The information you need to provide to the Trust Administrative Office includes your current medical coverage insurance plan name, your premium amount, tax subsidy amount, and the start date of your coverage for that premium amount. You can get this information from your insurance carrier or your Health Insurance Marketplace. Note: Once you submit this information and it is received by the Trust Administrative Office, it can take up to 20 business days to see that information reflected on your Benefit Convenience Card.
AFTER YOUR ANNUAL PAPERWORK IS COMPLETE, SUBMIT YOUR INFORMATION BY FILLING OUT THIS SECURE ENROLLMENT INFORMATION FORM. If you need assistance filling out the information, please refer to the Guide to Fill Out the Enrollment Information Form.
IMPORTANT: If you have not already done so, please fill out the annual pre-enrollment paperwork (HIPAA, Statement of Understanding, Agent of Record and Consent forms) for your area:
- 2020 Inside the Oregon or Washington Kaiser Service Area: English, Russian, Spanish, Chinese, Vietnamese, Somali, Arabic, or
- 2020 Outside the Oregon or Washington Kaiser Service Area: English, Russian, Spanish, Chinese, Vietnamese, Somali, Arabic, or
- 2020 California and Idaho English, Russian, Spanish, Chinese, Vietnamese, Somali, Arabic
This paperwork is required for your enrollment to be fully processed. If this paperwork is not on file it can delay your benefits.
You will get a premium bill from your insurance carrier once your information has been processed by your insurance carrier. You will need to pay this bill to your insurance carrier to activate or continue your insurance coverage, and you will need to continue to pay your monthly premium by the due date, in full, every month. If you do not, your insurance carrier will not activate or continue your medical coverage and you could be without medical insurance for the entire year.