The Oklahoma State and Education Employees Group Insurance Board, a division of the Office of State Finance

HEALTHCHOICE USA PLAN

For Plan Year January 1 through December 31, 2012

Overview

The HealthChoice USA Plan is a health plan designed for current employees who live and work outside of Oklahoma and Arkansas and pre-Medicare former employees who live outside of these states. The Plan provides benefits identical to the HealthChoice High Plan with access to a nationwide provider network.

HealthChoice USA includes one of the top nationwide PPO networks, the ChoiceCare Network. The ChoiceCare Network is one of the largest provider networks in the country, with nearly 450,000 providers and 3,000 facilities nationwide.

Identification Cards

When electing the HealthChoice USA Plan for the first time, you will receive two ID cards. The card imprinted with the ChoiceCare Network logo and the HealthChoice plan administrator’s contact information is for your health benefits. This ID card MUST be presented when using any of the ChoiceCare Network Providers; otherwise, you will forfeit the available discounts and be charged in accordance with non-Network benefits. The card imprinted with the Medco logo is for your pharmacy benefits.

To request additional or replacement health ID cards, contact HP Administrative Services, LLC at 1-405-416-1800 or toll-free 1-800-782-5218. TDD users call 1-405-416-1525 or toll-free 1-800-941-2160.

To request additional or replacement pharmacy ID cards, contact Medco toll-free at 1-800-903-8113. TDD users call toll-free 1-800-825-1230.

Eligibility

The following eligibility requirements must be met:

   You are a current employee living and working outside of Oklahoma and Arkansas for a minimum of 90 consecutive days.

   You are a pre-Medicare former employee or surviving spouse living outside of Oklahoma and Arkansas for a minimum of 90 consecutive days.

If you are a current employee temporarily living and working outside of Oklahoma and Arkansas or a pre-Medicare former employee temporarily living outside these states, you may enroll in HealthChoice USA, provided the 90-day requirement is met. You have 30 days after you relocate to change:

   From your current plan to HealthChoice USA, when relocating outside of Oklahoma and Arkansas, or

   From HealthChoice to one of the plans available in your area when relocating to Oklahoma or Arkansas.

If not requested within 30 days of relocation, you must wait until the next annual Option Period to change plans.

Current Employees

Your Insurance/Benefits Coordinator must sign your enrollment or change form to certify that you are assigned to work outside of Oklahoma and Arkansas. HealthChoice reserves the right to request employer documentation verifying work assignments. To enroll, you must submit the proper change form to your Insurance/Benefits Coordinator within 30 days of your relocation.

Pre-Medicare Former Employees

You must notify OSEEGIB in writing within 30 days of your relocation and include the following information:

   Your request to change your benefits to or from the HealthChoice USA Plan,

   Your new address, and

   Your relocation date.

Benefits

The benefits for the HealthChoice USA Plan are identical to the HealthChoice High Plan. You are encouraged to use ChoiceCare Network Providers whenever possible to reduce your out-of-pocket costs. If you use a non-Network provider, benefits will be paid as non-Network which will reduce plan benefits and increase your out-of-pocket cost. Please refer to the HealthChoice High, High Alternative, Basic, and Basic Alternative Health Plans Handbook for more information.

Locating a Provider

When you schedule an appointment with a ChoiceCare Network Provider, always confirm the provider still participates in the ChoiceCare Network. It is easy to locate a ChoiceCare Network Provider.

   Visit the ChoiceCare Network online provider directory at www.choicecarenetwork.com and select Physician Finder.

   Call the ChoiceCare Network Monday through Friday from 8 a.m. to 5 p.m. CST at the numbers that follow.

Contact Information

Customer Service, Claims Information, and Health ID Cards

HP Administrative Services, LLC

Oklahoma City Area 1-405-416-1800

All Areas 1-800-782-5218

TDD 1-405-416-1525 or 1-800-941-2160

Pharmacy Claims and ID Cards

Medco

All Areas 1-800-903-8113

TDD 1-800-825-1230

Certification

APS Healthcare

All Areas 1-800-848-8121

TDD 1-877-267-6367

Provider Information

ChoiceCare Network

All Areas 1-877-877-0715, ext. 4059

TDD 1-800-941-2160