How will the subsidy work?
Employee has a family of four: husband, wife, two children (children may be covered under the SoonerCare program).
The employer receives the Employee eligible letter indicating:
Applicant Name: John Smith
Health Plan Choice: H00000 Oklahoma Care
Spouse Name: Mary Smith
Health Plan Choice: H00000 Oklahoma Care
Effective on 11/01/2007 through 10/31/2008
Employee Premium Share Amount: $85.00
Employer Premium Share Amount: $83.00
State/Federal Subsidy Amount: $553.00
This example assumes:
Annual household income: $37,000
Oklahoma Care monthly premiums are: $420 for the employee, $450 for the spouse / $870 for employee & spouse.
Insure Oklahoma will calculate the following:
Payer
|
Employee
|
Spouse
|
Total
|
Employer
|
$83.00
|
$0.00
|
$83.00
|
Employee
|
$46.50
|
$46.50
|
$85.00
|
Insure Oklahoma
|
$206.50
|
$346.50
|
$553.00
|
Totals
|
$332.00
|
$389.00
|
$721.00
|
The employer share is 25 percent of the employee premium rate of $332 or $83. The employee share is 15 percent of $721, or $108.15. Since the $108.15 exceeds 3 percent of the employee family income, the employee share is capped at the 3 percent figure of $85.
The Insure Oklahoma subsidy equals the remaining balance of $553.