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 0 hours of work for 2 months in a row. Going 2 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.
• Submit the Healthcare Cost Assistance Benefits Request Form every year you are eligible for this benefit.
• 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. Just call 1-844-503-7348 for assistance.
• Stay current on your tax filing.

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

Medical Premium Reimbursement Claim Form

Medical Premium Reimbursement Claim Form (Online)

Use the Medical Premium 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 are enrolled in an approved plan on a Health Insurance Marketplace. If you need help calculating your individual premium amount, contact the Marketplace (1-800-318-2596), your insurance carrier, or Valley Insurance Professionals (503-480-0499 ext. 7). Please submit this form and a copy of your premium bill each month.
• You are eligible to receive a temporary average premium reimbursement (APR) for a non-approved plan on a Health Insurance Marketplace.

Ameriflex Reimbursement Claim Form

Ameriflex Reimbursement Claim Form (Online)

Use the Ameriflex Reimbursement Claim Form to claim reimbursement:

• Covered Medical Out-of-Pocket expenses if you paid with your own funds. For instance, if you paid for a prescription medication out-of-pocket because you didn’t have your Benefit Convenience Card with you at the time.
• Covered Medicare Out-of-Pocket expenses if you paid with your funds. For instance, if you paid for a prescription medication out-of-pocket because you didn’t have your Benefit Convenience Card with you at the time.
• Medical Monthly Premium – net monthly premium for qualifying individual plans purchased through the Marketplace (not family plan, not average premium reimbursement).

Losing Carewell SEIU 503 benefits does not mean you’re losing your health insurance coverage! But at the end of your grace period month, your Benefit Convenience Card (BCC) will be turned off and you will have to start paying your own premiums and out-of-pocket medical expenses.

Don’t throw away your BCC!  If you become eligible for Healthcare Cost Assistance benefits again, you’ll be able to use your card again.

Remember! If you set up automatic payment with your health insurance carrier, you’ll need to contact your carrier to update your payment information. Click here to find contact information for carriers (like Kaiser Permanente, Moda, or Providence).

If you have coverage through a Marketplace plan:

• Make your premium payments on time, or you may lose coverage for not making a payment. Losing eligibility for Healthcare Cost Assistance is not a Qualifying Life Event, so you may need to wait until the next Open Enrollment to enroll in health insurance.
• Update your Marketplace application if your income has changed.

If your income is lower because you lost work hours, you may become eligible for Medicaid coverage. You can apply any time of the year for:

• Oregon Health Plan (OHP) in Oregon — click here to go to website.
• Apple Health in Washington — click here to go to website.

If you have a Marketplace plan, you’ll have to fill out the Healthcare Cost Assistance Benefits Request Form to let us know about your plan and your premiums. We also recommend you call 1-844-503-7348 to ensure your Healthcare Cost Assistance (HCA) benefits start again without delays.

If you kept your Benefit Convenience Card (BCC), you should still be able to use it, unless the expiration date on the front has passed. Please note that Ameriflex, the BCC Administrator, issued new cards in July 2022. If you received your BCC before that date, it is no longer valid, regardless of its expiration date.

If you don’t have a valid BCC, call Carewell SEIU 503 at 1-844-503-7348 to order a new card.

If you have no medical coverage, you may not be able to enroll in a medical insurance plan on the Healthcare Insurance Marketplace until Open Enrollment, unless you qualify for a Special Enrollment Period. Open Enrollment usually begins on November 1 for coverage the following year. Until you enroll in an approved plan on the Marketplace, you would not be able to receive Healthcare Cost Assistance benefits.

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 (generally between November 1 and December 15 for coverage the next year). Otherwise, your Healthcare Cost Assistance will stop at the end of the calendar year.

Click here for more information. To check if you qualify for average premium reimbursements, call 1-844-503-7348.

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.

Your Benefit Convenience 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 Benefit Convenience Card to pay for?”

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

There are two accounts on your Benefit Convenience 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 2023, that amount is $6,900, 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 advance premium tax credit (APTC).

• The deductible applicable to your Medicare plan. A deductible is the amount you must pay for the services that your Medicare plan covers before Medicare begins to pay. 
• The copayments for medical services and prescriptions covered by your Medicare plan. A copayment (or copay) is a fixed amount your Medicare plan may require you to pay, and is usually due at the time that you receive the service or prescription. 
• The coinsurance for medical services and prescriptions covered by your Medicare plan. Coinsurance is a percentage of the costs you must pay for services your Medicare plan covers. Cost sharing may range from 20% to 50% of a covered service, depending on your Medicare plan. For example, if your Medicare plan has an “80/20” coinsurance arrangement, this means that, after you pay any deductible, your Medicare plan will pay 80% of the cost of the covered medical expense and you must pay the remaining 20%. 

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.