(a) Employees not eligible to participate in an employer's QHP, employees of non-participating employers, self-employed, unemployed seeking work, and workers with a disability may apply for the Individual Plan. Applicants cannot obtain IP coverage if they are eligible for ESI.
(b) The eligibility determination is processed within 30 days from the date the complete application is received by the TPA. The applicant is notified in writing of the eligibility decision.
(c) In order to be eligible for the IP, the applicant must:
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(1) choose a valid PCP according to the guidelines listed in OAC
317:45-11-22, at the time they make application;
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(2) be a US citizen or alien as described in OAC
317:35-5-25;
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(3) be an Oklahoma resident;
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(4) provide social security numbers for all household members;
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(5) be not currently enrolled in, or have an open application for, SoonerCare/Medicare;
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(6) be age 19 through 64 or an emancipated minor;
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(7) make premium payments by the due date on the invoice; and
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(8) not have full-time employment with any employer who does not meet the eligible employer guidelines listed in OAC
317:45-7-1(a)(1)-(2).
(d) If employed and working for an approved Insure Oklahoma/O-EPIC employer who offers a QHP, the applicant must meet the requirements in subsection (c) of this Section and:
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(1) have household income at or below 200% of the Federal Poverty Level.
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(2) be ineligible for participation in their employer's QHP due to number of hours worked.
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(3) have received notification from Insure Oklahoma/O-EPIC indicating their employer has applied for Insure Oklahoma/O-EPIC and has been approved.
(e) If employed and working for an employer who doesn't offer a QHP, the applicant must meet the requirements in subsection (c) of this Section and have a countable household income at or below 200% of the Federal Poverty Level. The standard deduction for work related expenses such as income tax payments, Social Security taxes, and transportation to and from work, is $240 per each full-time or part-time employed member.
(f) If self-employed, the applicant must meet the requirements in subsection (c) of this Section and:
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(1) must have household income at or below 200% of the Federal Poverty Level;
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(2) verify self-employment by providing the most recent federal tax return with all supporting schedules and copies of all 1099 forms;
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(3) verify current income by providing appropriate supporting documentation; and
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(4) must not be employed by any full-time employer who meets the eligibility requirements in OAC
317:45-7-1(a)(1)-(2).
(g) If unemployed seeking work, the applicant must meet the requirements in subsection (c) of this Section and:
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(1) Applicant must have household income at or below 200% of the Federal Poverty Level. In determining income, payments of regular unemployment compensation in the amount of $25 per week ending June 30, 2010 and any amount of emergency unemployment compensation paid through May 31, 2010, will not be counted, as authorized under the American Recovery and Reinvestment Tax Act of 2009.
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(2) Applicant must verify eligibility by providing a most recent copy of their monetary OESC determination letter and a most recent copy of at least one of the following:
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(A) OESC eligibility letter,
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(B) OESC weekly unemployment payment statement, or
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(C) bank statement showing state treasurer deposit.
(h) If working with a disability, the applicant must meet the requirements in subsection (c) of this Section and: