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 Benefits 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.
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
Sign up for a Trust-qualified health plan through your state’s Health Insurance Marketplace if you are not eligible for OHP Plus and/or any other major medical insurance.
The Supplemental Trust does not provide health insurance directly. If you are not eligible for OHP Plus 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. The Trust-approved qualified health plans for 2016 in Oregon are the Kaiser Permanente $1500 Deductible Silver 1500/30 HMO plan (if you live within the Kaiser Service area), the MODA $1,550 Deductible Be Prepared Silver plan (if you live outside the Kaiser service area) and the Oregon's Health Co-op $3,500 Deductible Simple Silver HSA Broad plan (statewide). The Trust-approved qualified health plan for 2015 in Idaho is Pacific Source BrightIdea Balance Silver $2500 Deductible HMO plan. UPDATE July 2016: The Trust-approved qualified health plans for 2016 in Oregon beginning 7/15/16 are the Kaiser Permanente $1500 Deductible Silver 1500/30 HMO plan (if you live within the Kaiser Service area), the PacificSource $2,500 Deductible OR Standard Silver Plan PSN (AI) PPO plan (if you live outside the Kaiser service area and within Clackamas, Crook, Deschutes or Jefferson counties) and the BridgeSpan Health Company: BridgeSpan $2,500 deductible Oregon Standard Silver Plan Value PPO (outside of the Kaiser and PacificSource areas).
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.
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.
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 Benefits 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 -Qualified Health Plan on the applicable Exchange.
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.
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
Effective February 1st, 2016, to be eligible for 20 hours of PTO benefits on February 1st, personal support workers or hourly homecare worker 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.
- Perform at least 112 Hours of Eligible Live-in Homecare Work
Effective November 1, 2015, to be eligible for PTO benefits each month, a live-in homecare worker must perform 112 or more hours of eligible live-in homecare work, providing services to seniors and people with physical disabilities. The amount of benefits accrued each month will depend on the number of hours of eligible live-in homecare work performed in the eligibility month (two months prior to the accrual month), according to the following chart. However, in no event may a live-in homecare worker have more than 144 hours of accrued PTO benefits at any given time:
Hours Worker Per Month PTO Benefits Earned Per Month 112 8 160 12 222 16 288 20 352 or more 24
- 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.
- For more information on Paid Time Off benefits, please refer to the appropriate Frequently Asked Questions 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@bsitpa.com
- Paid Time Off - Frequently Asked Questions Rev June 2016: PSWs and Hourly HCWs
- Paid Time Off – Frequently Asked Questions – for eligible Live-in Homecare Workers providing services to seniors and people with physical disabilities
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Opt Out of Benefits
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 Dental, Vision and Employee Assistance Program
- Reimbursement amount paid incorrectly
- Reimbursement not paid
- Reimbursement mailed to the wrong address