Interested In Joining

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Presentation
Data Gathering
Underwriting
Document Signing
Enrollment
Go Live


The OPEH&W Health Plan understands that change can be difficult for some people to handle, changing health benefits for employees can be especially so. That's why the OPEH&W Health Plan makes becoming a participating employer group as simple as possible. The following outlines the process an employer group takes in joining the OPEH&W Health Plan.

To learn more about the OPEH&W Health Plan, it is suggested that decision makers within an employer group should first read the OPEH&W Health Plan's Briefing Book.

Briefing Book
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Presentation
This presentation is designed to be given to decision makers of an employer group. It takes about 30-45 minutes and covers all aspects of the OPEH&W Health Plan. No decision about joining the OPEH&W Health Plan is made at this time. A decision is needed on whether to proceed with an Underwriting Study. The Underwriting Study is at no cost to the employer group, and the result is non-binding. To schedule a Presentation
Email    healthplan@opehw1.com
Phone   800.468.5744
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Data Gathering
Collecting data required to perform underwriting requires an employer group to contact its current benefits provider. Underwriting is performed by a third party at no charge to the employer group. The results of underwriting provide the OPEH&W Health Plan with an impact assessment of an employer group joining the OPEH&W Health Plan.

Unable to Provide Data?
Should an employer group be unable to provide such data as necessary to perform an underwriting study, the employer group will be at the consent of the OPEH&W Health Plan’s Board of Trustees to be accepted onto the OPEH&W Health Plan, however, the employer group will be assessed a flat 5% risk assessment charge based on the first year of participation only.
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Underwriting
Underwriting is performed on any prospective employer group. This helps ensure the future security of the OPEH&W Health Plan. Remember, every employer group on the OPEH&W Health Plan pays the same premium rate. The OPEH&W Health Plan does not experience rate individual employer group’s, as the OPEH&W Health Plan is a true pool. The results of the Underwriting Study may indicate some potential risk. However, with the OPEH&W Health Plan Board’s determination and the employer group’s agreement to pay the risk differential, no employer group will ever be turned down.

In extremely rare circumstances, the results of the Underwriting Study may indicate a potential risk to the OPEH&W Health Plan. This is determined as the difference between expected premiums paid and expected claims during the first year of enrollment. The board of the OPEH&W Health Plan has stipulated that in order to protect the OPEH&W Health Plan, all prospective employer groups with a risk assessment of 5% or higher are required to pay this differential for their first year of coverage with the OPEH&W Health Plan, after which the employer group will be considered vested, and part of the Pool, and no longer required to pay this differential. It should be noted that any assessed risk differential is applied solely to the employee rate, while premium rates remain unaffected.

Mostly this differential rarely amounts to more than 5%, and so an employer group is not required to pay anything. If it is over 5% it can be split into 12 equal monthly installments.


Data Required for Underwriting Study
》Claims Information A summary of aggregated total paid and allowed claims by month for a minimum of the most recent 24-months, split into medical and pharmacy claims, and whether the pharmacy claim information is net of pharmacy rebates.
》Shock Claims A summary of high-cost shock claimants for a minimum of two most recent 12-month periods, with a threshold of $50,000, but threshold is not critical so long as we know the cutoff used by your current carrier.
》Membership/Census Information Demographic information for each month of the provided claims information is preferred Otherwise, any summaries regarding the demographic distribution of enrollees relative to the experience periods. Or, at a minimum, a count of members and subscribers (employees) for each month of the provided claims information.
》Current Population Census An MS Excel spreadsheet census containing the following data elements for each Employee, COBRA or Retiree group members is required.
   》Age
   》Gender
   》ZIP Code
   》Coverage Tier (e.g., Employee Only Coverage)
   》Plan Name (if more than one plan option is offered)
   》Benefit information Benefit information underlying the claims data provided, including the most recent benefit plan information.
》Additional Information
   》Current & Proposed Premium Rates
   》Network of Current Insurer
   》Participation Requirements & Employer Premium Contribution Levels
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Document Signing
For employer group to join the OPEH&W Health Plan, they must sign the OPEH&W Health Plan's Inter-Local Government Agreement and complete the Group Application. Once this is done, planning can begin for the employer group's enrollment onto the OPEH&W Health Plan.

By signing these 2 agreements, an employer group is committing to an initial term of 12-months only. After which, participation in the OPEH&W Health Plan continues without the need to recommit. An employer group can chose to leave the OPEH&W Health Plan at any time after the initial 12-month period with written 60-day notice.

The Inter-Local Government Agreement enjoins a employer group into the cooperative pool public trust that is the OPEH&W Health Plan. This is made possible by Oklahoma State Statutes 51 & 74.
Inter-Local Government Agreement

The Group Application details the particulars of the employer group, such as contact information and the benefits to be offered.
Group Application

2 original copies of the signed Inter-Local Government Agreement must be mailed to the OPEH&W Health Plan's Administration Office. One will be countersigned and returned for the employer group's records.
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Enrollment
All enrollments of new employer group employees and new hires of existing employer groups use the Health Plan's online administration platform. The OPEH&W Health Plan calls this platform HEART (OPEH&W Health Plan Enrollment, Administration & Resource Tool). The HEART Platform has been designed specifically to meet the needs of the OPEH&W Health Plan. It has been tried, tested and refined over several years. The HEART Platform has been proven to be simple to use, even for the most difficult of employees. It provides administrative improvements that serve to make the OPEH&W Health Plan even stronger.
HEART Platform
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Go Live
New employer groups always begin coverage through the OPEH&W Health Plan on the first day of a month. Which month is entirely at the new employer group's discretion. The OPEH&W Health Plan will make every effort to make the changeover as seamless as possible, however, there are several transition items that will require careful attention to avoid undue duress on the employees and their covered family members.
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