The State of Oklahoma (OMES/EGID) offers a wide range of quality insurance benefits to TPS employees to help meet their health care needs. For health insurance there are six plans available – three PPO (Preferred Provider Organization) plans and three HMO (Health Maintenance Organization) plans.

PLEASE NOTE: Any deductibles, copays, or other expenses discussed below are based on employee only coverage. Additional costs will apply if family members are also covered.

Healthcare Plans at a Glance

Note: Be sure to review each plan’s details in full before making a decision on which plan is best for you.

	PPO	PPO	HDHP	HMO
	HealthChoice High	HealthChoice Basic	HealthChoice High Deductible	HMO
Any doctor, any hospital (in-network less expensive) Lowest deductible Least out-of-pocket at time of service Pays at 80% after $750 deductible	✓
Any doctor, any hospital (in-network is less expensive) Plan pays first $500 of medical expenses per year; 50% coinsurance thereafter Considered major medical coverage only		✓
High deductible ($1,750) before coverage kicks in at 80% Health savings account option Most out-of-pocket			✓
Requires primary care physician Copays per service No dealing with insurance processes In-network services are less expensive				✓

Our PPO plans are the HealthChoice plans which give you the freedom to choose any provider or hospital and receive some type of reimbursement. To minimize out-of-pocket costs, be sure to use in-network providers. Common trails of all of our PPO plans:

• Deductible – a specified amount of money the member pays before the health plan will start to pay for medical costs and procedures.
• Coinsurance – the percentage of the cost due to the provider after insurance payment is made. Coinsurance is paid by the employee.
• In-network and out-of-network providers – using in-network providers lowers the employee’s out-of-pocket responsibility.
• Plan year maximum – the total dollar amount that a member could pay per year. After the plan year maximum is paid, the insurance plan pays 100% of additional costs.

PPO Plan Options

Plan	Overview	Details
HealthChoice High	The most popular PPO plan is the HealthChoice High plan. About 80% of employees enroll in this plan because it offers office visit copays without having to meet the annual deductible. This plan has the lowest deductible and lowest out-of-pocket costs of all the HealthChoice plans. It’s also a good choice for employees who want a PPO and who would like to pay the least out-of-pocket at the time of service.	For anything outside of an office visit, the $750 deductible must be met before the plan starts to pay its 80% portion on services The maximum risk out-of-pocket per year is $3,300 per individual Least out-of-pocket costs compared to the other HealthChoice plans
HealthChoice Basic	For those employees who are looking to save on monthly premiums but are willing to take a larger out-of-pocket risk, HealthChoice provides the HealthChoice Basic plan. The Basic plan is a good choice for employees who want a PPO and who are looking for major medical coverage only.	Plan pays the first $500 of medical expenses for all covered services. If you don’t spend the full $500 in a plan year, then you never pay anything to a provider out-of-pocket. If you do use the full $500, then you must meet a $1,000 deductible per year before the plan will start to pay 50% of allowed charges. The maximum risk out-of-pocket per year is $4,000 per individual.
HealthChoice High Deductible Plan	For employees who are looking for a qualified High Deductible Health Plan (HDPH) or who want to open a Health Savings Account (HSA) and have unused funds rollover year-to-year, The HealthChoice High Deductible plan might be a good option.	Both prescription and medical services must be paid in full by the member until the $1,750 deductible is met After the deductible is met, the HDHP plan pays 80% for your covered services and works like the HealthChoice High Option plan. The maximum risk out-of-pocket for this plan per year is $6,000.

HMO Plan Details

For those members who don’t like dealing with insurance processes (checking providers, deductibles, and coinsurance) or who don’t mind selecting a Primary Care Physician, the State offers HMO plans.

• HMO plans have a copay for each service so you will know the amount owed at the time of treatment.
• HMO plans require that you choose a Primary Care Physician (PCP) to help guide you on your healthcare journey.
• HMO plan also have an out-of-pocket maximum that varies by plan.