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Your Benefits
Oklahoma County Employee Benefits 2015
www.countyclerk.oklahomacounty.org/benefits/forms-information
Our Health, Prescription, Dental and Vision Plans….
Are YOUR PLANS – There is NO INSURANCE Company!
Our plans are Self-Funded.
Single Monthly Premium > $163 (Employee) + $489 (County) = $652.00
Family Monthly Premium > $383 (Employee) + $1,148 (County) = $1,531.00
Fully
Insured
100% Nonrefundable
Premium
Self-Funded
Administration
Stop Loss
Premiums
Potential
Claims
(Opportunit
y to Save)
How to Utilize your Benefits Wisely – Cost
Effective Choices for Our Plan – Be a
Conscious Consumer

Surgery/Procedure 100% Benefit

Example – Hysterectomy Surgery

Local Hospital Cost: 25K > Patient Cost $3K > Plan Cost > $23K

100% Benefit Cost:

That’s a savings to the patient of $3K and a savings to OUR plan of $17K!!!!

Providers: Surgery Center, McBride, additional providers and coming soon
– The Heart Hospital for certain Inpatient Procedures.
6K > Patient Cost $0 > Plan Cost > $6K
100% Surgery/Procedure Benefit

Call a HealthSmart Nurse Case Manager at 405.607.2675

They will schedule a consultation appointment, or schedule your procedure.

They will issue you an e-ticket – NO ID CARD – just an e-ticket for services.

Make sure you present your e-ticket for all services.

Quality Providers – You save $$ - Our plan saves $$
HealthCheck Screenings 100% Radiology Benefit – MRI,
CT, Ultrasound, X-Ray, Preventative Body Scan and
Virtual Colonoscopy


Example CT of Abdomen
Local Hospital Cost: $4K > Patient Cost $800 > Plan Cost $3.2K

100% Cost: $332.10 > Patient Cost $0 > Plan Cost $332.10

That’s a savings to the patient of $800 and a savings to OUR plan of $2.8K!!
HealthCheck - Preventative Body Scan
You are now eligible to receive a FULL BODY SCAN covered 100% by the Oklahoma County
Health Plan. The full body scan is a safe, accurate and life-saving preventative screening
performed with low-dose EBCT imaging technology. The scan takes less than 15 minutes,
you do not have to be sedated, you can wear your normal clothes (no gowns) and there is
no fasting or any other preparation necessary. The scan is a highly sensitive and precise
screening that will give you a detailed picture of the inner workings of your body in order
to find and prevent major illnesses such as cancer and heart disease as soon as possible.
The scan is performed starting at your thyroid and exceeds down to your lower abdomen,
and can detect any abnormality down to the size of a grain of rice.
Each scan is read and interpreted by a Board Certified Radiologist and your results will be
ready in approximately ten (10) days. Once you receive your results, you can make an
appointment with the IMWell clinic, or your physician to discuss your results.
Participants who are eligible include those age 40+ and under the age of 40 with a
doctor’s referral.
All of your results are kept confidential and will not be shared with your employer.
HealthCheck – Virtual Colonoscopy (CT)
During virtual colonoscopy, an imaging technique known as computerized tomography (CT)
is used to produce hundreds of cross-sectional images of the abdominal organs. The
images are combined and digitally manipulated to provide a detailed view of the inside of
the colon and rectum. Unlike traditional colonoscopy, virtual colonoscopy doesn't require
sedation or the insertion of a scope into the colon.
No sedation Simple Bowel Prep 20-30 minute procedure. Drive Yourself No Optical Scope Non-Invasive. Complete View of Colon 3D Imaging.
Call 405-486-7444 to
schedule. Fax physician
referral to 1-888-210-4637
3209 NW Expressway,
Oklahoma City, OK
73112
100% Covered Lab work/ Lab Card / Quest Diagnostics
Using the Lab Card program is as easy as 1-2-3…
1 Verbally request to use the Lab Card Program. Your physician will send your medical information to Quest
Diagnostics under the Lab Card benefit.
2 You may take your medical information to an approved Lab Card site in the event your physician does not
participate with the Lab Card Program.
3 Once your tests are processed through the Lab Card program at an approved
results will be sent back to your physician within 24
to 48 hours.
Quest Diagnostics facility,
The Lab Card program is completely voluntary and provides you with 100% coverage for all your covered
outpatient laboratory testing services.
•Blood testing (e.g., cholesterol, CBC).
•Urine testing (e.g., urinalysis).
•Cytology and pathology (e.g., pap smears, biopsies).
•Cultures (e.g., throat culture).
www.labcard.com
IMWell Health Clinic
100% Paid benefit. No out-of-pocket costs for anyone covered under the
health plan. Additional benefit to your existing health plan. You do not
have to change your PCP. The individual services you use are your choice.
At your direction, lab results/records may be sent to any physician you
wish.
IMWell Health OKC Midtown Clinic
Acute care
treatment of common illnesses and minor injuries (flu, sore throat,
sinus infections, sprains etc.)
136 N.W. 10th Street, Suite 110, OKC,
OK 73103
Treat common diseases
like hypertension, diabetes, asthma etc. Including chronic disease
(405) 778-8552 phone
evaluation, monitoring, and care management
Open 8 am to 5 pm Mon-Fri
Closed noon – 1 pm for lunch
Preventative care and comprehensive physical exams
(age appropriate physicals, routine gynecological exams, kids
sports/camp physicals, prostate exams etc.)
Minor procedures and wound care to include skin tag removal, simple
biopsies, etc.
Emergency Room vs. Urgent Care Center
Emergency Room Visit – Deductible then 20%
Visit an Urgent
Care Center
Minor burns or injuries
Sprains and strains
Coughs, colds, and sore throats
Ear infections
Fever or flu-like symptoms
Rash or other skin irritations
Mild asthma
Animal bites
Minor broken bones
Urinary tract infections
Urgent Care Center Visit - $25 Co-pay
Visit the ER
Chest pain or pressure
Uncontrolled bleeding
Sudden or severe pain
Coughing or vomiting blood
Trouble breathing
Major burns
Spinal injuries
Severe head injury
Loss of consciousness
Abdominal pain or severe diarrhea
How to Find an In-Network Medical Provider
Nationwide
Call First Health
Most reliable
800.226.5116
This information is listed on your Medical/RX card
Go Online
www.myfirsthealth.com
The Cost of Benefits – What can you do? Use In-Network Providers
(First Health Providers)
Services
In-Network
Out-of-Network
Inpatient or Outpatient
Facilities
20% after $500
Deductible
50% after $1,000
Deductible
Office Visits
(Includes x-ray,
ultrasounds and
injections in the
doctor’s office)
100% after $25
Copayment
50% after $1,000
Deductible
Surgery
20% after $500
Deductible
50% after $1,000
Deductible
Emergency Room
20% after $500
Deductible
20% after $500
Deductible
Schedule of Benefits
CA LE N D A R Y E A R D E D U CT IB LE (P P O a nd Out o f N e two rk D e d uc ti b l e s a re a c c um ul a te d s e p a ra te l y )
Per Individual
Per Family
CALENDAR YEAR OUT-OF-POCKET MAX (Includes Deductible, Copays and Coinsurance):
Per Individual
Per Family
HOSPITAL, FACILITY, INDEPENDENT LABORATORY & OTHER SERVICES:
Inpatient Hospital Admissions (Requires Case Management)
Inpatient Physician Visit
Emergency Room
Outpatient Hospital Services
Outpatient Surgery (May require Case Management)
Surgeon or Anesthesiologist Fees
Surgery Center of Oklahoma & McBride Orthopedic Hospital (To obtain pre-certification approval, please call
1.800.825.3540 ext. 2675)
Mammograms, colonoscopies and prostate exams (including PSA tests)
HealthCheck Radiology including MRI, CT, PET Scans, Preventative Body Scan and Virtual Colonoscopy - Utilizing the
Healthcheck screening benefit (To access call 405-486-7444)
Skilled Nursing Facility Care (Requires Case Management)
Home Health Care (Requires Case Management)
Outpatient Physical Therapy (Requires Case Management after 12 Visits)
Non-surgical TMJ Treatment
Other Covered Expenses
MRI, CT and PET Scans - Utilizing the One Call Medical Program (To access One Call Medical call 888.458.8746 or
www.onecallmedical.com)
Laboratory, Pathology, Radiology, MRI, CT & PET Scans
LabCard (Must use LabCard to get 100% benefit) Laboratory & Pathology
Physical Therapy, Speech Therapy & Occupational Therapy (Requires Case Management after 12 Visits)
Chiropractic Treatment (Limited to 24 visits per year)
Early Pre-Natal Care Management (Requires Case Mgmt.; applies to Obstetrician's Global Delivery Fee Only)
100% - copay and/or deductible w aived (Only applies to PPO Providers)
Ambulance
Second Surgical Opinions (When authorized by Utilization Management)
PHYSICIAN OFFICE VISITS & URGENT CARE:
IMWell Clinic
Physician Office Visits & Urgent Care (Includes x-ray, ultrasounds, injections performed in the doctors office) LAB
WOULD BE DEDUCTIBLE & COINSURANCE WHEN BILLED BY DOCTOR - USE LAB CARD FOR 100% BENEFIT
Other Covered Expenses
CHEMICAL DEPENDENCY TREATMENT:
Inpatient Care (Requires Case Management)
Outpatient Practitioner Office Visits (Limited to 24 visits per year)
PSYCHIATRIC TREATMENT:
Inpatient Care (Requires Case Management)
Outpatient Practitioner Office Visits (Limited to 24 visits per year)
WELLNESS BENEFITS:
Routine Wellness Benefit
Mammograms, colonoscopies and prostate exams (including PSA tests)
Routine Childhood Immunizations
OU T P A T IE N T P R E S CR IP T ION CA R D B E N E F IT :
Prescription Plan Out of Pocket Annual Maximum
Covered Prescription Drug Expenses
Per Prescription Limit:
Generic:
Formulary Brand:
Brand Name: (if a generic or formulary brand is available and the member chooses the brand name drug, then the
member will pay the entire cost; unless deemed medically necessary by medical review)
Life Threatening Emergency Care
Emergency Out-Of-Area Treatment
Services for which there are No Network Providers
In Network - PPO
$500
$1,500
In Network - PPO
$3,000
$9,000
Deductible,
Deductible,
Deductible,
Deductible,
Deductible,
Deductible,
then
then
then
then
then
then
Out of Network
$1,000
No maximum limitation
Out of Network
No maximum limitation
No maximum limitation
20%
20%
20%
20%
20%
20%
Deductible, then 50%
Deductible, then 50%
PPO Deductible, then 20%
Deductible, then 50%
Deductible, then 50%
Deductible, then 50%
No Deductible then 100%
No Deductible, then 100%
No Deductible, then 100%
No deductible, then 100%
Deductible, then 20%
Deductible, then 20%
Deductible, then 20%
Deductible, then 20%
Deductible, then 20%
Deductible,
Deductible,
Deductible,
Deductible,
Deductible,
$100 Copay, then 100%
Deductible, then 20%
No deductible, then 100%
Deductible, then 20%
Deductible, then 20%
then
then
then
then
then
50%
50%
50%
50%
50%
Deductible, then 50%
Deductible, then50%
Deductible, then50%
Deductible, then 20%
100% - copay and/or deductible waived
In Network - PPO
No Deductible, then 100%
Out of Netw ork
$25 copay per visit
Deductible, then 20%
Deductible, then50%
Deductible, then50%
Deductible, then 20%
$25 copay per visit
Deductible, then50%
Deductible, then50%
Deductible, then 20%
$25 copay per visit
In Network - PPO
No Deductible, then 100%
No Deductible, then 100%
No Deductible, then 100%
Deductible, then50%
Deductible, then50%
Out of Network
NOT COVERED
No Deductible, then 100%
NOT COVERED
Single: $3,600 Family: $4,200
RETAIL
34 day supply
$5
20% with $20 min. and $60 max.
RETAIL 90
90 days
$15
20% with $60 min. and $180 max.
30% with $40 min. and $80 max.
PPO Deductible, then 20% (coinsurance applies
pocket maximums)
PPO Deductible, then 20% (coinsurance applies
pocket maximums)
PPO Deductible, then 20% (coinsurance applies
pocket maximums)
PPO Deductible, then 20% (coinsurance applies
pocket maximums)
Participants Residing Out-of-Area
The Retail 90 is available only at participating pharmacies. For a complete list of these pharmacies, please visit the
Oklahoma County Clerk’s website at: http://countyclerk.oklahomacounty.org/hr/forms Please refer to the Plan Document
for a full explanation of benefits, definitions, limitations, and exclusions.
County Pharmacy - Free Generic Maintenance Prescriptions (Please see enrollment information in the Annual Enrollment Guide)
Please refer to the Plan Document for a full explanation of benefits, definitions, limitations, and exclusions.
to PPO out-of to PPO out-of to PPO out-of to PPO out-of -
30% with $120 min. and $240 max.
MAIL
90 days
$10
$55
$75
Oklahoma County
2015 Prescription Drug Benefit
Choices
Generic
Formulary
Brands
Non-Formulary
Brands
Retail
30 Day Supply
$5
20%
$60 max
30%
$80 max
Retail 90 Day
Program
$10
3X
3X
CVS Mail Order 90
Day Supply
(Maintenance RX
Only)
$10
$55
$75
County Pharmacy
(Maintenance RX
Only)
FREE
Not Available
Not Available
Oklahoma County Pharmacy Program
Free to enrolled plan participants and their eligible dependents
Maintenance prescriptions only
ex: Hypertension, Asthma, Diabetic care, Birth Control (Ortho-Novum 135)
Generic only
Monthly limit of $500 per prescription
Filled as 90 day supply only
May pick up or mail out
Enrollment Packet is available on the County Clerk’s Benefit Website.
http://countyclerk.oklahomacounty.org/benefits/forms-information
Dental Plan – Delta Dental of
Oklahoma
(No ID Card)
$3,000 Annual Benefit (excluding class 1 services)
Class 1 – Diagnostic & Preventative
100%
(cleanings, oral evaluations, x-rays)
Class 2 – Basic Restorative
80%
*(fillings, extractions, root canals)
Class 3 – Major Restorative
70%
*(crowns, dentures, bridges)
Orthodontics (dependent children only no deductible) 80%
*$25 Annual Deductible per individual for class 2 & 3
*$125 Annual Deductible per family for class 2 & 3
www.deltaldentalok.org
405.607.2100
VSP
Vision Service Plan
(NO ID CARD)
You may choose either glasses or contacts. The benefit resets January 1st.
Exam
$5
Materials
$35
(single vision lenses, standard frame)
Elective Contact Lenses
Plan pays up to $105
www.vsp.com
Medically Necessary Contact Lenses
Plan pays up to $210
800.877.7195
Oklahoma County Employee’s Defined
Contribution Retirement Plan
www.checkmy401k.com
Vesting at 5 years of service. 0% vested until 5 years of service.
After 5 years of service, you can borrow against your retirement account. If you leave
employment, the money is yours.
Rule of 60 – Employees that were hired before January 1, 2005, are eligible for retirement
with health coverage when their age + years of service equal 60. If you were hired after
January, 1, 2005, you can still retire under the rule of 60, but will not be able to continue
the health coverage.
Rule of 75 – Employees hired on or after January 1, 2005, are eligible for retirement with
health coverage when their age + years of service equal 75.
BOTH YEARS OF SERVICE AND AGE ROUND UP AT THE SIX MONTH POINT
10% Early Withdraw Penalty – Under age 55 ½ when you retire. Applies until 59 ½.
Oklahoma County Pays for Life & AD&D Coverage for All Full-Time Employees
• The amount of coverage is 1 ½ times your annual salary with a maximum of
$100,000.00 in coverage. If you pass away in an accident, your base amount is
doubled.
• If you were hired prior to February 1, 1987, you can elect to retire with ½ of
your life volume as of 2/1/87.
Oklahoma County pays for the Deer Oaks Employee Assistance Program for All Full-Time
Employees
All members of your household are covered. You do not have to have the Health
Package. Three free counseling visits, per person, per year are covered – per issue.
Also, they have experts on staff for health coaching, help with chronic disease
management, ask an expert on any life issues – financial, elder care etc…
1-866-327-2400 www.deeroaks.com (login: Oklahoma Password: County)