Need to enroll in or renew your medical coverage for 2022? Enroll before December 15 for coverage effective January 1, 2022.

Healthcare Cost Assistance for

Approved Plans

Get healthy, get covered.

Benefit Summary

Carewell SEIU 503 Healthcare Cost Assistance helps eligible workers in approved health insurance Marketplace plans pay:

  • The net cost of your monthly premium (see FAQ for definition).
  • Out-of-pocket costs like deductibles, copayments, coinsurance, and prescription costs for services covered by your approved individual plan. Up to $6,600 of out-of-pocket expenses are covered in 2022.

This benefit applies only if you are enrolled in an approved Marketplace plan. However, if you became eligible for Carewell SEIU 503 benefits after the end of the last Open Enrollment period, and you are enrolled in a non-approved plan through a health insurance Marketplace, you may qualify for average premium reimbursements under Healthcare Cost Assistance. More information can be found in the FAQs.

Healthcare Cost Assistance is only available to eligible homecare and personal support workers, not to family members. If your family is included in your health insurance policy, Healthcare Cost Assistance will only cover the portion of the monthly premium that applies to your individual coverage. More information can be found in the Use this Benefit section below.

If you are eligible for Healthcare Cost Assistance, you will receive a Benefit Convenience Card (a Mastercard debit card) to pay for your monthly premium and covered out-of-pocket expenses. The card will come from Ameriflex (the Benefits Convenience Administrator). For more information about the Benefit Convenience Card and how to use it, click here.

Note: Renewal information for Healthcare Cost Assistance benefits for homecare and personal support workers enrolled in approved Marketplace plans can be found below in the Enrollment section.

Important Things to Know
  • This benefit pays for the net monthly premium for qualifying individual plans purchased through the Marketplace. It also covers up to $6,600 in 2022 in out-of-pocket medical expenses for claims covered by your approved individual plan. Carewell SEIU 503 Healthcare Cost Assistance benefits are not employer-sponsored or group health insurance coverage.
  • When you enroll, the Health Insurance Marketplace will offer you several plans to choose from. You can choose any plan you wish, but in order to receive Healthcare Cost Assistance benefits, you must enroll in the approved plan for your area.
  • Ameriflex will mail you a Benefit Convenience Card that you can use to pay your monthly premiums. You can also use it to pay your eligibile copays, coinsurance, and prescriptions.

Check your Eligibility

This information is for people who are eligible and need to sign up for an approved plan on a Healthcare Marketplace.

To see if you qualify, please complete this eligibility questionnaire.

A Carewell eligibility questionnaire on a mobile phone screen

Enrollment

Open Enrollment

If you’re enrolling in a Marketplace plan for the first time, you’ll probably need to wait until Open Enrollment to enroll. This year, Open Enrollment is between November 1 and January 15. For coverage starting January 1, 2022, you need to enroll before December 15. If you enroll between December 16 and January 15, your coverage will begin February 1, 2022. Special circumstances may allow you to enroll outside of this period, during what’s known as a Special Enrollment Period (SEP). 

Special Enrollment Period (SEP)

Outside Open Enrollment, there are limited exceptions that may allow you to enroll during a Special Enrollment Period. For example, if you lost your insurance coverage from a spouse’s plan or another employer, or you lost Medicaid coverage, you may be eligible to enroll outside Open Enrollment. Special Enrollment Periods only last 60 days from the date of the qualifying event (like termination of coverage), so if you believe you may be eligible for a SEP, call 1-844-503-7348 right away. See FAQ for more information on Special Enrollment Periods.

Enrollment

If you are enrolling into an approved Marketplace plan and Healthcare Cost Assistance benefits for the first time, please scroll down to see Steps to Enroll below the list of Steps to Renew.

Steps to Renew

 

Take the steps below before December 15, 2021 so you don’t experience a gap in health insurance coverage! 

Fill out the required 2022 annual paperwork

2022 Annual Paperwork (Digital) (Oregon and Washington).

These forms give the Carewell SEIU 503 Benefits team permission to assist you with enrolling in and maintaining your healthcare coverage. This paperwork is not an application for health insurance.

Renew your medical coverage

Take this short test to see what your best option is for renewing your coverage for 2022!

You can let your coverage renew automatically if you can answer yes to all five questions below: 

  • Are you still enrolled in your Marketplace medical plan? 
  • Are you up to date on your premium payments? 
  • Are you looking to renew just your own coverage, and not add or change coverage for family members?  
  • Have you updated your information with the Marketplace in the last two years? 
  • Are you enrolled in an approved plan for your area? You can find the list of approved plans for Oregon here, and for other states, look below in the Approved Plans section. 

IMPORTANT! Even if you let your coverage renew automatically, you still need to fill out the Enrollment Information Form to let us know your new premiums and advance premium tax credits for 2022. Insurance carriers like Kaiser Permanente, Providence, or Moda generally send that information by mail in October or November. Please be on the lookout for that letter! 

If you answered no or unsure to any of the questions above, you have two choices:  

The fastest option, if you’re comfortable renewing your coverage online yourself, is using the Enrollment Platform, administered by Valley Insurance Professionals, our insurance agency partner. Please note that the Enrollment Platform is only available in English and Spanish, and that only Oregon residents can use this platform.

        • Click here to see short guide to help you renew your coverage on the Enrollment Platform.  
        • Click here to access the Enrollment Platform.

      If you prefer to speak to an agent for assistance, give us a call to schedule an appointment with Valley Insurance Professionals at 1-844-503-7348. For instance, call us if you can’t use the Enrollment Platform for any reason (language barrier, technical issue, or because you live in a state other than Oregon….) Note: you need to first submit the 2022 annual paperwork, or Valley Insurance Professionals won’t be able to assist you.

You must pay your premium before your coverage renews.

You can use your Benefit Convenience Card to continue paying your premium. However, if you’re enrolled in a family plan, you need to use the Reimbursement process. Remember to update your billing information with your insurance carrier! Check out Set up automatic payments with your insurance carrier under Benefit Details. 

Finally, please be sure to read and reply to your mail from the Marketplace. If you don’t respond to a Marketplace request for information, you may lose your insurance coverage, Advance Premium Tax Credits, and Healthcare Cost Assistance benefits. Please monitor your mail and email for notifications from the Marketplace.

Steps to Enroll

 

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Important

All the steps listed must be completed in order to enroll in Healthcare Cost Assistance.

Fill out the required 2022 annual paperwork

2022 Annual Paperwork (Digital) (Oregon and Washington).

These forms give the Carewell SEIU 503 Benefits team permission to assist you with enrolling in and maintaining your healthcare coverage. This paperwork is not an application for health insurance.

Find an approved plan for your area from the list of plans and write down the plan name and number

In order to receive Healthcare Cost Assistance benefits, you must enroll in the approved plan for your area.

In order to enroll in an approved Marketplace plan

Call us at 1-844-503-7348 to schedule an enrollment appointment with our partner insurance agency, Valley Insurance Professionals.

Pay your first month’s premium to your insurance carrier before the due date

You will need to pay the first premium out of your own funds, and you will be reimbursed for the net premium amount you paid. You will then receive a Benefit Convenience Card for future payments. Set up automatic payments with your insurance carrier using the Benefit Convenience Card to avoid missing payments. Your plan will not be activated and you may lose coverage for the rest of the year if you don’t pay your first month’s premium on time.

For faster reimbursement of the first premium, you can sign up for direct deposit.

Direct Deposit Form (Digital)

Be sure to read and reply to your mail from the Marketplace

If you don’t respond to a Marketplace request for information, you may lose your insurance coverage, Advance Premium Tax Credits, and Healthcare Cost Assistance benefits. Please monitor your mail and email for notifications from the Marketplace.

You will know you are enrolled in Healthcare Cost Assistance when you receive the Benefit Convenience Card (BCC) in the mail. From the day of your enrollment, it can take up to 20 business days for the BCC to arrive in the mail. You should also receive reimbursement for your first premium, either by check or through direct deposit, within 20 business days of your enrollment.

If you have questions about enrolling in and accessing Healthcare Cost Assistance, please call 1-844-503-7348.

Benefit Details

Use This Benefit

Use your Benefit Convenience Card to pay for your covered:

  • Medical premiums
  • Out-of-pocket expenses (deductibles, copayments, coinsurance, and prescriptions)

You may be asked to show proof of your expenses, so keep the Explanation of Benefits you receive from your insurance carrier and all receipts.

The Card cannot be used for:

  • dental care or vision and hearing services;
  • expenses for your spouse or dependents;
  • expenses for services that your health insurance plan does not cover;
  • expenses incurred while you were not eligible for Healthcare Cost Assistance;
  • covered medical expenses from a previous calendar year. See the Reimbursements tab for more information.

If your family is on your health insurance policy, you won’t be able to use the Card for your premium payments. You will need to pay your premium using your own funds and then request a reimbursement each month. See the Reimbursements tab for more info.

Set up automatic payments with your insurance carrier

Make sure your premium is paid on time every month! Contact your insurance carrier to set up automatic payments from your Benefit Convenience Card:

Make an appointment

Before you make an appointment with a medical provider, make sure that they are in your insurance carrier’s provider network. If you receive services from out-of-network providers, you will incur much higher out-of-pocket expenses.

Keep Your Benefit

To ensure you continue receiving Healthcare Cost Assistance, please remember to:

  • Turn in your timesheets and/or payroll vouchers on a regular basis.
  • Avoid recording zero hours of work for two months in a row. Going two months in a row with no work could cause you to lose your Carewell SEIU 503 benefits, including Healthcare Cost Assistance. In this case, you would still have your Marketplace insurance plan but you would have to start paying for premiums yourself or look for alternative coverage like the Oregon Health Plan.
  • Keep your personal information up to date with Carewell SEIU 503 and your employer.
  • Pay your monthly premium to your insurance carrier on time, and monitor your premium payments. Your carrier may terminate your insurance plan if payments are missed.
  • Report to the Marketplace any change in your information within 60 days. We’re here to help with this… call 1-844-503-7348 for assistance.
  • Stay current on your tax filing.
Reimbursements

The fastest way to get your reimbursement is by completing the following forms online!

Medical Reimbursement Claim Form

Medical Reimbursement Claim Form (Digital)

Use the Medical Reimbursement Claim Form for:

  • Premium reimbursements if you are enrolled with family members on your plan. You can only claim the portion of your premium equal to your individual coverage. If you need help calculating your individual premium amount, contact the Marketplace (1-800-318-2596), your insurance carrier, or Valley Insurance Professionals (1-844-507-7554, option 2). Please submit this form and a copy of your premium bill each month.
  • Claiming reimbursement after March 31 for eligible costs from the previous calendar year.

Ameriflex Reimbursement Form

Ameriflex Reimbursement Form (Digital)

Use the Ameriflex Reimbursement Form to claim reimbursement:

  • When you have paid for an eligible cost out of your own funds instead of using the Benefit Convenience Card. For instance, if you paid for a prescription medication out-of-pocket because you didn’t have your Card with you at the time.
  • Claiming reimbursement until March 31 for eligible costs from the previous calendar year.

To make an appointment with Valley Insurance Professionals, please call 1-844-503-7348, or email carewellseiu503benefits@risepartnership.com.

You can also call that number or email for the following reasons:

  • Asssistance in determining a pathway to enroll in medical coverage
  • Assistance with OHP applications
  • Basic assistance with Carewell SEIU 503 benefits
Benefits Administrative Office

1-844-507-7554, option 3, option 2

ohcwt@vimly.com

Reasons to contact the Benefits Administrative Office:

  • Verify your eligibility for and enrollment into Carewell SEIU 503 Healthcare Cost Assistance
  • Questions about reimbursements
Valley Insurance Professionals

1-503-974-8471

hcwenroll@valleyinsurancepro.com

Reasons to contact Valley Insurance Professionals:

  • Questions about the enrollment platform or assistance over the phone
  • To make any of the following changes with the Marketplace:
    • Correct any personal information (name, date of birth, income or address)
    • Add or remove dependents due to pregnancy, birth, adoption, marriage, divorce, or death
    • Change your status (disability, tax filing, citizenship, tribal, incarceration)
    • Change in health coverage (for example, if you were offered coverage through a job or you started on Medicaid)
  • For assistance with submitting documentation requested by the Marketplace

Note: Do not call Valley Insurance Professionals to make an appointment with them. Instead, please call 1-844-503-7348, or email carewellseiu503benefits@risepartnership.com.

Federal Marketplace

1-800-318-2596

healthcare.gov

Reasons to contact the federal Marketplace:

  • Find out the amounts of advance premium tax credits you may receive, as well as your gross and net health insurance premiums
  • Request copies of your annual 1095 form

Note: For enrollment and life changes, we recommend that you enroll in and report life changes through Valley Insurance Professionals to ensure your information is also reported to the Benefits Administrative Office

Insurance Carriers

Reasons to contact your insurance carrier:

  • Set up automatic payments
  • Obtain new coverage ID cards
  • Questions about billing
  • Verify if your doctor or a specific procedure is covered

Kaiser Permanente
Customer service: 1-800-813-2000
kp.org

MODA Medical
Customer service: 1-877-605-3229
Moda Health contact information

PacificSource (Oregon)
Customer service: 1-888-977-9299
pacificsource.com

Providence
Customer service: 1-888-816-1300
providence.org

Ameriflex

1-888-868-3539

When calling, please identify yourself as a homecare or personal support worker receiving Carewell SEIU 503 benefits, and also have your Benefit Convenience Card with you.

Ameriflex online portal

Click here to learn more about the Ameriflex mobile app

Reasons to contact Ameriflex:

  • Check the balance on your Benefit Convenience Card, review your payment history, order a replacement card, etc.
  • If your Benefit Convenience Card was declined and you were unable to make a payment
  • Reimbursement claims on health insurance premium or medical expenses that were submitted to Ameriflex

Frequently Asked Questions

Read common questions about the Carewell Healthcare Cost Assistance benefit for approved plans. See the FAQs page for more information.

What's a Special Enrollment Period and am I eligible for one?

A Special Enrollment Period (“SEP”) allows you to enroll in a health insurance plan outside of the regular Open Enrollment period (Nov. 1 – Jan. 15 for 2022 coverage). You may qualify for a SEP if you have experienced life changes, such as losing job based-coverage, or a change in income that makes you no longer eligible for Medicaid.

If your SEP is approved by the Marketplace, you can enroll in a Marketplace Plan but you have limited time to get enrolled, usually 60 days from the date of your qualifying life event. The Marketplace will also need proof that you qualify for a Special Enrollment Period, so you need to gather that information as soon as possible to complete your enrollment. For assistance, call 1-844-503-7348.

Do I qualify for average premium reimbursements?

You may qualify for Healthcare Cost Assistance if you became eligible for Carewell SEIU 503 benefits after the end of the last Open Enrollment period and you are enrolled in a non-approved plan on a health insurance Marketplace. In this case, you would receive a Benefit Convenience Card to pay covered out-of-pocket expenses. You would also be eligible for reimbursement of your premium costs up to either

  • the lesser of your actual premiums, or
  • the average premium amount received by eligible care providers through Healthcare Cost Assistance.

To continue receiving Healthcare Cost Assistance after the end of the year, you must enroll in an approved plan as soon as possible and no later than Open Enrollment (between November 1 and January 15 for 2022 coverage). Otherwise, your Healthcare Cost Assistance will stop at the end of the calendar year. To check if you qualify for average premium reimbursements, call 1-844-507-7554, option 3, option 2.

What is my net health insurance premium?

Your net premium is the monthly amount that you must pay to your insurance company to maintain your insurance. For example, if your gross premium (the full cost of the premium from your insurance carrier) is $500 per month and your Advance Premium Tax Credit or APTC (the financial assistance from the Federal Government) is $200 per month, your net premium would be $300 per month.

How do I use my Benefit Convenience Card?

Your Card works just like a regular debit card, with two important differences:

1. Your card is limited in use, meaning you can only use it for the covered expenses listed under “What can I use the Card to pay for?”

2. You cannot use your Card at an ATM or to obtain cash back when making a purchase.

How much money is on the Benefit Convenience Card?

There are two “accounts” on your Card. One account is preloaded with the annual amount for paying medical and prescription copays, deductibles and coinsurance expenses for covered services and prescriptions. In 2022, that amount is $6,600, but this may change from year to year. The other account is preloaded with the amount necessary to pay your net monthly premium: the portion of your individual health insurance premium that is not covered by your Federal tax credit (APTC).

What is the Advance Premium Tax Credit (APTC)?

The Advance Premium Tax Credit (APTC) is a tax credit issued by the federal government that you can use to lower your monthly insurance payment (called your “premium”) when you enroll in a plan through the Health Insurance Marketplace. Your tax credit is based on the income estimate and household information you put on your Marketplace application. If your estimated income falls between 100% and 400% of the Federal Poverty Line, you qualify for a premium tax credit.

Approved Plans for 2022

You can enroll into any medical insurance plan you would like on the Marketplace. However, if you are eligible for Healthcare Cost Assistance, you must select an approved plan in order to get assistance from Carewell SEIU 503 with paying for your premium and eligible out-of-pocket medical costs.

As approved plans are decided, they will be listed here. Last Updated: October 20, 2021.

 

Oregon

Download PDF of 2022 Oregon plans by county (PDF)

Washington

Download PDF of 2022 Washington plans by county (PDF)

California

Anthem Silver 70 EPO
BlueShield of California Silver 70 PPO

Idaho

PacificSource Navigator SILVER HSA 3500

You can see Summaries of Benefits and Coverage for approved plans here.

Approved Plan for Multnomah County

KP OR Silver 2500/40, Plan ID 71287OR0420011

2022-SBC-KP-OR.pdf


Kaiser Permanente: KP OR Silver 2500/40, Plan ID 71287OR0420011

Download Summary of Benefits and Coverage (PDF)

Approved Plan for Asotin County

LifeWise Health Plan of Washington Essential Silver Low Deductible Plan

WA-LifeWise-Essential-Silver-Low-Deductible.pdf


LifeWise Health Plan of Washington Essential Silver Low Deductible Plan, Plan ID 38498WA0320004

Download Summary of Benefits and Coverage (PDF)

Approved Plan for Washington County

KP OR Silver 2500/40, Plan ID 71287OR0420011

2022-SBC-KP-OR.pdf


Kaiser Permanente: KP OR Silver 2500/40, Plan ID 71287OR0420011

Download Summary of Benefits and Coverage (PDF)

Approved Plan for Lane County (Inside Kaiser Service Area)

KP OR Silver 2500/40, Plan ID 71287OR0420011

2022-SBC-KP-OR.pdf


Kaiser Permanente: KP OR Silver 2500/40, Plan ID 71287OR0420011

Download Summary of Benefits and Coverage (PDF)

Approved Plan for Lane County (Outside Kaiser Service Area)

Providence Oregon Standard Silver - Choice Network, ID 56707OR1330004

2022_SBC-Providence_Oregon_Standard_Silver_Plan_Choice_Network_00.pdf


Providence Oregon Standard Silver Plan - Choice Network, Plan ID 56707OR1330004

Download Summary of Benefits and Coverage (PDF)

Approved Plan for Baker County

Providence Oregon Standard Silver - Signature Network, ID 56707OR1360004

2022_SBC-Providence_Oregon_Standard_Silver_Plan_Signature_Network_00.pdf


Providence Oregon Standard Silver Plan - Signature Network, Plan ID 56707OR1360004

Download Summary of Benefits and Coverage (PDF)

Approved Plan for Benton County (Inside Kaiser Service Area – OR)

KP OR Silver 2500/40, Plan ID 71287OR0420011

2022-SBC-KP-OR.pdf


Kaiser Permanente: KP OR Silver 2500/40, Plan ID 71287OR0420011

Download Summary of Benefits and Coverage (PDF)

Approved Plan for Benton County (Outside Kaiser Service Area – OR)

Providence Oregon Standard Silver - Choice Network, ID 56707OR1330004

2022_SBC-Providence_Oregon_Standard_Silver_Plan_Choice_Network_00.pdf


Providence Oregon Standard Silver Plan - Choice Network, Plan ID 56707OR1330004

Download Summary of Benefits and Coverage (PDF)

Approved Plan for Benton County (WA)

KP WA Flex Silver

WA-Kaiser-Flex-Silver.pdf


Kaiser Permanente Washington Flex Silver, Plan ID 80473WA1000001

Download Summary of Benefits and Coverage (PDF)

Approved Plan for Clackamas County (Inside Kaiser Service Area)

KP OR Silver 2500/40, Plan ID 71287OR0420011

2022-SBC-KP-OR.pdf


Kaiser Permanente: KP OR Silver 2500/40, Plan ID 71287OR0420011

Download Summary of Benefits and Coverage (PDF)

Approved Plan for Clackamas County (Outside Kaiser Service Area)

PacificSource OR Standard Silver Plan NAV, Plan ID 10091OR0750013

PacificSource-Oregon-Standard-Silver-Plan-NAV_10091OR0750013-00-SBC.pdf


PacificSource Oregon Standard Silver Plan NAV, Plan ID 10091OR0680007

Download Summary of Benefits and Coverage (PDF)

Approved Plan for Clark County

KP WA Silver 2500/40

2022-SBC-KP-WA-Silver-250040.pdf


Kaiser Permanente Washington Silver 2500/40, Plan ID 23371WA1760002

Download Summary of Benefits and Coverage (PDF)

Approved Plan for Clatsop County

Providence Oregon Standard Silver - Choice Network, ID 56707OR1330004