This page is a summary for what costs are covered by the Supplemental Trust. For a comprehensive explanation of what is covered by the Supplemental Trust, please check your Plan Booklet (PDF) in English, Spanish, Vietnamese, or Russian.
Open Enrollment is closed for 2020, and unless you qualify for a Special Enrollment Period you will not be able to enroll into Marketplace medical coverage. Visit healthcare.gov for more information on Special Enrollment Periods.
For participants who have medical insurance through a Trust-Approved plan offered through the applicable Exchange:
- The Supplemental Trust covers any amount of your premium above and beyond your federal tax credit. If you are covered under one of the Trust-Approved plans through the Exchange and are eligible for benefits under the Supplemental Trust, the Trust will continue to reimburse your net premium, which is the part of your individual premium that is left after applying the maximum federal Advance Premium Tax Credit ("APTC") you are eligible to receive.
- If you are enrolled as an individual, the Trust will provide your premium assistance through your Benefit Convenience Card ("Card") - English, Spanish, Russian, Vietnamese, Chinese directly. You will need to set up your Card with your insurance carrier directly. Please refer to the Benefit Convenience Card Set-Up instructions for your medical plan, which can be found on the Resources page. For more information on about your Benefit Convenience Card, please see the Benefit Convenience Card - Frequently Asked Questions (PDF) - English, Spanish, Russian, Vietnamese, Chinese. If you already have a Card, you can continue to use your Card to pay your monthly premiums.
- If you enrolled in family coverage under a Trust-Approved Exchange plan, the Trust will not pay your premium directly. Instead, you will need to pay the premium directly to the insurance carrier and then submit a copy of your premium bill to the Trust Administrative Office for reimbursement of the premium amount relating to your individual coverage. In order to receive monthly premium reimbursements from the Trust in 2020, you will need to submit a new Reimbursement Form and proof of premium payment to the Trust Administrative Office every month you are requesting premium reimbursement(s). Please note, the Trust will reimburse you only your portion of the premium. You will need to submit proof from your medical carrier or the Marketplace of your portion of the net premium amount after your APTC. You can fill out the Reimbursement Form online or request the paperwork be mailed to you.
In addition to your premium, the Trust reimburses for:
- Your Trust-Approved Exchange plan deductibles, copays and coinsurance: You will be eligible for coverage of up to $3,000 in 2016, up to $4,000 in 2017, up to $5,000 in 2018, up to $6,000 in 2019 and up to $6,190 in 2020 from the Trust for your covered deductible, copayment and coinsurance expenses relating to any claims you incur that are covered under the Trust-Approved Exchange plan in which you are enrolled.
You may pay for covered medical deductibles, copayments and coinsurance expenses at the point of service using the Benefit Convenience Card issued to you by the Trust. If you have not received your Benefit Convenience Card, please follow the Trust's reimbursement process by submitting a completed Ameriflex Reimbursement Form along with a copy of your explanation of benefits ("EOB"). Your maximum yearly reimbursement is $3,000 in 2016, $4,000 in 2017, up to $5,000 in 2018, up to $6,000 in 2019 and up to $6,190 in 2020 for all deductible, copayment and coinsurance costs covered by your Trust-Approved plan.
The Supplemental Trust does not cover the following costs; you are responsible for paying these on your own.
- Family members: There is no assistance provided for the expenses of a participant's non-Trust eligible family members.
- Dental, Vision and Employee Assistance Benefits are not reimbursed through the Supplemental Trust and you cannot use your Benefit Convenience Card for these expenses.
- The Supplemental Trust does not cover expenses relating to services not covered under your Trust-Approved Qualified Health Plan.
To get reimbursed, you will need to submit the following reimbursement claim form and supporting materials to the Trust. Please type your information into the form, print and then mail or fax (along with a copy of your Explanation of Benefits or your bill) to the Trust. Once the Trust has processed your paperwork for payment, you will receive a check from the Trust. To reference what type of reimbursement check you are receiving, refer to the Check from the Trust Guide (PDF).
For premium reimbursements if you enrolled with family members onto your plan:
Reimbursement Claim Form (PDF) - Revised October 2019 - English, Spanish, Russian, Vietnamese, Chinese or securely via DocuSign - English, Spanish, Russian, Vietnamese, Chinese
For premium adjustments - refer to page 20 of your plan booklet: Premium Adjustment Reimbursement Form (PDF) - English
Oregon Homecare Workers Trusts
PO Box 6
Mukilteo, WA 98275
For eligible Benefit Convenience Card Reimbursements, please use the Ameriflex Reimbursement Form (PDF). If you need assistance filling out the form, please refer to this Guide to Ameriflex Reimbursement Form (PDF).
Ameriflex Claims Department
PO Box 269009
Plano, TX 75026