Healthcare Cost Assistance for
Approved Medical Plans on the Marketplace
Have medical coverage, be healthy.
Benefit Summary
Carewell SEIU 503 Healthcare Cost Assistance helps eligible care providers 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 $7,165 of out-of-pocket expenses are covered in 2025.
This benefit applies only if you are enrolled in an approved Marketplace plan:
Please note that the Moda health insurance plans are no longer available as approved plans in 2025. Care providers on Moda need to switch to an approved 2025 plan for their county to request Healthcare Cost Assistance benefits.
Not on an approved plan?
2025 Open Enrollment
During Open Enrollment, if you are on a non-approved plan through a health insurance Marketplace and/or receiving temporary Healthcare Cost Assistance benefits, you need to enroll in an approved Marketplace Silver plan to receive Healthcare Cost Assistance for the full amount of your 2025 individual net premiums.
If you do not change to an approved Silver plan during Open Enrollment, you may not be eligible for Healthcare Cost Assistance benefits in 2025.
Act Now! Click here to enroll
Questions? Call us at 1-844-503-7348, Monday – Friday, 8am to 6pm (PST) or email CarewellSEIU503Benefits@RISEpartnership.com
We’re here to help!
Healthcare Cost Assistance is only available to eligible homecare workers, personal care attendants, 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 credit 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.
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 $7,165 in 2025 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 eligible 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 Health Insurance Marketplace.
To see if you qualify, please complete this eligibility questionnaire.
Enrollment
Open Enrollment
An open enrollment period is a window of time that happens once a year when you can sign up for health (medical) insurance or change your current plan. The Marketplace Open Enrollment is between November 1 and December 15 for coverage starting the following January 1. If you enroll between December 16 and January 15, your coverage starts February 1. If you are enrolling in a Marketplace plan for the first time, you will most likely need to wait until Open Enrollment to enroll. There are some special circumstances that may allow you to enroll outside of this period; see the FAQs for more information.
Request Healthcare Cost Assistance Benefits
To request Healthcare Cost Assistance benefits, Trust rules require you to provide proof of your Marketplace plan by submitting:
- Your Marketplace Eligibility Notice; and
- Either your premium bill or the “My plans and programs” page from your 2025 Marketplace (Healthcare.gov) application.
To submit the required documentation, complete the Healthcare Cost Assistance Benefits Request Form and upload the required documents.
If you don’t provide these supporting documents by May 2025, your Benefit Convenience Card may be switched to “temporarily inactive” until the required documents are submitted.
If you enroll in or renew an approved plan or update your income with assistance from Valley Insurance Professionals (VIP), they submit this information on your behalf.
2025 Enrollment Steps
2025 Enrollment Steps
It’s time for Open Enrollment on the Marketplace where you can choose a health (medical) insurance plan for 2025. Please be sure to choose a Carewell-approved Silver plan if you are requesting Healthcare Cost Assistance benefits.
- If you enroll between November 1, 2024 and December 15, 2024, your coverage starts January 1, 2025.
- If you enroll between December 16, 2024 and January 15, 2025, your coverage starts February 1, 2025.
Select one of the options below that best describes your situation to see the steps you need to take for 2025 enrollment.
IMPORTANT
With the 2025 pay raise negotiated by your SEIU 503 Homecare Worker Bargaining Team, your income might be higher. If it is, be sure to update your household income on your Marketplace application to avoid surprises at tax time. Income levels may impact how much Advance Premium Tax Credits (APTC) you receive. And if they do, HCA benefits adjust to cover any changes to your net monthly premiums.
I need to enroll in medical coverage and/or Healthcare Cost Assistance benefits for the first time.
Check your benefit eligibility.
If you have worked 40 hours per month for 2 months in a row, and you do not have access to other medical coverage (for example, through the Oregon Health Plan, another employer, or through your spouse, partner, or family member), you're likely eligible - go to Step 2! (Read our Carewell SEIU 503 Guide to Training and Benefits for complete eligibility rules.)
Learn more about the approved Marketplace Silver plans for your area.
- To receive Healthcare Cost Assistance benefits, you must enroll in a plan that’s approved for your area: See list of approved plans.
- Read through the insurance carriers’ Plan Benefit Summaries to find the best fit for your health needs: See Benefit Summaries.
Complete the Annual Paperwork.
2025 Annual Paperwork (Online Form)
Complete the 2025 Annual Paperwork packet during Open Enrollment where we can help you find coverage and review your eligibility for Healthcare Cost Assistance benefits. This paperwork takes most people about 15 minutes to fill out the forms. For coverage starting January 1, 2025, you must enroll before December 15.
Call us at 1-844-503-7348.
We can help schedule an enrollment appointment with our partner insurance agents at Valley Insurance Professionals.
Pay your premium before the due date.
- Pay by December 31 for a plan starting January 1.
- Pay by January 31 for a plan starting February 1.
If you don’t pay your premium on time, your plan will not be turned on by the insurance carrier, and you may find yourself without coverage throughout 2025.
How premium payments work
- You will receive a Benefit Convenience Card from Ameriflex, which you can use to pay for your monthly premiums and covered out-of-pocket medical expenses.
- However, this Benefit Convenience Card may not arrive in time for you to pay your first premium if you enrolled later during Open Enrollment. In this case, you would have to pay your premium out of your own pocket before the deadline. Carewell SEIU 503 will send you a check to reimburse you for the first premium.
- Find out more about the Benefit Convenience Card.
Be sure to read and reply to your mail from the Marketplace.
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 and Advance Premium Tax Credits. You may also lose your Carewell SEIU 503 Healthcare Cost Assistance benefits. Please monitor your mail and email for notifications from the Marketplace.
HCA Benefits Confirmation
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.
If you have questions about becoming eligible for and accessing Healthcare Cost Assistance, please call 1-844-503-7348.
I need to renew my coverage and Healthcare Cost Assistance Benefits.
2025 Annual Paperwork (online form) Complete the 2025 Annual Paperwork where we can help you find coverage and review your eligibility for Healthcare Cost Assistance benefits. For coverage starting January 1, 2025, you must enroll by December 15. These forms give the Carewell SEIU 503 Benefits team and our partners permission to assist you with enrolling in and maintaining your healthcare coverage. Completing the annual paperwork also confirms that you understand and agree to the rules of the program as governed by the rules of the Trust. If you are renewing your coverage and your premiums are current, you may likely auto-renew and can schedule an appointment with Valley Insurance Professionals after Open Enrollment to update your Marketplace application. We are happy to help you get that scheduled now. To receive Healthcare Cost Assistance benefits, you must enroll in a plan that’s approved for your area: See list of approved plans. Pay your premium before the due date (December 31 for a plan starting January 1, January 31 for a February 1 start). If you don’t pay your premium on time, your plan will not be renewed, and you may find yourself without coverage throughout 2025. If you’ve set up automatic payments with your carrier, please remember to update your payment information with the new premium amount. 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 and Advance Premium Tax Credits. You may also lose your Carewell SEIU 503 Healthcare Cost Assistance benefits. Please monitor your mail and email for notifications from the Marketplace.Fill out the 2025 Annual Paperwork.
Pay your first month’s premium to your insurance carrier before the due date.
Be sure to read and respond to requests for information from the Marketplace
Approved Plans for 2025
You can enroll in 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.
Oregon
Download PDF of 2025 Oregon plans by county
Please note that the Moda health insurance plans are no longer available as approved plans in 2025. Care providers on Moda need to switch to an approved 2025 plan for their county to request Healthcare Cost Assistance benefits.
Washington
Download PDF of 2025 Washington plans by county
California
Anthem Silver 70 EPO
BlueShield of California Silver 70 PPO
Idaho
PacificSource Navigator Silver 3600
You can see Summaries of Benefits and Coverage for approved plans here.
Find Your County, Find Your Plan:
Approved Plan for Multnomah County
Download Summary of Benefits and Coverage
Approved Plan for Asotin County
Download Summary of Benefits and Coverage
Approved Plan for Washington County
Download Summary of Benefits and Coverage
Approved Plan for Lane County (inside Kaiser service area)
Download Summary of Benefits and Coverage
Approved Plans for Lane County (outside Kaiser service area)
Download Summary of Benefits and Coverage
2025 Regence Oregon Standard Silver Plan Individual and Family Network Plan ID 77969OR5290001
Download Summary of Benefits and Coverage
Approved Plans for Baker County
Download Summary of Benefits and Coverage
2025 Regence Oregon Standard Silver Plan Individual and Family Network Plan ID 77969OR5290001
Download Summary of Benefits and Coverage
Approved Plan for Benton County (inside Kaiser service area – OR)
Download Summary of Benefits and Coverage
Approved Plans for Benton County (outside Kaiser service area – OR)
Download Summary of Benefits and Coverage
2025 Regence Oregon Standard Silver Plan Individual and Family Network Plan ID 77969OR5290001
Download Summary of Benefits and Coverage
Approved Plan for Benton County (WA)
Download Summary of Benefits and Coverage
Approved Plan for Clackamas County (inside Kaiser service area)
Download Summary of Benefits and Coverage
Approved Plans for Clackamas County (outside Kaiser service area)
Download Summary of Benefits and Coverage
2025 Regence Oregon Standard Silver Plan Individual and Family Network Plan ID 77969OR5290001
Download Summary of Benefits and Coverage
Approved Plan for Clark County
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Approved Plans for Clatsop County
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2025 Regence Oregon Standard Silver Plan Individual and Family Network Plan ID 77969OR5290001
Download Summary of Benefits and Coverage
Approved Plan for Columbia County
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Approved Plans for Coos County
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2025 Regence Oregon Standard Silver Plan Individual and Family Network Plan ID 77969OR5290001
Download Summary of Benefits and Coverage
Approved Plan for Cowlitz County
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Approved Plans for Crook County
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2025 Regence Oregon Standard Silver Plan Individual and Family Network Plan ID 77969OR5290001
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Approved Plans for Curry County
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2025 Regence Oregon Standard Silver Plan Individual and Family Network Plan ID 77969OR5290001
Download Summary of Benefits and Coverage
Approved Plans for Deschutes County
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2025 Regence Oregon Standard Silver Plan Individual and Family Network Plan ID 77969OR5290001
Download Summary of Benefits and Coverage
Approved Plans for Douglas County
Download Summary of Benefits and Coverage
2025 Regence Oregon Standard Silver Plan Individual and Family Network Plan ID 77969OR5290001
Download Summary of Benefits and Coverage
Approved Plan for Franklin County
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Approved Plans for Gilliam County
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2025 Regence Oregon Standard Silver Plan Individual and Family Network Plan ID 77969OR5290001
Download Summary of Benefits and Coverage
Approved Plans for Grant County (OR)
Download Summary of Benefits and Coverage
2025 Regence Oregon Standard Silver Plan Individual and Family Network Plan ID 77969OR5290001
Download Summary of Benefits and Coverage
Approved Plan for Grant County (WA)
Download Summary of Benefits and Coverage
Approved Plans for Harney County
Download Summary of Benefits and Coverage
2025 Regence Oregon Standard Silver Plan Individual and Family Network Plan ID 77969OR5290001
Download Summary of Benefits and Coverage
Approved Plan for Grays Harbor County
Download Summary of Benefits and Coverage
Approved Plan for Hood River County (inside Kaiser service area)
Download Summary of Benefits and Coverage
Approved Plans for Hood River County (outside Kaiser service area)
Download Summary of Benefits and Coverage
2025 Regence Oregon Standard Silver Plan Individual and Family Network Plan ID 77969OR5290001
Download Summary of Benefits and Coverage
Approved Plan for Island County
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Approved Plans for Jackson County
Download Summary of Benefits and Coverage
2025 Regence Oregon Standard Silver Plan Individual and Family Network Plan ID 77969OR5290001
Download Summary of Benefits and Coverage
Approved Plans for Jefferson County
Download Summary of Benefits and Coverage
2025 Regence Oregon Standard Silver Plan Individual and Family Network Plan ID 77969OR5290001
Download Summary of Benefits and Coverage
Approved Plans for Josephine County
Download Summary of Benefits and Coverage
2025 Regence Oregon Standard Silver Plan Individual and Family Network Plan ID 77969OR5290001
Download Summary of Benefits and Coverage
Approved Plan for King County
Download Summary of Benefits and Coverage
Approved Plan for Kitsap County
Download Summary of Benefits and Coverage
Approved Plans for Klamath County
Download Summary of Benefits and Coverage
2025 Regence Oregon Standard Silver Plan Individual and Family Network Plan ID 77969OR5290001
Download Summary of Benefits and Coverage
Approved Plan for Klickitat County
Download Summary of Benefits and Coverage
Approved Plans for Lake County
Download Summary of Benefits and Coverage
2025 Regence Oregon Standard Silver Plan Individual and Family Network Plan ID 77969OR5290001
Download Summary of Benefits and Coverage
Approved Plan for Lewis County
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Approved Plans for Lincoln County
Download Summary of Benefits and Coverage
2025 Regence Oregon Standard Silver Plan Individual and Family Network Plan ID 77969OR5290001
Download Summary of Benefits and Coverage
Approved Plan for Linn County (inside Kaiser service area)
Download Summary of Benefits and Coverage
Approved Plans for Linn County (outside Kaiser service area)
Download Summary of Benefits and Coverage
2025 Regence Oregon Standard Silver Plan Individual and Family Network Plan ID 77969OR5290001
Download Summary of Benefits and Coverage
Approved Plans for Malheur County
Download Summary of Benefits and Coverage
2025 Regence Oregon Standard Silver Plan Individual and Family Network Plan ID 77969OR5290001
Download Summary of Benefits and Coverage
Approved Plan for Marion County (inside Kaiser service area)
Download Summary of Benefits and Coverage
Approved Plans for Marion County (outside Kaiser service area)
Download Summary of Benefits and Coverage
2025 Regence Oregon Standard Silver Plan Individual and Family Network Plan ID 77969OR5290001
Download Summary of Benefits and Coverage
Approved Plan for Morrow County
Download Summary of Benefits and Coverage
2025 Regence Oregon Standard Silver Plan Individual and Family Network Plan ID 77969OR5290001
Download Summary of Benefits and Coverage
Approved Plan for Pierce County
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Approved Plan for Pacific County
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Approved Plan for Polk County
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Approved Plans for Sherman County
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2025 Regence Oregon Standard Silver Plan Individual and Family Network Plan ID 77969OR5290001
Download Summary of Benefits and Coverage
Approved Plan for Skamania County
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Approved Plan for Snohomish County
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Approved Plan for Spokane County
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Approved Plan for Thurston County
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Approved Plans for Tillamook County
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2025 Regence Oregon Standard Silver Plan Individual and Family Network Plan ID 77969OR5290001
Download Summary of Benefits and Coverage
Approved Plans for Umatilla County
Download Summary of Benefits and Coverage
2025 Regence Oregon Standard Silver Plan Individual and Family Network Plan ID 77969OR5290001
Download Summary of Benefits and Coverage
Approved Plans for Union County
Download Summary of Benefits and Coverage
2025 Regence Oregon Standard Silver Plan Individual and Family Network Plan ID 77969OR5290001
Download Summary of Benefits and Coverage
Approved Plan for Walla Walla County
Download Summary of Benefits and Coverage
Approved Plan for Wahkiakum County
Download Summary of Benefits and Coverage
Approved Plans for Wallowa County
Download Summary of Benefits and Coverage
2025 Regence Oregon Standard Silver Plan Individual and Family Network Plan ID 77969OR5290001
Download Summary of Benefits and Coverage
Approved Plans for Wasco County
Download Summary of Benefits and Coverage
2025 Regence Oregon Standard Silver Plan Individual and Family Network Plan ID 77969OR5290001
Download Summary of Benefits and Coverage
Approved Plan for Whatcom County
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Approved Plans for Wheeler County
Download Summary of Benefits and Coverage
2025 Regence Oregon Standard Silver Plan Individual and Family Network Plan ID 77969OR5290001
Download Summary of Benefits and Coverage
Approved Plan for Yamhill County
Download Summary of Benefits and Coverage
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 (EOB) you receive from your insurance carrier and all receipts.
The Benefit Convenience Card can’t be used for:
- Premium or out-of-pocket expenses for dental, vision, and/or hearing services.
- ATM withdrawals or to get cash back when making a purchase.
- Expenses for your spouse or dependents.
- Expenses for products or services that your health insurance plan doesn’t cover.
- Premium expenses to anyone other than your current medical carrier.
- Expenses incurred while you were not eligible for Healthcare Cost Assistance benefits.
- Covered medical expenses from a previous calendar year; for these expenses submit a reimbursement request by filling out the Ameriflex Reimbursement Claim Form online.
- Your individual premium payment if your family is on the same premium bill; for your individual premium payment, submit a reimbursement request through MyCarewellSEIU503 or by filling out the Medical Premium Reimbursement Claim Form online.
You may be financially responsible for repaying funds to Carewell SEIU 503 if your card is used for expenses that are not covered medical expenses.
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:
- Kaiser: Visit the Kaiser Permanente website.
- PacificSource: Visit the PacificSource website.
- Moda: Call Moda customer service at 1-503-243-3962 or toll-free at 1-877-605-3229, identify yourself as a homecare worker, and let them know you want to set up recurring automatic payments.
- Providence: Call Providence billing at 1-503-574-5791 or pay your premium online – for first time premium payments, use this link and select New individual & family applicants.
- Regence: Call Regence customer service at 1-888-675-6570 or visit the Regence website.
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 every pay period.
- 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.
Reimbursements
The fastest way to get your reimbursement is by completing the following forms online!
Medical Premium Reimbursement Claim Form
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 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 Healthcare Cost Assistance benefit 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 for:
- 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 Eligibility
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. See below for contact information for insurance carriers (like Kaiser Permanente, Regence, 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:
What To Do When Regaining Trust Eligibility for Benefits After Losing Them
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 your card once you have submitted the Healthcare Cost Assistance Benefits Request form with supporting documents and it has been approved, unless the expiration date on the front of your card 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 Health 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.
Contact Information and Resources
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:
- Assistance in determining a pathway to enroll in medical coverage
- Assistance with OHP applications
- Basic assistance with Carewell SEIU 503 benefits
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
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 Carewell SEIU 503.
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
Regence
Customer service: 1-888-675-6570
regence.org
Ameriflex
1-888-868-3539
When calling, please identify yourself as a homecare worker, personal support worker, or personal care attendant receiving Carewell SEIU 503 benefits, and also have your Benefit Convenience Card with you.
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 – Dec. 15 for 2024 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 temporary Healthcare Cost Assistance benefits?
You may qualify for temporary 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 that case, you would receive a Benefit Convenience Card to pay covered out-of-pocket expenses. You may also be eligible for temporary reimbursement of your premiums.
To continue receiving Healthcare Cost Assistance after the end of the year, you must enroll in an approved plan as soon as you can and no later than Open Enrollment (between November 1 and December 15). Otherwise, your Healthcare Cost Assistance will stop at the end of the calendar year.
To check if you qualify for temporary Healthcare Cost Assistance benefits, call 1-844-503-7348.
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 Benefit Convenience Card works just like a regular credit card, with 2 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.
How much money is on the Benefit Convenience Card?
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 2024, that amount is $7,165, 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).
What can I use the Benefit Convenience Card to pay for?
- Your net monthly premium bill for an approved Marketplace plan.
- The deductible applicable to your Marketplace plan. A deductible is the amount you must pay for the services that your insurance plan covers before your insurer begins to pay.
- The copayments for medical services and prescriptions covered by your approved Marketplace plan. A copayment (or copay) is a fixed amount your insurance 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 approved Marketplace plan. Coinsurance is a percentage of the costs you must pay for services your insurance plan covers. Cost sharing may range from 20% to 50% of a covered service, depending on your insurance plan. For example, if your insurance plan has an “80/20” coinsurance arrangement, this means that, after you pay any deductible, your insurance company will pay 80% of the cost of the covered medical expense and you must pay the remaining 20%.
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.
Learn & Connect: Open Enrollment Questions Answered
During these in-person events, the Carewell Benefits team and our insurance partners, Valley Insurance Professionals, review how Healthcare Cost Assistance benefits work when you choose a Carewell-approved plan on the Marketplace.
You can:
- Learn about the approved health insurance plans for 2025
- See how Advance Premium Tax Credits (APTC) work to reduce your premium
- Get support in enrolling in an approved health (medical) insurance plan on the Marketplace
- Check your eligibility for Healthcare Cost Assistance benefits that cover your net monthly health (medical) insurance premiums and up to $7165 in out-of-pocket medical costs in 2025.
Click here for more information!
10 Essential Health Benefits Covered by All Marketplace Plans
All plans offered in the Marketplace cover these 10 essential health benefits:
- Prescription drugs
- Laboratory services
- Outpatient care you get without being admitted to a hospital
- Preventive and wellness services and chronic disease management
- Emergency services
- Hospitalization (like surgery and overnight stays)
- Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Pregnancy, maternity, and newborn care (both before and after birth)
- Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)