HealthChoice is a managed health care program providing comprehensive health and dental benefits to over 186,000 state, education and local government employees, former employees, survivors and their covered dependents.
HealthChoice is administered by the Office of Management and Enterprise Services Employees Group Insurance Department (EGID). The HealthChoice plans are a partnership between providers, members and EGID in the delivery of health and dental care services and products that helps control costs, assists in the provision of high quality health and dental care, and enhances provider/patient relationships. The HealthChoice benefit structure offers financial incentives to encourage Plan members to utilize HealthChoice Network Providers.
EGID provides health and dental care benefits in accordance with the provisions of Oklahoma Statutes, (74 O.S. 2012, §§ 1301, et seq.). The information provided in this manual is a SUMMARY of the benefits, conditions, limitations and exclusions of the HealthChoice High, High Alternative, Basic, Basic Alternative, FOCUS, High Deductible Health Plan (HDHP) and Dental Plans. It should not be considered an all-inclusive listing.
While the HealthChoice Network Provider Manual is a summary only and is not intended to be all-inclusive, its contents should offer providers and their staff vital information regarding the most important aspects of the provider network.
Plan benefits are subject to conditions, limitations and exclusions. These conditions, limitations and exclusions are described and located in Oklahoma Statutes, Administrative Rules, and Administrative Procedures adopted by the plan administrator. You can obtain a copy of the official rules from the office of the Oklahoma Secretary of State. An unofficial copy of the rules is available on this website. Under the heading “About EGID”, select the link for the “Administrative Rules.” A copy of the Administrative Procedures can be obtained from the plan administrator.
The sections of the provider manual can be found in the menu to the left. Please click on the link to view that section. The following link is a printable version of the complete manual:
HealthChoice Provider Manual (pdf. 21pp, 327 KB)
A description of the plans offered by HealthChoice can be found in the member handbooks. The following links are to the HealthChoice member handbooks:
HealthChoice High Option & Basic Health Plans Handbook
HealthChoice Dental Insurance Handbook