Interested In Joining?

Quick Links:
» Step 1 - Presentation
» Step 2 - Data Gathering
» Step 3 - Underwriting Study
» Step 4 - Document Signing
» Step 5 - Enrollment
» Step 6 - Go Live

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

Briefing Book: Click Here
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Step 1 - 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 Health Plan.

No decision about joining the 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.

Schedule a Presentation: 800.468.5744
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Step 2 - Data Gathering

Collecting data required to perform the underwriting Study requires an employer group to contact its current benefits provider.

The underwriting study is performed by a third party at no charge to the employer group.

The results of the Underwriting Study provide the Health Plan with an impact assessment of an employer group joining the Health Plan.
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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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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 Health Plan’s Board of Trustees to be accepted onto the 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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Step 3 - Underwriting Study

Underwriting Study is performed on any prospective employer group. This helps ensure the future security of the Health Plan.

Remember! Every employer group on the Health Plan pays the same premium rate. The Health Plan does not experience rate individual employer group’s, as the Health Plan is a true pool.

The results of the Underwriting Study may indicate some potential risk. However, with the Health Plan Board’s determination and the employer group’s agreement to pay the risk differential, no employer group will ever be turned down.
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In extremely rare circumstances, the results of the Underwriting Study may indicate a potential risk to the 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 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 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.

In most respects 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. Furthermore, of the last 10 employer group's to join the Health Plan, have all posed a negative or marginal risk of less than 5% and, therefore, were not required to pay a risk assessment at all.
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Step 4 - Document Signing

For employer group to join the Health Plan, they must sign the Health Plan's Inter-Local Government Agreement and complete the Group Application & Participation Agreement. Once this is done, planning can begin for the employer group's enrollment onto the 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 Health Plan continues without the need to recommit. An employer group can chose to leave the Health Plan at any time after the initial 12-month term with a written 60-day notice.

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

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

2 original copies of the signed Inter-Local Government Agreement must be mailed to the Health Plan's Administration Office. One will be countersigned and returned for the employer group's records.

Inter-Local Government Agreement: Click Here
Group Application & Participation Agreement: Click Here
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Step 5 - Enrollment

All enrollments of new employer group employees and new hires of existing employer groups use the Health Plan's online administration platform. The Health Plan calls this platform HEART (Health Plan Enrollment, Administration & Resource Tool).

The HEART Platform has been designed specifically to meet the needs of the Health Plan. It has been tried, tested and refined over the past 3-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 Health Plan even stronger.

Visit the HEART Platform: Click Here
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Step 6 - Go Live

New employer groups always begin coverage through the Health Plan on the first day of a month. Which month is entirely at the new employer group's discretion.

The 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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