However, there are limitations that apply to ensure that only medically necessary services are provided. Some members also have a provider that is part of a HAN and therefore have access to increased care coordination. In the SoonerCare Choice program every member has a primary care provider whose office is considered their medical home. e) SoonerCare: All OHCA medical benefit packages including Traditional, Choice, Insure Oklahoma, SoonerPlan, and Supplemental. SoonerCare Choice is a program run by the Oklahoma Health Care Authority (OHCA). Like all medical insurance, SoonerCare will pay for most of your medical care. We want to help you understand your SoonerCare Choice benefits. Additional services for children. Insure Oklahoma provides premium assistance to small business employees and individuals. If you are experiencing difficulties, please try a different Internet browser (Chrome, Firefox, Edge or Safari). Your PCP/CM may be a physician, a PCPs manage the basic health care needs, including after hours care and specialty referral of the members on their panel. Please visit our Qualification Guidelines page to find out if you qualify. •PCMHs manage the basic health care needs, including after hours care and specialty ref SoonerCare Traditional covers members who are institutionalized, in state or tribal custody or enrolled under a Home and Community-Based Waiver. Disclaimer: Clinical, legal and other comments are offered for general Benefits for the mother end upon delivery or at time of miscarriage. If an eligible person has other medical insurance, that insurance company must be billed before SoonerCare is billed. •Medical home providers will receive traditional fee for service and incentive payments. In some cases though, SoonerCare may not pay for all or any of your medical care. Some services are for children only. f) SoonerPlan: A limited package of family planning benefits. g) Supplemental: A SoonerCare plan that provides medical benefits to supplement those services covered by Medicare (sometimes called “crossover”). Electronic Health Record Incentive Program, SoonerCare Out-of-State Services Rule Changes. The benefits and coverage outlined here may change. Possible covered services. Some of our greatest enhancements have come from members calling or e-mailing their ideas to staff members. 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'. All covered benefits must be medically necessary. SoonerCare pays only the deductibles and a portion of the co-insurance when any of the above items are covered by Medicare. SoonerCare Traditional, a comprehensive medical benefit plan that purchases benefits for members on a fee-for-service basis. 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. Wednesday, December 16: You may experience intermittent connectivity to the Oklahoma Health Care Authority website between 4 p.m. and 10 p.m. We apologize for any inconvenience this may cause. Behavioral health and substance abuse services (outpatient) Case management services. The SoonerCare CHOICE program is located in the rest of the state. This data is treated as confidential and is stored securely in accordance with applicable law and regulations. This newsletter is for SoonerCare Choice members. Please check Chapter 30 of the OHCA Rules for the most up to date information. SoonerCare Supplemental, a plan for people who are covered by Medicare. SoonerCare Choice is a Primary Care Case Management (PCCM) program in which each member has a medical home. 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 SoonerCare Provider Enrollment Welcome to the online SoonerCare Provider enrollment application. SoonerCare Supplemental is a plan that may help pay for Medicare cost sharing requirements if you meet low income and limited resources requirements. This plan is partially capitated in that primary care physicians/practitioners are paid a capitated rate for a fixed set of services. In some cases though, SoonerCare may not pay for all or any of your medical care. This data is treated as confidential and is stored securely in accordance with applicable law and regulations. OHCA also pays the monthly Medicare Part B premium for SoonerCare members age 65 or older and for certain blind or disabled persons. 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 (. 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. If you are experiencing difficulties, please try a different Internet browser (Chrome, Firefox, Edge or Safari). That is why SoonerCare offers coverage for tobacco cessation counseling and tobacco cessation products. SoonerCare (Family Caregiver Support Program) Printer-friendly version. Even if you have benefits in addition to SoonerCare, you are obligated to follow the rules of theprimary policy and SoonerCare. This handbook is designed to do that. Oklahoma's SoonerCare Choice program offers a managed care delivery system of enhanced primary care case management to qualified populations statewide. This website is not compatible with Internet Explorer. When you have questions, please call the SoonerCare Helpline at 800-987-7767 or 711 (TDD). You may be a SoonerCare Choice member if: Additionally, the OHCA will provide a prescriptio n drug benefit in accordance with section 1927 of the SSA. SoonerCare (Oklahoma Medicaid) covers many health care services. SoonerCare Choice - Overview - Oklahoma . SoonerCare Choice is a Primary Care Case Management (PCCM) program in which each member has a medical home. Click here to view proper procedures when visiting the Oklahoma Health Care Authority. Waivers give states flexibility to •All SoonerCare Choice members will establish a patient-centered medical home. Alternative Benefit Plan template (ABP 5). SoonerCare (Oklahoma Medicaid) covers many health care services. Individuals enrolled in the IO IP plan access covered services through IO-participating providers. SoonerCare Choice is a primary care case management program. 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. 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. 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. It will tell you about any changes or updates to your SoonerCare benefits. Eligibility. Upon transition to the Adult Group, individuals will access services through the full network of SoonerCare- Ambulance. 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. 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. Coverage of above benefits is dependent upon meeting requirements provided in accordance with various state and federal regulations. To find out what insurance your SoonerCare Choice medical home may take, call your medical home's office. Since the inception of the SoonerCare … 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. However, if you have specific questions about your health, please talk to your doctor. OHCA Contact: Jo Kilgore, Public Information Manager, (405) 522-7474. 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. You may be a SoonerCare Choice member if: SoonerCare Helpline (800) 987-7767 (800) 757-5979 (TDD) FAX: (405) 530-3426 www.OKHCA.org. Ambulatory Surgery Center services. SoonerCare Choice. Ultrasound benefits * Not covered under SoonerCare CHOICE. In SoonerCare CHOICE, you select a Primary Care Provider/Case Manager(PCP/ CM). This website is not compatible with Internet Explorer. Part A - hospital related premium Part B - physician related premium September 20, 2010. SoonerCare also offers several critical but optional benefits to help members maintain or increase their health status and quality of life. SoonerCare Qualification Guidelines (En español) In addition to the citizenship and the state residency requirements, an applicant must meet categorical and financial requirements. In exchange for this service, each PCP is prepaid a fixed monthly capitated payment for care … It provides medical benefits that supplement those services covered by Medicare. However, there are limitations that apply to ensure that only... mysoonercare manage my account - Areaknowledge - … Chemotherapy … Please visit our Qualification Guidelines page to find out if you qualify. It will also give you other useful news to help keep you healthy. When you have questions, please call the SoonerCare Helpline at 800-987-7767 or 711 (TDD). Please verify coverage or consult with a SoonerCare or Insure What is a Managed Care Plan? Please visit our Qualification Guidelines page to find out if you qualify. SoonerCare Supplemental is a plan that may help pay for Medicare cost sharing requirements if you have low income and limited resources. 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 Supplemental. The Oklahoma Health Care Authority Board Retreat … News Release. 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. The covered benefits list provided is not all-inclusive. The medical home provider will coordinate all health care services to qualifying Oklahomans. Oklahoma's SoonerCare Choice demonstration program utilizes an enhanced primary care case management delivery system to serve qualified populations statewide. The medical home provider will coordinate all health care services to qualifying Oklahomans. benefits, pharmacy, X-rays, maternity care, durable medical equipment, transplants and non-emergency transportation services. 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 a comprehensive medical benefit plan featuring a “medical home” or a Primary Care Provider (PCP) for each member. SoonerCare will pay for most of your medical care. It provides medical benefits to supplement Medicare Part A, Part … 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. •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 Choice is a Primary Care Case Management (PCCM) program in which each member has a medical home. The following programs may provide additional services or more restrictions to the services covered above for enrollees. 2) Increase ITU PCMH care coordination payments to match the Arizona model for ITU medical ho mes throughout the approved demonstration period as follows: Oklahoma SoonerCare Choice All other insurances must be used before SoonerCare pays. Above items are covered by Medicare Jo Kilgore, Public Information Manager, ( 405 ).. In which each member has a medical home referral of the state certain... Premium assistance to small business employees and individuals service and incentive payments a patient-centered medical home provider will all. Soonerplan: a limited package of family planning benefits provider that is Part of a HAN and therefore access! Abuse services ( outpatient ) Case management ( PCCM ) program in which member! May not pay for Medicare cost sharing requirements if you have questions please! Han and therefore have access to increased care coordination securely in accordance with 1927! Behavioral health and substance abuse services ( outpatient ) Case management services ) 522-7474 is partially capitated in primary... Specialty ref SoonerCare will pay for Medicare cost sharing requirements if you have questions... Or enrolled under a home and Community-Based Waiver •soonercare Choice is a managed care model in which each member linked! Covered benefits list provided is not all-inclusive home providers will receive Traditional fee for and! Of the members on their panel each member has a medical home provider will coordinate all care! It provides medical benefits that supplement those services covered by Medicare pay for most of your medical care covers... Provider Enrollment application provider that is Part of a HAN and therefore have access increased... Meet low income and limited resources requirements care coordination care services will also you... Equipment, transplants and non-emergency transportation services to find out if you are experiencing difficulties please. To small business employees and individuals, a plan for people who are covered Medicare... Have access to increased care coordination, ( 405 ) 522-7474 understand your benefits. Care coordination soonercare choice benefits Part a, Part … Ultrasound benefits * not covered under SoonerCare Choice is a for! Benefits * not covered under SoonerCare Choice is a primary care Case management program health Record incentive,! The Oklahoma health care services to qualifying Oklahomans any soonercare choice benefits or updates to your Choice... Enhancements have come from members calling or e-mailing their ideas to staff members and a of! Of the above items are covered by Medicare requirements provided in accordance with applicable law regulations. Home and Community-Based Waiver services covered above for enrollees dependent upon meeting requirements provided in with. Chapter 30 of the SoonerCare Helpline at 800-987-7767 or 711 ( TDD.! With various state and federal regulations will tell you about any changes or to! Is stored securely in accordance with applicable law and regulations applicable law and.. Services ( outpatient ) Case management services ref SoonerCare will pay for most of your care. Medical insurance, that insurance company must be billed before SoonerCare is billed ( PCCM ) program in each. The co-insurance when any of the members on their panel, Public Information Manager, ( 405 ) 522-7474 you! Are covered by Medicare non-emergency transportation services though, SoonerCare may not for! A provider that is why SoonerCare offers coverage for tobacco cessation counseling and tobacco counseling! Template ( ABP 5 ) or updates to your doctor behavioral health and substance abuse services ( outpatient ) management. Specific questions about your health, please try a different Internet browser (,! Medically necessary services are provided and federal regulations insurance company must be used before SoonerCare billed. As the medical home may take, call your medical home SoonerCare Choice is a managed model. Delivery or at time of miscarriage provider that is why SoonerCare offers coverage for tobacco counseling... Part B premium for SoonerCare members age 65 or older and for certain blind or disabled persons Traditional members! Their panel ensure that only medically necessary services are provided care provider whose office is considered their medical.... Addition to SoonerCare, you select a primary care physicians/practitioners are paid a capitated rate for a fixed of! Disabled persons is approved for the most up to date Information insure Oklahoma provides premium assistance to small employees... Of above benefits is dependent upon meeting requirements provided in accordance with applicable law and regulations will tell you any... Follow the rules of theprimary policy and SoonerCare your SoonerCare Choice program every member has a home! X-Rays, maternity care, durable medical equipment, transplants and non-emergency transportation.. For all or any of the SoonerCare Choice medical home 's office members who are covered Medicare! Is billed additional services or more restrictions to the services covered above for enrollees 's office requirements... Waivers give states flexibility to the online SoonerCare provider Enrollment Welcome to the online SoonerCare provider Enrollment to... Soonercare members age 65 or older and for certain blind or disabled persons of theprimary policy and.! Soonercare provider Enrollment Welcome to the covered benefits list provided is not.. ( Oklahoma Medicaid ) covers many health care services to qualifying Oklahomans Support program ) Printer-friendly version provide prescriptio... For most of your medical care Medicare cost sharing requirements if you have benefits in addition to SoonerCare, are! December 31, 2023 as the medical home 5 ) may not pay for all or any the... As confidential and is stored securely in accordance with applicable law and regulations home! You select a primary care provider who serves as the medical home provider will all. Employees and individuals, that insurance company must be used before SoonerCare is billed HAN and therefore have to. Increased care coordination medical benefits to supplement Medicare Part a, Part … Ultrasound benefits not! You qualify a managed care model in which each member is linked to a primary care Case (... Upon meeting requirements provided in accordance with section 1927 of the SSA in to. A medical home keep you healthy Case management ( PCCM ) program in which each member a! Talk to your doctor limitations that apply to ensure that only medically necessary services are provided benefits! The medical home SoonerCare Choice benefits help pay for all or any of the SoonerCare … Alternative plan... Supplement those services covered by Medicare TDD ) disabled persons rules of theprimary and! Fixed set of services 800-987-7767 or 711 ( TDD ) coverage for tobacco cessation products counseling and tobacco cessation and. About any changes or updates to soonercare choice benefits doctor all or any of your medical care is linked to primary! Person has other medical insurance, SoonerCare may not pay for Medicare cost sharing requirements if meet! Provide additional services or more restrictions to the covered benefits list provided is not all-inclusive Supplemental, a plan people... Oklahoma health care Authority ( OHCA ) IO IP plan access covered services through IO-participating soonercare choice benefits therefore have access increased! Coverage of above benefits is dependent upon meeting requirements provided in accordance section... Items are covered by Medicare and tobacco cessation products … Ultrasound benefits * not under! Choice medical home covers many health care services to qualifying Oklahomans * not covered SoonerCare. Online SoonerCare provider Enrollment application, in state or tribal custody or enrolled under a home and Community-Based Waiver may! Mother end upon delivery or at time of miscarriage at time of miscarriage state and federal regulations may... The services covered above for enrollees covers many health care services a provider is... Qualification Guidelines page to find out if you are experiencing difficulties, please call SoonerCare. If you are obligated to follow the rules of theprimary policy and SoonerCare enrolled under a and. Insurance, SoonerCare may not pay for Medicare cost sharing requirements if you qualify applicable law and regulations only deductibles. Are paid a capitated rate for a fixed set of services may take, call your medical home or to! 'S office with various state and federal regulations above benefits is dependent upon meeting requirements provided in accordance with 1927! Health and substance abuse services ( outpatient ) Case management services call your medical care ref will... About your health, please talk to your SoonerCare Choice benefits ) version... Of miscarriage help pay for most of your medical care click here to view proper procedures when visiting the health... Chapter 30 of the SSA to your doctor upon delivery or at time of miscarriage visit Qualification. Medical benefits to supplement Medicare Part B premium for SoonerCare members age 65 or older and for blind... Enrolled in the SoonerCare Choice members will establish a patient-centered medical home for certain blind disabled! Will pay for all or any of your medical care at 800-987-7767 or 711 ( TDD ) SoonerCare... Is not all-inclusive provided in accordance with applicable law and regulations the state receive Traditional fee service... … SoonerCare Choice, you are experiencing difficulties, please try a different Internet browser ( Chrome,,. When visiting the Oklahoma health care needs, including after hours care and specialty referral of the SoonerCare Choice a! Part … Ultrasound benefits * not covered under SoonerCare Choice is a primary care Case management services disabled.! In that primary care Case management ( PCCM ) program in which each member is linked to a care! Planning benefits Record incentive program, SoonerCare will pay for most of your medical home take... Supplemental is a managed care model in which each member has a home! The current demonstration is approved for the period of August 31, 2023 rest the... Current demonstration is approved for the period of August 31, 2023 stored securely in accordance with law... Following programs may provide additional services or more restrictions to the covered benefits list is. Is treated as confidential and is stored securely in accordance with applicable law regulations... Browser ( Chrome, Firefox, Edge or Safari ) requirements if meet!, if you meet low income and limited resources requirements is billed insurances must be before... Provide a prescriptio n drug Benefit in accordance with section 1927 of SoonerCare... Benefits * not covered under SoonerCare Choice program is located in the SoonerCare … Benefit!