Open enrollment for 2016 closed on January 31st. The 2017 open enrollment period is currently scheduled to begin in November.
Please note, there may be a different process and these materials may not apply to you if you currently, or you have ever been, eligible for other medical insurance even if you do not currently use it. This includes: Medicare; Medicare through Disability; dual Medicaid/Medicare; Medicaid such as the Oregon Health Plan; coverage through another employer; Tribal or Indian Health Services coverage; coverage through your spouse; other private medical insurance; a plan through the Health Insurance Marketplace that is not a Trust-approved plan; Veteran’s Affairs benefits; or any other coverage that may meet the Federal standard for minimum essential coverage. Please call us at 1-855-437-2694 if you have not already discussed this other insurance with your ACA Healthcare Enrollment Team before continuing.
If you are a Trust eligible Participant that qualifies for enrollment through an Exchange, in order to receive benefits from the Trust, you will want to select one of the Trust Approved plans applicable to your State.
UPDATED October 25, 2016
Through November 30th for 2016 coverage: If you qualify for a Special Enrollment Period to enroll into a Qualified Health Plan through the Health Insurance Marketplace, you have a limited time to get enrolled, usually 60 days from the date of your qualifying event. If you experience a Qualifying Life Event and are eligible for a Special Enrollment Period for 2016 please follow the steps below as soon as possible:
- Review the enrollment process checklist in English or Russian
- Review the Trust-approved plans for 2016
- Fill out the required pre-appointment paperwork:
- Kaiser Service Area pre-appointment materials via DocuSign in English, Spanish,
- PacificSource Service Area pre-appointment materials via DocuSign in English, Spanish,
- BridgeSpan Service Area pre-appointment materials via DocuSign in English, Spanish, and the Community Partner Consent form - English, Spanish
- Schedule your phone enrollment appointment with Valley Insurance Professionals or the Trust's Healthcare Enrollment Team
- Respond to any Marketplace requests for information
- Pay your first month's premium to your insurance carrier to activate your coverage
- Get your new medical ID card
- Set up automatic premium payments for the due date so that you do not lose your medical insurance due to non-payment
- If you live in the Kaiser service area, the Trust-approved plan is the Kaiser Permanente: KP OR Silver 1500/30 HMO plan with the $1,500 deductible. The Plan ID number is 71287OR0420011. You can review the Kaiser Permanente plan here and search for providers here, and look up prescription coverage here (PDF).
- If you live in Crook, Deschutes or Jefferson Counties, or the part of Clackamas County not covered by Kaiser, the Trust-approved plan is the PacificSource OR Standard Silver Plan PSN (AI) PPO plan with the $2,500 deductible. The Plan ID number is 10091OR0360005. You can review the PacificSource PSN plan here, search for providers here, and look up prescription coverage here.
- If you live outside of the Kaiser service area, and outside of Crook, Deschutes or Jefferson Counties, the Trust-approved plan is the BridgeSpan Health Company: BridgeSpan Oregon Standard Silver Plan Value PPO with the $2,500 deductible. The Plan ID is 63474OR0010002. You can review the BridgeSpan Value PPO network plan here, search for providers here, and look up prescription coverage here.
- If you are unsure which plan is for your area, please look at the 2016 County Reference.
Through November 30th for 2016 coverage: If you need to report a change to your Marketplace information for 2016, you can contact your Marketplace directly online or by telephone and make that report and then complete the Enrollment Information Form to alert the Trust Administrative Office to your new information so that they can update your Benefit Convenience Card. If you need assistance reporting your change, please visit the online phone appointment scheduling tool. Remember to monitor your premium payments with your medical insurance company as your premium may have changed and you may need to take steps to make sure you are paying the correct premium amount.
Materials you may find useful to assist your enrollment
- Employer Coverage Tool in English (PDF), Spanish, Vietnamese or Russian – only if you or anyone in your tax filing household is eligible for or has other medical insurance through an employer
- Consent to Release in English (via DocuSign), Spanish, Vietnamese, Russian or Chinese - only if you need to allow a trusted family member to make inquiries, schedule appointments or confirm information on your behalf
- Let us know your current contact and medical coverage information so we can assist you with your options for 2016 by filling out this form
- My HealthCare.gov Account, Updated October 2016
- Creating a Healthcare.gov Account
Materials to assist you after your enrollment
- Benefits Convenience Card Frequently Asked Questions Revised May 2016 - English
- Benefit Convenience Card Affidavit: PDF versions - English, Spanish, Vietnamese, Russian or DocuSign versions: English, Spanish, Vietnamese, Russian, or Chinese
Below are answers to several common questions about the enrollment process.
Q: I was in the Oregon Health Co-op, where can I find more information?
A: Visit the What To Do Page.
Q: There are no phone appointments available on the website scheduler. What should I do?
A: Continue to check the website for new appointment openings. Appointments continue to fill up as they become available.
Q: Am I required to enroll in one of the Trust-approved plans?
A: No, you can select any plan on the Marketplace. However, if you are eligible and would like to be eligible for premium assistance and out-of-pocket assistance under the Supplemental Trust, you must enroll in one of the Trust-approved plans on the Health Insurance Marketplace. Refer to your Plan Booklet--available in English, Spanish, Vietnamese, or Russian--for more information.
Q: I have used my $3,000 out-of-pocket benefit under the Supplemental Trust already this year for covered out-of-pocket expenses. What’s going to happen?
A: You are eligible for a maximum $3,000 out-of-pocket assistance benefit from the Trust each year, if you meet all the eligibility requirements of the Trust. If you have already spent your entire $3,000 for the year, you are responsible for any out-of-pocket costs you incur for the rest of the year. Refer to your Benefit Convenience Card Frequently Asked Questions for more information.
Q: I enrolled in a Non-Trust-approved plan, what should I do if I want to receive Supplemental Trust benefits?
A: If you became Trust-eligible outside of open enrollment and already have coverage under a plan, you may qualify for the Supplemental Trust’s average premium reimbursement benefit. Refer to pages 11-12 of your Plan Booklet, and if you qualify, you can submit your information to the Trust Administrative Office for review via the reimbursement process.