Frequently Asked Questions

A Contracted Entity is an insurance company that contracts with providers and medical facilities to provide health care services to its members.

Oklahoma Complete Health services include physical health, behavioral health, pharmacy, transportation and community benefits resources.

In addition to meeting certain income levels, applicants must meet specific eligibility requirements to receive SoonerSelect coverage. Eligibility for programs and services is determined by the Oklahoma Health Care Authority (OHCA). For more information on Oklahoma SoonerSelect eligibility, please contact the OHCA Contact Center at 1-800-987-7767.

No. There is no cost to enroll in Oklahoma Complete Health. Some members may pay minimal copayments for doctor visits and hospital services.

You can apply for services in several ways.

By Phone:

Oklahoma Health Care Authority at 1-800-987-7767.

Online:

Apply online at the Oklahoma Health Care Authority website. (This is an external link that will take you outside the Oklahoma Complete Health website)

Download:

You can use a form to apply for SoonerCare coverage for yourself and everyone in your immediate family who lives with you. (This is an external link that will take you outside the Oklahoma Complete Health website) You may complete the application in English or Spanish on the Oklahoma Health Care Authority website.

If you need help filling out the form, call the SoonerCare Helpline at 1-800-987-7767.

Ask your doctors if they are contracted with Oklahoma Complete Health.

You can check the Find A Provider webpage on our website to view our online provider directory or consult our Provider Directory.

If you have questions about our doctors, contact Oklahoma Complete Health Member Services at 1-833-752-1664 (TTY: 711).

Yes, SoonerSelect members can change their PCP online through the member portal or by calling Member Services at 1-833-752-1664. Children's Specialty Program members can only change their PCP by calling member services at 1-833-752-1665. 

You do not need a referral to get an examination from an in-network specialist. However, we encourage you to talk with your PCP before you see a specialist. There are some treatments and services that will need prior approval. Your PCP will be able to tell you what they are. You can also call Member Services at 1-833-752-1664 (TTY: 711) if you have questions about whether you need a referral for a particular service. 

A participating provider is a physician or other provider who is contracted with or employed by Oklahoma Complete Health to deliver services under the SoonerSelect program. A non-participating provider is a physician or other provider who has not contracted with or is not employed by Oklahoma Complete Health to deliver services under the SoonerSelect program.

If we do not have a specialist in our provider network who can give you the care you need, we will get you the care you need from a specialist outside our plan, or an out-of-network provider.

For help and more information about getting services from an out-of-network provider, talk to your primary care provider or call Member Services at 1-833-752-1664 (TTY: 711). If you are AI/AN, you may receive services from any Indian Healthcare Provider (IHCP), even if the IHCP is out of network.

You can receive family planning services (birth control) from a doctor in or out of network. 

Oklahoma Complete Health can choose not to cover certain services because of an objection on moral or religious grounds. Currently, Oklahoma Complete Health does not object to any services based on moral or religious grounds. If this changes in the future, and you want to leave our plan because of this objection, you have the right to do so. It is considered a good cause.

The Dental benefit is covered by DentaQuest and Liberty Dental. Visit the SoonerCare website to learn more.This is an external link that will take you outside the Oklahoma Complete Health website.

You may change CEs, without showing cause, during your first 90 days of enrollment, or during the 90 days following the date OHCA sends you notice of that enrollment, whichever is later. 

After your period for Disenrollment from the Oklahoma Complete Health plan has lapsed, you will remain enrolled with the Oklahoma Complete Health until the next annual Open Enrollment Period, unless:

• You are disenrolled due to loss of eligibility; 
• You become a foster child under custody of the State;
• You become juvenile justice involved under the custody of the State;
• You are a Former Foster Child or Child Receiving Adoption Assistance and opts to enroll in the SoonerSelect Specialty Children’s Plan;
• You demonstrate cause:
  •  You move out of Oklahoma Complete Health’s service area;
  • You require specialized care for a Chronic Condition and you or your representative, the Oklahoma Complete Health, OHCA and receiving CE agree that assignment to the receiving CE is in your best interest; 
  • You seek covered benefits that Oklahoma Complete Health does not cover for moral or religious reasons;
  • You need related services (for example a cesarean section and a tubal ligation) to be performed at the same time; not all related services are available within the  network; and your PCP or another Provider determines that receiving the services separately would subject the you to unnecessary risk;
  • You have filed and prevailed in a Grievance regarding poor quality of care, lack of access to services covered or lack of access to Providers experienced in dealing with the your care needs or other matters deemed sufficient to warrant Disenrollment; or
  • You have been enrolled in error, as determined by OHCA. 
• A temporary loss of eligibility or enrollment has caused you to miss the annual Disenrollment period, then you may disenroll without cause upon reenrollment; or
• OHCA imposes Intermediate Sanctions on Oklahoma Complete Health and allows you to disenroll without cause.  

Oklahoma Complete Health offers services statewide in Oklahoma.