Oklahoma State Home Builders Association (OSHBA)

The OSHBA has teamed up with Blue Cross Blue Shield of Oklahoma to offer health insurance coverage to its members.  Below you will find a Benefit Summary detailing the four benefit plan options that are available, including Rate Tables.  Coverage is available only to those businesses that generate 70% or more of revenues from activities related to residential construction. 

Who can join…

1.   Sole Proprietors.  If you fall into this category, you need only to review the Benefit Summary to make a determination of which plan best suits your needs, find the appropriate Rate Table (Table A – under 30, Table B – 30 to 39, etc.) to determine your premium and complete the BCBS Application for Membership form.

2.      Businesses with 2 or more employees.   Businesses other than sole proprietors must provide the items on the Small Business Checklist in order to obtain coverage.  The rates for your business will be assigned by determining the average age of your group and then finding the appropriate Rate Table (i.e. average age under 30 is Table A, Table B is for 30 to 39, etc.).  Each employee can then select their own health plan.

Benefit Plan Options

OSHBA offers four benefit plan options as follows:
BluePreferred PPO - $500 deductible
BlueChoice PPO - $500 deductible
HSA Blue - $1,500 deductible
HSA Blue - $3,000 deductible
Both PPO options include the following:

• $20 office visit copay (includes lab & x-ray when performed in conjunction with a covered office visit), childhood immunizations, annual gynecological exam, routine DRE/PSA test;
• Annual $300 preventive care benefit

Provider directories can be found online at www.bcbsok.com by clicking on “Locate a Health Care Provider”.  Please make certain that you are referencing the appropriate network of providers when reviewing the information online (i.e. BluePreferred PPO, BlueChoice PPO).

Medical Expense Reimbursement Plan (MERP)

When you enroll in one of the BCBS PPO plans, you're purchasing a $5,000 deductible plan. OSHBA implemented a MERP which is designed to reimburse the difference between a $500 deductible and $5,000 deductible plan. Your true deductible is $500 and after you meet your $500 deductible, OSHBA will reimburse you at the rate of either 80% (in-network charges) or 60% (out-of-network charges) of the next $4,500 of eligible expenses. This reimbursement is available for both the BluePreferred PPO and the BlueChoice PPO. It is important to note, however, that under the BluePreferred PPO plan, your BCBS deductible for out-of-network charges is $7,500. The OSHBA reimbursement for BluePreferred out-of-network charges will be limited to 60% of $4,500 equaling a total benefit of $2,700. Accordingly, your actual out-of-pocket deductible expense could be as high as $4,800 if you receive services from out-of-network providers.

Claim Filing Procedure

Your claim for health care services received will be submitted to BCBS by your health care provider. Once you receive your Explanation of Benefits (EOB) statement from BCBS, you need to determine if there are any expenses in excess of $500 that were applied to your BCBS $5,000 deductible. If so, you will need to send a copy of your EOB and a completed and signed HRA claim form to Precision Administrators, Inc. (PAI). PAI is our administrator for the MERP. You may submit your EOB and HRA claim form by mail, fax or e-mail to:

Precision Administrators, Inc
3240 W. Britton Road, Suite 202
Oklahoma City, OK  73120
Telephone:      (800) 615-2797
Fax:                 (405) 507-0700
E-mail:             claims@precisioncompanies.com

Once you have satisfied your $500 deductible, the claim will be processed in the following manner:

You will be responsible for the first $500 of expenses applied to the deductible. After meeting the $500 deductible, your cost share will be 20% of the next $4,500 of eligible expenses ($900.00) and OSHBA will reimburse you for the remaining 80% ($3,600). After the total $5,000 deductible is satisfied, you will then be responsible for 20% of eligible “In-Network” charges or 40% of “Out-of-Network” charges up to your maximum out-of-pocket amount as determined by BCBS.

Your new BCBS ID card will indicate that your plan’s deductible is $5,000. If you are asked by a provider to pay up front for any amount over your true $500 deductible, you will need to explain that your employer has a supplemental Medical Expense Reimbursement Plan plan with a $500 deductible benefit. If verification is required, you can request that the provider contact PAI at the above number.

Please note:

• Claims are paid on a daily basis by Precision Administrators, Inc.
• All claims must be submitted with a completed and signed HRA claim form along with the Explanation of Benefits (EOB) statement supporting the claim.
• Only medical expenses that apply to the deductible are eligible—those for which a participant receives an EOB.
• Claims received by 2:30 p.m. will be processed the following business day.
• Claimants will be notified via e-mail with an explanation of any claim PAI was unable to pay. If PAI does not have an e-mail address on file, a letter will be sent via the U.S. Postal Service.
• Direct deposit of reimbursements is available upon request.

Voluntary Group Dental Plan Options

OSHBA offers two dental plan options through HumanaDental as follows:

Preventive Plus – Covers most Preventive services at 100% without meeting a deductible.  Includes coverage for some Basic services at 50% after satisfying a $50 deductible.  No coverage provided for Major services.

PPO – If seeing a participating dentist, Preventive services are covered at 100%; Basic services at 90%; Major services at 60%. There is no deductible on in-network or out-of-network preventive services.  If the member is not coming from prior dental coverage, a 12-month waiting period will be imposed on Major services with the exception of root canals.

Questions regarding any of the benefit plan options should be directed to Susie Stockton at (918) 712-5278 or e-mail susie@cfr-ins.com. 

All paperwork should be forwarded to the following address:

CFR, Inc.
5314 S. Yale, Suite 900
Tulsa, OK  74135

or can be faxed to (918) 712-6386.