OHCA Policies and Rules

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[Revised 09-01-16]
(a) Employer and employee eligibility are tied together. If the employer is no longer eligible, then the associated employees enrolled under that employer are also ineligible. Employees are mailed a notice 10 days prior to closure of eligibility.

(b) The employee's certification period may be terminated when:

(1) termination of employment, either voluntary or involuntary, occurs;

(2) the employee moves out-of-state;

(3) the covered employee dies;

(4) the employer ends its contract with the qualified benefit plan;

(5) the employer's eligibility ends;

(6) a review indicates a discrepancy that makes the employee or employer ineligible;

(7) the employer is terminated from the program;

(8) the employer fails to pay the premium;

(9) the qualified benefit plan or carrier no longer meets the requirements set forth in this Chapter;

(10) the employee becomes eligible for SoonerCare or Medicare;

(11) the employee or employer reports any change affecting eligibility;

(12) the employee is no longer listed as a covered person on the employer's benefit plan invoice;

(13) the employee requests closure; or

(14) the employee no longer meets the eligibility criteria set forth in this Chapter.


Disclaimer. The OHCA rules found on this Web site are unofficial. The official rules are published by the Oklahoma Secretary of State Office of Administrative Rules as Title 317 of the Oklahoma Administrative Code. To order an official copy of these rules, contact the Office of Administrative Rules at (405) 521-4911.