Important Policy Change

You won’t need a waiver for providers in Oklahoma or for providers who are in network with a Blue Cross and Blue Shield Plan in the border counties below:

• Arkansas: Benton, Crawford, Little River, Polk, Scott, Sebastian, Sevier, Washington
• Colorado: Baca
• Kansas: Barber, Chautauqua, Cherokee, Clark, Comanche, Cowley, Harper, Labette, Meade, Montgomery, Morton, Seward, Stevens, Sumner
• Missouri: McDonald, Newton
• New Mexico: Union
• Texas: Bowie, Childress, Clay, Collingsworth, Cooke, Dallam, Fannin, Grayson, Hansford, Hardeman, Hemphill, Lamar, Lipscomb, Montague, Ochiltree, Red River, Sherman, Wheeler, Wichita, Wilbarger

Certain conditions or situations that began before January 1, 2025, and require ongoing treatment may qualify for “continuity of care” or “transition of care” for a period of time. For example, you may qualify if you are currently going to a provider or facility outside Oklahoma and Oklahoma’s contiguous counties for:

• An ongoing course of treatment for a serious and complex condition;
• Institutional or inpatient care that began before January 1, 2025;
• Nonelective surgery before January 1, 2025, including receiving ongoing postoperative care from the provider or facility related to the surgery;
• Current pregnancy and/or an ongoing course of treatment for a current pregnancy; or
• Ongoing treatment of an illness that was determined to be terminal.

To find out more about continuity or transition of care and to see if you may qualify, call Customer Service at the number on your ID card. A health advocate will help you. You may also receive communications from us with more information.

• If the care you are receiving now is available in Oklahoma or from a provider contracted with the Blue Cross and Blue Shield Plan in a contiguous county, you will need to find care in Oklahoma or a contiguous county to receive benefits under your plan starting January 1, 2025.
• If the care you are receiving is not available in Oklahoma or from a provider contracted with the Blue Cross and Blue Shield Plan in a contiguous county, you will need to get an approved waiver before any appointments scheduled in 2025 with the provider.

The waiver approval or denial will be provided within 7 days after we receive your request. It will be mailed through the United States Postal Service. Please note, waiver approval is not guaranteed.

A review will be conducted to determine:

• The location of the service being requested,
• Whether the service being requested is available in Oklahoma,
• Whether there is a Blue Cross and Blue Shield Plan where the service will be provided, and
• Whether the provider is contracted with the Blue Cross and Blue Shield Plan where the service will be provided.

A waiver may be granted to receive non-urgent or non-emergency care from:

• Providers outside Oklahoma and its contiguous counties if the service being requested is not available in Oklahoma or from a provider contracted with a Blue Cross and Blue Shield Plan in its contiguous counties.
• An out-of-network provider in a contiguous county if the service being requested is not available from an in-network provider in Oklahoma or its contiguous counties.

Waivers do expire. When a waiver expires depends on the service you receive.

You may see the provider as many times as is medically necessary while the approved waiver is in effect.

As with claims denials, you may appeal a waiver denial. Information on how to appeal a waiver denial will be included in any waiver denial you receive.

• You do not need a waiver to see any provider in Oklahoma.
• If the provider is not in your plan’s network, you may have to pay any out-of-network cost sharing.
• Keep in mind that any out-of-network cost sharing will be higher than if you went to an in-network provider.

• If you wish to receive non-urgent or non-emergency care outside Oklahoma and its contiguous counties, you must get an approved waiver before receiving such care.
• This plan change applies to “snowbirds,” students who attend school outside Oklahoma, and covered dependents who reside outside Oklahoma.