonerCare may not pay for all or any of your medical care. You may be a SoonerCare Choice member if: Hearing aids; Immunizations; Incontinence Supplies for certain children ages 4-20; Incontinence Supplies (Spanish) Inpatient hospital services for patients in institutions for mental disease; Optometric or optical services, including eyeglasses; Orthodontics We want to help you understand your SoonerCare Choice benefits. Oklahoma's SoonerCare Choice demonstration program utilizes an enhanced primary care case management delivery system to serve qualified populations statewide. The current demonstration is approved for the period of August 31, 2018 through December 31, 2023. The medical home provider will coordinate all health care services to qualifying Oklahomans. Since the inception of the SoonerCare … In exchange for this service, each PCP is prepaid a fixed monthly capitated payment for care … Electronic Health Record Incentive Program, SoonerCare Out-of-State Services Rule Changes. •Medical home providers will receive traditional fee for service and incentive payments. However, there are limitations that apply to ensure that only... mysoonercare manage my account - Areaknowledge - … OHCA may share this personally identifiable data with its authorized business associates, government agencies with jurisdiction over the OHCA, or as otherwise required or permitted by applicable law. Benefits for the mother end upon delivery or at time of miscarriage. Please visit our Qualification Guidelines page to find out if you qualify. SoonerCare Choice is a Primary Care Case Management (PCCM) program in which each member has a medical home. SoonerCare Choice - Overview - Oklahoma . Disclaimer: Clinical, legal and other comments are offered for general Like all medical insurance, SoonerCare will pay for most of your medical care. Behavioral health and substance abuse services (outpatient) Case management services. This data is treated as confidential and is stored securely in accordance with applicable law and regulations. Additional services for children. SoonerCare Provider Enrollment Welcome to the online SoonerCare Provider enrollment application. Alternative Benefit Plan template (ABP 5). Upon transition to the Adult Group, individuals will access services through the full network of SoonerCare- Your PCP/CM may be a physician, a News Release. Individuals enrolled in the IO IP plan access covered services through IO-participating providers. Ambulatory Surgery Center services. 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