This is a summary of the Eligibility Rules. Please refer to your Plan Booklet May 2016 for more information on eligibility, available in English, Spanish, Vietnamese, and Russian. To be eligible for benefits (other than paid time off benefits) under the Oregon Homecare Workers Supplemental Trust and the Oregon Homecare Workers Benefit Trust, you need to:
Perform 40 hours of eligible homecare or personal support work per month for two months in a row.
These 40 hours per month can be based on work performed for multiple consumers, and can include both homecare and personal support work. Hours worked and paid through the Independent Choices Program do not qualify. You can learn more about eligibility on Page 6 of your Plan Booklet.
Sign Up for OHP Plus if You Are Eligible
You must sign up for OHP Plus if you are eligible. OHP Plus is affordable quality health care – there are no premiums and only minimal co-pays. If you are eligible for OHP Plus and you choose not to enroll, you will not be eligible to receive a premium reimbursement from the Supplemental Trust for health coverage under another plan. Click here to learn more about the Oregon Health Plan. In Washington it is Apple Health, in California it is Medi-Cal and in Idaho it is Medicaid.
Sign Up for Medicare if You Are Eligible
If you are eligible to receive Medicare and you choose not to enroll, you will not be eligible to receive a premium reimbursement from the Supplemental Trust for medical coverage under another plan. If you are enrolled in Medicare, please visit the Medicare page for more information.
Sign Up for a Trust-Approved Qualified Health Plan through your State's Health Insurance Marketplace during Open Enrollment or a Special Enrollment Period if you are not eligible for OHP Plus, Apple Health, Medi-Cal, Medicaid, Medicare or any other major medical insurance.
The Supplemental Trust does not provide health insurance directly. If you are not eligible for OHP Plus, Apple Health, Medi-Cal, Medicaid, Medicare or any other major medical insurance, you must sign up through your State's Health Insurance Marketplace during Open Enrollment or a Special Enrollment Period to be eligible for benefits under the Supplemental Trust.
Open Enrollment begins November 1, 2018 for medical coverage beginning January 1, 2019. For information on 2018 coverage, visit the 2018 Marketplace Enrollment Materials Page.
As Trust-Approved Plans are decided for 2019 they will be listed here. Last Updated: October 3, 2018. Check back in late October of 2018 for more information.
- For participants that reside within the 2018 Oregon or Washington Kaiser Service Area: Kaiser Permanente $2,500 Deductible Silver 2500/30 HMO plan will be the Trust-Approved Plan for 2019. The Oregon plan ID is 71287OR0420011, and the Washington plan ID is 23371WA1760002.
Make sure your information is up-to-date
The Trust Administrative Office must verify that you have completed your required hours before you can get Trust benefits. It can take time for the State data to be updated, so make sure you turn in your vouchers on a regular basis and make sure all your information (including gender and birthdate) is updated with the State. You can submit your updated demographic information to the Trust Administrative Office by filling out the Update Info form, but this does not replace the data that the Trusts receive from the State.
Once you become eligible for Trust benefits:
You remain eligible for benefits under the Trusts, including supplemental benefits, dental, vision and Employee Assistance Program benefits unless you work zero hours for two consecutive months. You can learn more about eligibility on Page 6 of your Plan Booklet.
If you have health insurance through a different employer, spouse or government program:
You still can get dental, vision and Employee Assistance Program benefits through the Benefit Trust.
However, you cannot get supplemental benefits through the Supplemental Trust. Those benefits are available only for eligible individuals whose only health coverage is provided through a Trust-Approved Qualified Health Plan on the applicable Exchange or Medicare Part B and/or Medicare Advantage/Supplemental or Part D coverage.
Family members are not covered under the Trusts. You can often find affordable health care options for your family through the Health Care Exchange.
If your eligibility was previously denied and you would like to appeal the decision or request a new determination of eligibility, please submit an Appeal form along with your proof of hours worked.
There are opportunities to meet with the Healthcare Enrollment Team in person at an education event or education seminar. Call the Trusts' Healthcare Enrollment Team at 503-303-5668 (Portland Metro Area) or toll free 1-855-437-2694 to learn more and RSVP!
To be eligible for Paid Time Off (PTO) benefits under the Oregon Homecare Workers Benefit Trust, which are designed to be used in connection with taking time-off from regularly scheduled hours with a consumer, you need to:
- Perform at least 80 Hours of Eligible Personal Support Work or Hourly Homecare Work in the applicable determination period.
For 20 hours of PTO benefits on February 1st, you must perform 80 or more hours of eligible personal support work or hourly homecare work in one of these months: October, November or December of the preceding calendar year. To be eligible for 20 hours of PTO benefits on July 1st, you must perform 80 or more hours of eligible personal support work or hourly homecare work in one of these months: March, April or May of the same calendar year.
- Submit your W-9 Form and Beneficiary Designation Form to the Trust Administrative Office.
If you have worked the required number of hours to earn a PTO benefit, the Trust will mail you an eligibility packet containing a Benefit Request Form, a Form W-9 and a Beneficiary Designation Form. You must complete and return the Form W-9 in order to be eligible for PTO benefits. You can do this securely now through Docusign.
- For more information on Paid Time Off benefits, please refer to the Frequently Asked Questions (PDF) - English, Russian, Spanish, Vietnamese, Chinese. If you have questions about PTO, please contact your Trust Administrative Office at 1-844-507-7554, select Option 3 then Option 2 or email OHCWTPTO@vimly.com.
- Hourly Homecare and Personal Support Workers' Paid Time Off: Dates to Remember - English, Spanish, Russian, Vietnamese, Chinese
Plan Booklet May 2016 English, Spanish, Vietnamese, or Russian
Enrollment Rules - DACA Immigration Status - English or Spanish
Enrollment Rules for Oregon Residents Residing More than 30 Miles from a Kaiser Medical Facility - English
Paid Time Off Rates of Pay and Coverage Options to Replace the Oregon Health Co-op - English
2017 Updates: Enrollment Rules, Summary of Benefits, Medicare, Exchange Medical Insurance, Costs Covered by the Trust, Reimbursement, What's Next - English, Spanish, Vietnamese, Russian, Chinese
2017 Updates: California and Washington Trust-Approved Plans - English
2017 Updates: Claims and Appeal Procedure, Overpayments - English
2018 Kaiser Service Area Trust-approved Plan - English, Spanish, Russian, Vietnamese, or Chinese
2018 Eligibility Grace Period - English, Russian, Chinese, Spanish, or Vietnamese
2018 Updates: Enrollment Rules, Summary of Benefits, Exchange Medical Insurance Plans, Supplemental Trust Reimbursement - English, Russian, Chinese, Spanish, Vietnamese
2018 Updates: Enrollment Rules, Exchange Medical Insurance for California, Idaho and Washington
2019 Kaiser Service Area Trust-Approved Plan for 2018 Kaiser Service Area participants and 2018 Eligibility Grace Period
If you wish to opt out of the dental, vision and Employee Assistance Program benefits provided through the Benefit Trust, fill out and submit the following form by mail or fax to:
Oregon Homecare Workers Trusts
PO Box 6
Mukilteo, WA 98275
Please note that once you opt out of these benefits, you will not be eligible to re-apply until the next federal open enrollment period.
If there is an issue with a reimbursement claim you previously submitted, or if you would like to request an eligibility re-determination, fill out and submit the following form and any supporting materials by mail or fax to:
Oregon Homecare Workers Trusts
PO Box 6
Mukilteo, WA 98275
Some of the possible issues that you can address with the Appeals form include:
- Eligibility re-determination for Benefit Trust
- Concern relating to Supplemental Trust Reimbursement amount issue
- Supplemental Trust reimbursement not paid
- Reimbursement mailed to the wrong address