For more HealthChoice information call 405-717-8780 or toll-free 800-752-9475

or visit HealthChoiceOK.com. TTY users call 711.

THE PLAN THAT OFFERS YOU CHOICE

HealthChoiceOK.com

4470

HealthChoice High HealthChoice High Deductible Health Plan HealthChoice Basic

FLEXIBILITYEnjoy the flexible use of

your health plan.

SAVINGSMaximize your premium to maximize

your savings.

BUDGET-FRIENDLYOffers first dollar coverage. Ideal for

those with minimal health care needs.

TOBACCO FREE

Individual deductible: $750Family deductible: $2,000

Maximum out-of-pocket: $3,300 Ind./$8,400 Fam.

COPAYS FOR COVERED NETWORK SERVICES:Primary office visit: $30Specialist office visit: $50Urgent care: $30ER: $200

AFTER DEDUCTIBLE HAS BEEN MET:You pay 20% coinsurance. HealthChoice pays 80%.

You may self-refer to a specialist.

Individual deductible: $1,750Family deductible: $3,500

Maximum out-of-pocket:$6,000 Ind./$12,000 Fam.

Combined medical and pharmacy deductible must be met before benefits are paid, other than for preventive services.

COPAYS FOR COVERED NETWORK SERVICES AFTER DEDUCTIBLE:Primary office visit: $30Specialist office visit: $50Urgent care: $30ER: $200

AFTER DEDUCTIBLE HAS BEEN MET:You pay 20% coinsurance.HealthChoice pays 80%.

You may self-refer to a specialist.

HealthChoice pays the first $500 of covered medical expenses.

AFTER HEALTHCHOICE PAYS:You pay deductible:$1,000 Ind./$1,500 Fam.

AFTER YOU MEET THE DEDUCTIBLE:You pay 50% until you reach the out-of-pocket maximum.

Maximum out-of-pocket:$4,000 Ind./$9,000 Fam.

No copays on this plan for network services.

You may self-refer to a specialist.

ALTERNATIVE PLANS FOR TOBACCO USERS

HealthChoice High Alternative

Not applicable for HDHP

HealthChoice BasicAlternative

Individual deductible: $1,000 Family deductible: $2,750

Maximum out-of-pocket:$3,550 Ind./$8,400 Fam.

HealthChoice pays the first $250of covered medical expenses.

AFTER HEALTHCHOICE PAYS:You pay deductible:$1,250 Ind./$1,750 Fam.

AFTER YOU MEET THEDEDUCTIBLE:You pay 50% until you reach theout-of-pocket maximum.

Maximum out-of-pocket:$4,000 Ind./$9,000 Fam.

WHICH PLAN IS RIGHT FOR YOU?

Find a list of preventive services for all

HealthChoice plans at https://omes.ok.gov/services/

healthchoice/member/preventive-services.

PRESCRIPTION DRUGS 30-DAY SUPPLY 31- TO 90-DAY SUPPLY

Generic drugs Up to $10 Up to $25

Preferred drugs Up to $45 Up to $90

Non-preferred drugs Up to $75 Up to $150

Specialty drugs Preferred drugs – $100 copay Non-preferred drugs – $200 copay Not available

HealthChoice High, High Alternative, Basic and Basic Alternative plans have an annual prescription drug deductible of $100 individual with a maximum of $300 per family. Pharmacy maximum out-of-pocket: $2500/Ind. and $4000/Fam.

The HealthChoice Benefits app has everything you need in one easy place.

Live chat with a Care Guide 24/7• Answers benefits questions.• Helps schedule appointments.• Saves you money with $0 or low cost care.• All conversations are 100% confidential.

Benefit tools• Digital insurance cards.• Wellness incentives.• Telemedicine.• Deductible and maximum out-of-pocket information.

Download your HealthChoice Benefits app today!

THE HEALTHCHOICE BENEFITS APP

WE HAVE A PHARMACY PACKAGE FOR YOU!Your plan of choice includes pharmacy coverage:

• Allergies and rashes• Bronchitis• Ear infections• Fever and flu• Insect bites and stings• Pink eye• Poison ivy• Sinus infections• Respiratory infections• Urinary tract infections

HealthChoice Select services and procedures are covered at 100% of the bundled allowable fees with no out-of-pocket costs to members.

HealthChoice High, High Alternative, Basic and Basic Alternative plans are covered at 100% of bundled allowable fee with no out-of-pocket costs to you. Services must be received from facilities participating in HealthChoice Select.

Prescriptions are covered subject to the member’s plan provisions.

HealthChoice HDHP members are covered at 100% after their annual deductible is met, except for preventive services.

WE HAVE A TEAM STANDING BY TO HELP!

• One bundled bill for related services performed on the same day.• Allowable fees apply to the HDHP deductible.• Pay less out of pocket.• Incentive payment of $100 for colonoscopies and

sigmoidoscopies once per calendar year.• Referrals to participating facilities are not required.• No age limit for Select services.• No limit on the number of Select services.• Dedicated provider directory on the HealthChoice website.

WHAT DOES THIS MEAN FOR YOU?

SAVINGS!

TELEMEDICINE

SwiftMD doctors are board-certified physicians trained in the U.S., with a minimum 10 years practice experience. They are available 24/7, offering a great alternative to the emergency room or urgent care clinic.

For HealthChoice High and Basic plan members, there is $0 cost per visit with no limitations. For HealthChoice HDHP members, refer to your HealthChoice member materials.

HealthChoice members and covered dependents are now eligible for consults with SwiftMD doctors by phone and videoconference. With SwiftMD, you can receive a diagnosis and medical advice for common medical conditions at home or on the go. When necessary, they can send a prescription to your preferred local pharmacy where you can pick it up at your convenience. SwiftMD physicians provide consults for many minor illnesses and injuries such as:

Find a provider, as well as more info about Select services, at omes.ok.gov/services/healthchoice/providers.

HEALTHCHOICE SELECT

This publication was printed by the Office of Management and Enterprise Services as authorized by Title 62, Section 34. 5,000 copies have been printed at a cost of $396.00. A copy has been submitted to Documents.OK.gov in accordance with the Oklahoma State Government Open Documents Initiative (62 O.S.2012, § 34.11.3). This work is licensed under a Creative Attribution-NonCommercial-NoDerivs 3.0 Unported License.HealthChoice complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex.ATTENTION: If you speak a language other than English, language assistance services, free of charge, are available to you. Call 80z0-752-9475 (TDD:866-447-0436).(Spanish)ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 800-752-9457 (TDD: 866-447-0436). (Vietnamese)