TPL FF_04_2013 1
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20 and Under, 42,732 21 to 54, 39,900 55 to 64, 19,501 65 and Over, 55,198 TPL by Age Black or African American, 19,198, 12% American Indian, 12,551, 8% Asian or Pacific Islander, 2,207, 1% Caucasian, 117,442, 75% Multiple Race, 5,933, 4% TPL by Race Third Party Liability Fast Facts 5/16/2013 Race is self-reported by members at the time of enrollment. The multiple race members have selected two or more races. Hispanic is an ethnicity not a race. Hispanics can be of any race and are accounted for in a race category above. Unless otherwise stated, CHILD is defined as an individual age 18 and under. TPL counts include those with the following coverage types: hospitalization, medical, major medical, Medicare supple-mental insurance Part A and/or B and skilled or intermediate care in a nursing facility. This publication is authorized by the Oklahoma Health Care Authority in accordance with state and federal regulations. OHCA is in compliance with the Title VI and Title VII of the 1964 Civil Rights Act and the Rehabilitation Act of 1973. For additional copies, you can go online to OHCA’s web site www.okhca.org under Research/Statistics and Data (www.okhca.org/research/data). The Oklahoma Health Care Authority does not discriminate on the basis of race, color, national origin, gender, religion, age or disability in employment or the provision of services. The data is valid as of the report date and is subject to change. All counts exclude Insure Oklahoma. Members can be in multiple coverage types. *Approximately 98% of the members with Medicare are enrolled in both Part A and Part B. Total Members with Medicare - 108,700 Total Members with Other TPL - 56,095 Total 108,700* 53,868 4,189 235 Medicare Supplemental Insurance Other Insurance TPL Coverage Type Medicare A and/or B Major Medical Insurance Medicare Only Medicare and Other TPL Other TPL Only Total Female 62,156 5,604 26,656 94,416 Male 39,080 1,860 21,975 62,915 Total 101,236 7,464 48,631 157,331 TPL by Gender and Type Medicare Only Medicare and Other TPL Other TPL Only Total Child 25 4 41,069 41,098 Adult 101,211 7,460 7,562 116,233 Total 101,236 7,464 48,631 157,331 TPL by Age Group and Type Hispanic Ethnicity - 9,039 Total TPL Enrollment Total Enrollment Percent of Total Child 41,098 489,085 8.4% Adult 116,233* 291,422 39.9% Total 157,331 780,507 20.2% *87.1% of the Adults with TPL are Medicare Only. Members can have both Medicare and Other TPL. Unless otherwise stated, CHILD is defined as an individual age 18 and under. April 2013 SoonerCare is the payer of last resort in most circumstances. If another insurer or program has the responsibility to pay for medical costs incurred by a SoonerCare member, that entity is generally required to pay all or part of the cost of the claim prior to SoonerCare making any payment. This is known as “Third Party Liability” (TPL). Third parties include but are not limited to, private health insurance, casualty insurance, worker's compensation, estates, trusts, tort proceeds and Medicare. SoonerCare members with Medicare are also known as "Dual Enrollees". For more information go to our website at www.okhca.org.
|Okla State Agency||
Health Care Authority, Oklahoma
|Okla Agency Code||
|Title||Third party liability fast facts, 04/2013|
Oklahoma Health Care Authority.
|Purpose||SoonerCare is the payer of last resort in most circumstances. If another insurer or program has the responsibility to pay for medical costs incurred by a SoonerCare member, that entitty is generally required to pay all or part of the cost of the claim prior to SoonerCare aking any payment. This is known as "Third Party Liability" (TPL).|
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|ODL electronic copy||Downloaded from agency website: http://www.okhca.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=14857&libID=13840|
|Rights and Permissions||This Oklahoma state government publication is provided for educational purposes under U.S. copyright law. Other usage requires permission of copyright holders.|