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wí:koʔ
Waco
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Frequently Asked Questions

Below are some questions that have been asked about the tribal member health plan:

  • Does the plan cover dentures? Yes
  • Does the plan cover orthodontics? Yes, for children under 18 with appeal. Appeals must be filed through Native Care Health.
  • Does the plan work for out-of-state hospitals, doctor's offices and pharmacies? Yes
  • Does the plan cover glasses more than once a year for an elder that has serious eye problems that requires their prescription to change often? Eye exams, frames and lenses are covered once a year.
  • Is there an appeals process for any disputes, chronic illness needs or major medical emergency needs?Yes, a letter with supporting documentation can be sent to the address on your card, and the appeal will be reviewed by the Executive Committee. 
  • How does the plan cover prescription drugs?If the plan is secondary to any other insurance, it will pick up the patient responsibility at 100% up to the calendar year max of $500.00. If you have no other coverage, the Tribal Member Plan will have a $0 co-pay for Generic drugs and a $25.00 co-pay for brand name up to the calendar year max of $500.00. If you are 55 years or older, there is no internal limit.
  • How does someone with Medicare and Medicaid benefit from the program? Medicare and Medicaid have a great deal of non-covered items.  These items are typically covered under the plan.  One example is coverage of your Medicare deductible.
  • How does someone with Sooner Care benefit from the program? Soonercare is a form of Medicaid in Oklahoma. Many items are considered non-covered.  
  • If someone has a primary insurance, does this affect their primary insurance? No. This is plan is used to supplement and help cover out-of-pocket costs for members who have insurance.  If you do not have any coverage, this will give you access to basic coverage.
  • If someone is on their spouse's insurance and has to list this coverage, will it affect their eligibility to be carried on their spouse's insurance?  Tribal Member Plans are covered under the Indian Healthcare Reauthorization Act as well as the ACA and are not required to be reported as minimum essential coverage in this situation.
  • Does the plan work if the individual is having a baby? Can the full $1,500 be applied to the delivery?  Yes, but please contact Native Care Health on how this can be applied.
  • Is chiropractic care covered? Yes
  • Is counseling covered? Are there specific types? All counseling services are covered as long as they are medically necessary.  This does include family and marital therapy, which are many times not covered under standard plans.
  • Can diabetic shoes be purchased through the plan? Yes