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 $7,165 of out-of-pocket expenses are covered in 2024.

This benefit applies only if you are enrolled in an approved Marketplace plan:

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Not on an approved plan?

Temporary Healthcare Cost Assistance benefits may be available if you become eligible during the year and you’re on a non-approved health insurance plan.

  1. If you become eligible for Carewell SEIU 503 benefits (like Dental, Vision and Hearing, and Employee Assistance Program) after the end of the last Open Enrollment period, AND
  2. You are enrolled in a non-approved plan through a health insurance Marketplace,  you may receive temporary Healthcare Cost Assistance (HCA) to help with the costs of your premiums and out-of-pocket expenses for your current health insurance plan. This amount is a temporary Average Premium Reimbursement (APR) provided through Healthcare Cost Assistance benefits. To remain eligible for HCA benefits, however, you must enroll in an approved qualified plan for your area at the next available opportunity — generally during Open Enrollment.

If you have reviewed and verified that you are not enrolled in an approved plan for 2024, complete the Medical Premium Reimbursement Form. Or give us a call at 1-844-503-7348, 8 am – 6 pm, PST Monday-Friday or email CarewellSEIU503Benefits@RISEpartnership.com. More information can be found in this FAQ.

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 2024 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.

A Carewell eligibility questionnaire on a mobile phone screen

Enrollment

Open Enrollment

If you are enrolling in a Marketplace plan for the first time, you will most likely need to wait until Open Enrollment to enroll. Open Enrollment is generally between November 1 and December 15 every year for coverage starting the following January 1. If you enroll between December 16 and January 15, your coverage will start February 1. There are some special circumstances that may allow you to enroll oustide of this period; see the FAQs for more information. 

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.

2023 OHP Eligibility Redeterminations

In April 2023, the Oregon Health Authority (OHA) began redeterminations of eligibility for the Oregon Health Plan (OHP). Redetermination is when OHA reviews your information to figure out if you still qualify for the Oregon Health Plan.  

How do I know if I do not qualify for OHP anymore?

If you are on OHP, Apple Health (in Washington), or another Medicaid plan, you might receive a letter letting you know that your medical benefits are ending. If you have questions about this letter, the fastest and best way to get help is to call the phone number in the letter. 

I don't qualify for OHP anymore. What are my next steps?

Contact us as you may be eligible for a Special Enrollment Period to get medical coverage. We may be able to support you in enrolling in an approved qualified health plan through the Health Insurance Marketplace (healthcare.gov). 

If you are eligible for an approved qualified health plan, you may also be eligible for Healthcare Cost Assistance (HCA) benefits through us. With HCA benefits, Carewell will provide the money to pay your net monthly premiums and up to $7,165 in out-of-pocket medical costs. For more info on how to enroll in HCA benefits, scroll down to the “I am enrolled in an approved plan and I need to request Healthcare Cost Assistance benefits” section of this webpage.

2024 Enrollment Steps

2024 Enrollment Steps

This section has information to help you enroll for 2024 benefits when you :

  • Qualify for a Special Enrollment Period; or
  • Need to apply for Healthcare Cost Assistance for the first time; or
  • Need to update your information with us, like your income​​

Select one of the options below that best describes your situation to see the steps you need to take for 2024 enrollment.

Note: Open Enrollment for 2024 coverage ended on January 16. Marketplace health insurance plans are renewed during Open Enrollment. 

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IMPORTANT

With the 2024 pay raise negotiated by your SEIU 503 Homecare Worker Bargaining Team, your income might be higher. If it is, you may need to update your income on your 2024 Marketplace application.

I am enrolled in an approved plan and did NOT have an appointment during Open Enrollment with Valley Insurance Professionals.

Here are 2 ways you can make sure that you are receiving the correct Advance Premium Tax Credit (APTC) amount and if eligible, enrolled in Healthcare Cost Assistance benefits:

You can get support from our insurance partner, Valley Insurance Professionals (VIP).

They can review your Marketplace application with you and make sure that you are receiving the correct APTC amount. VIP can also assist with checking your eligibility for HCA benefits. Call 1-844-503-7348 to schedule an appointment.

Use the form listed below.

To apply to receive the Healthcare Cost Assistance (HCA) benefit if you have updated your plan directly with the Marketplace or you need to update an estimated income with your actual income.

HCA Benefits Request Form (Online)

Where can I find the necessary information to fill out these forms?

You can:

  • Log in to your Marketplace application at healthcare.gov and download a copy of your Marketplace Eligibility Notice and the My Plans and Programs page. See samples here.
  • Check your mail. The Marketplace sent you a hard copy of the Marketplace Eligibility Notice and the health insurance carrier sent you a copy of your premium bill.
  • Ask your health insurance carrier (like Kaiser or Providence). They may have sent you that information by mail, or it may be available in your online portal. You can also just call — phone numbers for carriers can be found here.

See samples of the Marketplace Eligibility Notice, the My Plans and Programs page, and premium bills here.

I need to enroll in 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 receive other medical coverage (for example, through another employer, or through your spouse, partner, or family member coverage) or you are not enrolled, or eligible to enroll, in the Oregon Health Plan — you're likely eligible — go to Step 2!  (Read our Carewell SEIU 503 Guide to Training and Benefits  for complete eligibility rules.)

Complete the Annual Paperwork.

2024 Annual Paperwork (Online)

Complete the Annual Paperwork packet and we can help you find Marketplace coverage if you qualify for a Special Enrollment Period and review your eligibility for Healthcare Cost Assistance benefits. This paperwork takes most people about 15 minutes to fill out the forms.

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

  • 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 Plan Benefit Summaries to find the best fit for your health needs:  See Benefit Summaries.

Call us at 1-844-503-7348 if you qualify to enroll outside of Open Enrollment.

We can help schedule an appointment with our partner insurance agents at Valley Insurance Professionals (VIP) to enroll you in an approved Marketplace plan. And we can review your eligibility for Healthcare Cost Assistance benefits.

Or use the form listed below.  

HCA Benefits Request Form (Online)

Update on HCA Benefits Requirements

Updated 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 2024 Marketplace (Healthcare.gov) application. If you don’t provide these supporting documents after January 2024, your Benefit Convenience Card will 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), you are not required to submit proof of your Marketplace plan. VIP will submit your premium bill and Marketplace Eligibility Notice on your behalf.

Where can I find the necessary information to fill out these forms?

You can:

  • Log in to your Marketplace application at healthcare.gov and download a copy of your Marketplace Eligibility Notice and the My Plans and Programs page. See samples here.
  • Check your mail.The Marketplace sent you a hard copy of the Marketplace Eligibility Notice and the carrier sent a copy of your premium bill.  Ask your health insurance carrier (like Kaiser or Providence). They may have sent you that information by mail, or it may be available in your online portal. You can also just call — phone numbers for carriers can be found here.

See samples of the Marketplace Eligibility Notice, the My Plans and Programs page, and premium bills here.

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 (BCC) 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 (Online)

Learn more about the Benefit Convenience Card.

Be sure to read and respond to requests for information 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/or Healthcare Cost Assistance benefits.
You will know you’re enrolled in Healthcare Cost Assistance benefits when you receive the reimbursement check for your first premium, and then the 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 about 20 business days of your enrollment.  If you have questions about enrolling in or accessing Healthcare Cost Assistance benefits, please call 1-844-503-7348.

Approved Plans for 2024

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 2024 Oregon plans by county

Washington

Download PDF of 2024 Washington plans by county

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.

 

Find Your County, Find Your Plan:

Approved Plan for Multnomah County

2024 Kaiser Permanente Oregon Silver 3000/40 Plan ID 71287OR0420011

Download Summary of Benefits and Coverage


Approved Plan for Asotin County

2024 Regence Cascade Silver Individual and Family Network (WA) Plan ID 23371WA1940002

Download Summary of Benefits and Coverage


Approved Plan for Washington County

2024 Kaiser Permanente Oregon Silver 3000/40 Plan ID 71287OR0420011

Download Summary of Benefits and Coverage


Approved Plan for Lane County (inside Kaiser service area)

2024 Kaiser Permanente Oregon Silver 3000/40 Plan ID 71287OR0420011

Download Summary of Benefits and Coverage


Approved Plans for Lane County (outside Kaiser service area)

2024 Providence Oregon Standard Silver - Choice Network Plan ID 56707OR1330004

Download Summary of Benefits and Coverage


2024 Regence Standard Silver Plan Individual and Family Network - EPO, Plan ID 77969OR5290001

Download Summary of Benefits and Coverage (PDF)


Approved Plans for Baker County

2024 Providence Oregon Standard Silver - Signature Network Plan ID 56707OR1360004

Download Summary of Benefits and Coverage


2024 Regence Standard Silver Plan Individual and Family Network - EPO, Plan ID 77969OR5290001

Download Summary of Benefits and Coverage (PDF)


Approved Plan for Benton County (inside Kaiser service area – OR)

2024 Kaiser Permanente Oregon Silver 3000/40 Plan ID 71287OR0420011

Download Summary of Benefits and Coverage


Approved Plans for Benton County (outside Kaiser service area – OR)

2024 Providence Oregon Standard Silver - Choice Network Plan ID 56707OR1330004

Download Summary of Benefits and Coverage


2024 Regence Standard Silver Plan Individual and Family Network - EPO, Plan ID 77969OR5290001

Download Summary of Benefits and Coverage (PDF)


Approved Plan for Benton County (WA)

2024 Regence Cascade Silver Individual and Family Network (WA) Plan ID 23371WA1940002

Download Summary of Benefits and Coverage


Approved Plan for Clackamas County (inside Kaiser service area)

2024 Kaiser Permanente Oregon Silver 3000/40 Plan ID 71287OR0420011

Download Summary of Benefits and Coverage


Approved Plans for Clackamas County (outside Kaiser service area)

2024 PacificSource OR Standard Silver Plan NAV Plan ID 10091OR0750013

Download Summary of Benefits and Coverage


2024 Regence Standard Silver Plan Individual and Family Network - EPO, Plan ID 77969OR5290001

Download Summary of Benefits and Coverage (PDF)


Approved Plan for Clark County

2024 Kaiser Permanente Cascade Silver (WA) Plan ID 87718WA2170014

Download Summary of Benefits and Coverage


Approved Plans for Clatsop County

2024 Providence Oregon Standard Silver - Choice Network Plan ID 56707OR1330004

Download Summary of Benefits and Coverage


2024 Regence Standard Silver Plan Individual and Family Network - EPO, Plan ID 77969OR5290001

Download Summary of Benefits and Coverage (PDF)


Approved Plan for Columbia County

2024 Kaiser Permanente Oregon Silver 3000/40 Plan ID 71287OR0420011

Download Summary of Benefits and Coverage


Approved Plans for Coos County

2024 Moda Health Beacon Silver 3000 Plan ID 39424OR1600002

Download Summary of Benefits and Coverage


2024 Moda Health Oregon Standard Silver (Beacon) Plan ID 39424OR1610002

Download Summary of Benefits and Coverage


2024 Providence Oregon Standard Silver - Signature Network Plan ID 56707OR1360004

Download Summary of Benefits and Coverage


2024 Regence Standard Silver Plan Individual and Family Network - EPO, Plan ID 77969OR5290001

Download Summary of Benefits and Coverage (PDF)


Approved Plan for Cowlitz County

2024 Kaiser Permanente Cascade Silver (WA) Plan ID 87718WA2170014

Download Summary of Benefits and Coverage


Approved Plans for Crook County

2024 PacificSource OR Standard Silver Plan NAV Plan ID 10091OR0750013

Download Summary of Benefits and Coverage


2024 Regence Standard Silver Plan Individual and Family Network - EPO, Plan ID 77969OR5290001

Download Summary of Benefits and Coverage (PDF)


Approved Plans for Curry County

2024 Moda Health Beacon Silver 3000 Plan ID 39424OR1600002

Download Summary of Benefits and Coverage


2024 Moda Health Oregon Standard Silver (Beacon) Plan ID 39424OR1610002

Download Summary of Benefits and Coverage


2024 Providence Oregon Standard Silver - Signature Network Plan ID 56707OR1360004

Download Summary of Benefits and Coverage


2024 Regence Standard Silver Plan Individual and Family Network - EPO, Plan ID 77969OR5290001

Download Summary of Benefits and Coverage (PDF)


Approved Plans for Deschutes County

2024 PacificSource OR Standard Silver Plan NAV Plan ID 10091OR0750013

Download Summary of Benefits and Coverage


2024 Regence Standard Silver Plan Individual and Family Network - EPO, Plan ID 77969OR5290001

Download Summary of Benefits and Coverage (PDF)


Approved Plans for Douglas County

2024 Providence Oregon Standard Silver - Choice Network Plan ID 56707OR1330004

Download Summary of Benefits and Coverage


2024 Regence Standard Silver Plan Individual and Family Network - EPO, Plan ID 77969OR5290001

Download Summary of Benefits and Coverage (PDF)


Approved Plan for Franklin County

2024 Regence Cascade Silver Individual and Family Network (WA) Plan ID 23371WA1940002

Download Summary of Benefits and Coverage


Approved Plans for Gilliam County

2024 Providence Oregon Standard Silver - Signature Network Plan ID 56707OR1360004

Download Summary of Benefits and Coverage


2024 Regence Standard Silver Plan Individual and Family Network - EPO, Plan ID 77969OR5290001

Download Summary of Benefits and Coverage (PDF)


Approved Plans for Grant County (OR)

2024 Providence Oregon Standard Silver - Signature Network Plan ID 56707OR1360004

Download Summary of Benefits and Coverage


2024 Regence Standard Silver Plan Individual and Family Network - EPO, Plan ID 77969OR5290001

Download Summary of Benefits and Coverage (PDF)


Approved Plan for Grant County (WA)

2024 Regence Cascade Silver Individual and Family Network (WA) Plan ID 23371WA1940002

Download Summary of Benefits and Coverage


Approved Plans for Harney County

2024 Providence Oregon Standard Silver - Signature Network Plan ID 56707OR1360004

Download Summary of Benefits and Coverage


2024 Regence Standard Silver Plan Individual and Family Network - EPO, Plan ID 77969OR5290001

Download Summary of Benefits and Coverage (PDF)


Approved Plan for Grays Harbor County

2024 Regence Cascade Silver Individual and Family Network (WA) Plan ID 23371WA1940002

Download Summary of Benefits and Coverage


Approved Plan for Hood River County (inside Kaiser service area)

2024 Kaiser Permanente Oregon Silver 3000/40 Plan ID 71287OR0420011

Download Summary of Benefits and Coverage


Approved Plans for Hood River County (outside Kaiser service area)

2024 Moda Health Beacon Silver 3000 Plan ID 39424OR1600002

Download Summary of Benefits and Coverage


2024 Moda Health Oregon Standard Silver (Beacon) Plan ID 39424OR1610002

Download Summary of Benefits and Coverage


2024 Providence Oregon Standard Silver - Choice Network Plan ID 56707OR1330004

Download Summary of Benefits and Coverage


2024 Regence Standard Silver Plan Individual and Family Network - EPO, Plan ID 77969OR5290001

Download Summary of Benefits and Coverage (PDF)


Approved Plan for Island County

2024 Regence Cascade Silver Individual and Family Network (WA) Plan ID 23371WA1940002

Download Summary of Benefits and Coverage


Approved Plans for Jackson County

2024 Moda Health Beacon Silver 3000 Plan ID 39424OR1600002

Download Summary of Benefits and Coverage


2024 Moda Health Oregon Standard Silver (Beacon) Plan ID 39424OR1610002

Download Summary of Benefits and Coverage


2024 Providence Oregon Standard Silver - Choice Network Plan ID 56707OR1330004

Download Summary of Benefits and Coverage


2024 Regence Standard Silver Plan Individual and Family Network - EPO, Plan ID 77969OR5290001

Download Summary of Benefits and Coverage (PDF)


Approved Plans for Jefferson County

2024 PacificSource OR Standard Silver Plan NAV Plan ID 10091OR0750013

Download Summary of Benefits and Coverage


2024 Regence Standard Silver Plan Individual and Family Network - EPO, Plan ID 77969OR5290001

Download Summary of Benefits and Coverage (PDF)


Approved Plans for Josephine County

2024 Moda Health Beacon Silver 3000 Plan ID 39424OR1600002

Download Summary of Benefits and Coverage


2024 Moda Health Oregon Standard Silver (Beacon) Plan ID 39424OR1610002

Download Summary of Benefits and Coverage


2024 Providence Oregon Standard Silver - Signature Network Plan ID 56707OR1360004

Download Summary of Benefits and Coverage


2024 Regence Standard Silver Plan Individual and Family Network - EPO, Plan ID 77969OR5290001

Download Summary of Benefits and Coverage (PDF)


Approved Plan for King County

2024 Regence Cascade Silver Individual and Family Network (WA) Plan ID 23371WA1940002

Download Summary of Benefits and Coverage


Approved Plan for Kitsap County

2024 Regence Cascade Silver Individual and Family Network (WA) Plan ID 23371WA1940002

Download Summary of Benefits and Coverage


Approved Plans for Klamath County

2024 Providence Oregon Standard Silver - Signature Network Plan ID 56707OR1360004

Download Summary of Benefits and Coverage


2024 Regence Standard Silver Plan Individual and Family Network - EPO, Plan ID 77969OR5290001

Download Summary of Benefits and Coverage (PDF)


Approved Plan for Klickitat County

2024 Regence Cascade Silver Individual and Family Network (WA) Plan ID 23371WA1940002

Download Summary of Benefits and Coverage


Approved Plans for Lake County

2024 Providence Oregon Standard Silver - Signature Network Plan ID 56707OR1360004

Download Summary of Benefits and Coverage


2024 Regence Standard Silver Plan Individual and Family Network - EPO, Plan ID 77969OR5290001

Download Summary of Benefits and Coverage (PDF)


Approved Plan for Lewis County

2024 Regence Cascade Silver Individual and Family Network (WA) Plan ID 23371WA1940002

Download Summary of Benefits and Coverage


Approved Plans for Lincoln County

2024 Providence Oregon Standard Silver - Choice Network Plan ID 56707OR1330004

Download Summary of Benefits and Coverage


2024 Regence Standard Silver Plan Individual and Family Network - EPO, Plan ID 77969OR5290001

Download Summary of Benefits and Coverage (PDF)


Approved Plan for Linn County (inside Kaiser service area)

2024 Kaiser Permanente Oregon Silver 3000/40 Plan ID 71287OR0420011

Download Summary of Benefits and Coverage


Approved Plans for Linn County (outside Kaiser service area)

2024 Providence Oregon Standard Silver - Choice Network Plan ID 56707OR1330004

Download Summary of Benefits and Coverage


2024 Regence Standard Silver Plan Individual and Family Network - EPO, Plan ID 77969OR5290001

Download Summary of Benefits and Coverage (PDF)


Approved Plans for Malheur County

2024 Providence Oregon Standard Silver - Signature Network Plan ID 56707OR1360004

Download Summary of Benefits and Coverage


2024 Regence Standard Silver Plan Individual and Family Network - EPO, Plan ID 77969OR5290001

Download Summary of Benefits and Coverage (PDF)


Approved Plan for Marion County (inside Kaiser service area)

2024 Kaiser Permanente Oregon Silver 3000/40 Plan ID 71287OR0420011

Download Summary of Benefits and Coverage


Approved Plans for Marion County (outside Kaiser service area)

2024 Providence Oregon Standard Silver - Choice Network Plan ID 56707OR1330004

Download Summary of Benefits and Coverage


2024 Regence Standard Silver Plan Individual and Family Network - EPO, Plan ID 77969OR5290001

Download Summary of Benefits and Coverage (PDF)


Approved Plan for Morrow County

2024 Providence Oregon Standard Silver - Signature Network Plan ID 56707OR1360004

Download Summary of Benefits and Coverage


2024 Regence Standard Silver Plan Individual and Family Network - EPO, Plan ID 77969OR5290001

Download Summary of Benefits and Coverage (PDF)


Approved Plan for Pierce County

2024 Regence Cascade Silver Individual and Family Network (WA) Plan ID 23371WA1940002

Download Summary of Benefits and Coverage


Approved Plan for Pacific County

2024 Regence Cascade Silver Individual and Family Network (WA) Plan ID 23371WA1940002

Download Summary of Benefits and Coverage


Approved Plan for Polk County

2024 Kaiser Permanente Oregon Silver 3000/40 Plan ID 71287OR0420011

Download Summary of Benefits and Coverage


Approved Plans for Sherman County

2024 Providence Oregon Standard Silver - Signature Network Plan ID 56707OR1360004

Download Summary of Benefits and Coverage


2024 Regence Standard Silver Plan Individual and Family Network - EPO, Plan ID 77969OR5290001

Download Summary of Benefits and Coverage (PDF)


Approved Plan for Skamania County

2024 Regence Cascade Silver Individual and Family Network (WA) Plan ID 23371WA1940002

Download Summary of Benefits and Coverage


Approved Plan for Snohomish County

2024 Regence Cascade Silver Individual and Family Network (WA) Plan ID 23371WA1940002

Download Summary of Benefits and Coverage


Approved Plan for Spokane County

2024 Regence Cascade Silver Individual and Family Network (WA) Plan ID 23371WA1940002

Download Summary of Benefits and Coverage


Approved Plan for Thurston County

2024 Regence Cascade Silver Individual and Family Network (WA) Plan ID 23371WA1940002

Download Summary of Benefits and Coverage


Approved Plans for Tillamook County

2024 Moda Health Beacon Silver 3000 Plan ID 39424OR1600002

Download Summary of Benefits and Coverage


2024 Moda Health Oregon Standard Silver (Beacon) Plan ID 39424OR1610002

Download Summary of Benefits and Coverage


2024 Providence Oregon Standard Silver - Signature Network Plan ID 56707OR1360004

Download Summary of Benefits and Coverage


2024 Regence Standard Silver Plan Individual and Family Network - EPO, Plan ID 77969OR5290001

Download Summary of Benefits and Coverage (PDF)


Approved Plans for Umatilla County

2024 Providence Oregon Standard Silver - Signature Network Plan ID 56707OR1360004

Download Summary of Benefits and Coverage


2024 Regence Standard Silver Plan Individual and Family Network - EPO, Plan ID 77969OR5290001

Download Summary of Benefits and Coverage (PDF)


Approved Plans for Union County

2024 Providence Oregon Standard Silver - Signature Network Plan ID 56707OR1360004

Download Summary of Benefits and Coverage


2024 Regence Standard Silver Plan Individual and Family Network - EPO, Plan ID 77969OR5290001

Download Summary of Benefits and Coverage (PDF)


Approved Plan for Walla Walla County

2024 Regence Cascade Silver Individual and Family Network (WA) Plan ID 23371WA1940002

Download Summary of Benefits and Coverage


Approved Plan for Wahkiakum County

2024 Regence Cascade Silver Individual and Family Network (WA) Plan ID 23371WA1940002

Download Summary of Benefits and Coverage


Approved Plans for Wallowa County

2024 Providence Oregon Standard Silver - Signature Network Plan ID 56707OR1360004

Download Summary of Benefits and Coverage


2024 Regence Standard Silver Plan Individual and Family Network - EPO, Plan ID 77969OR5290001

Download Summary of Benefits and Coverage (PDF)


Approved Plans for Wasco County

2024 Moda Health Beacon Silver 3000 Plan ID 39424OR1600002

Download Summary of Benefits and Coverage


2024 Moda Health Oregon Standard Silver (Beacon) Plan ID 39424OR1610002

Download Summary of Benefits and Coverage


2024 Providence Oregon Standard Silver - Signature Network Plan ID 56707OR1360004

Download Summary of Benefits and Coverage


2024 Regence Standard Silver Plan Individual and Family Network - EPO, Plan ID 77969OR5290001

Download Summary of Benefits and Coverage (PDF)


Approved Plan for Whatcom County

2024 Regence Cascade Silver Individual and Family Network (WA) Plan ID 23371WA1940002

Download Summary of Benefits and Coverage


Approved Plans for Wheeler County

2024 Providence Oregon Standard Silver - Signature Network Plan ID 56707OR1360004

Download Summary of Benefits and Coverage


2024 Regence Standard Silver Plan Individual and Family Network - EPO, Plan ID 77969OR5290001

Download Summary of Benefits and Coverage (PDF)


Approved Plan for Yamhill County

2024 Kaiser Permanente Oregon Silver 3000/40 Plan ID 71287OR0420011

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 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 Benefit Convenience 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 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

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 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 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, 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.
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.

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

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 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.

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 – 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 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

  • your actual premium amount, or
  • the average premium amount received by eligible care providers through Healthcare Cost Assistance, whichever amount is less.

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.

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.

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