Open Enrollment 2023 has started!

Losing Eligibility

How you can lose eligibility

You may lose eligibility for Carewell SEIU 503 benefits (Dental, Vision + Hearing, EAP, and Healthcare Cost Assistance) if you have two months in a row with zero hours of work. After these two months, you’ll have a grace period of one more month before your benefits end. 

Mail will be sent out to care providers letting them know they might be losing their benefits. These notifications also include information about continuing Dental, Vision and Hearing, and EAP coverage through COBRA.

What happens when benefits end?

Dental, Vision and Hearing, and Employee Assistance Program (EAP) benefits  

Dental, Vision and Hearing, and EAP benefits end the last day of your grace period month. However, you can choose to stay on the Kaiser Permanente Dental, the Ameritas Vision and Hearing, and EAP plans through COBRA.  

If you decide to stay on DVE benefits through COBRA, this means you will now have to pay for premiums by sending payment to the Benefits Administrative Office. In 2022, premiums to continue the Dental, Vision and Hearing, and EAP coverage were $41.01 per month.

If you lose eligibility for benefits, you will receive a COBRA Election Notice by mail, with a form to sign up for COBRA.

Healthcare Cost Assistance (HCA) benefits 

Losing Carewell SEIU 503 benefits does not mean you’re losing your healthcare 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 

Open Enrollment Grace Period

Regardless of hours worked, the Board of Trustees has decided to extend Healthcare Cost Assistance benefits for care providers on an approved Marketplace plan and on Medicare. Your Healthcare Cost Assistance benefits will continue until January 31, 2023: 

  • If you work zero hours in August and September 
  • If you work zero hours in September and October 
  • If you work zero hours in October and November 

If you keep your HCA benefits through the Open Enrollment Grace Period, this means you can continue using your Benefit Convenience Card for out-of-pocket medical expenses and for your Marketplace plan premium payments until January 31. 

After that date, your eligibility will be determined based on the rules of the Trust. 

Please note this only applies to Healthcare Cost Assistance benefits. Your Dental, Vision and Hearing, and EAP benefits will come to an end according to the rules of the Trust, after 2 months of zero hours worked and a one-month grace period.

Paid Time Off (PTO) benefits 

Eligibility for Paid Time Off benefits is based on different conditions. Even when you lose eligibility for Carewell SEIU 503 benefits, you may still qualify for Paid Time Off benefits if you worked the required number of hours. 

Note that to be eligible for PTO, you must also fill out a W-9 form for the Benefits Administrative Office. 

Go here for more information about PTO benefits. 

Can you regain eligibility for Carewell SEIU 503 benefits?

Yes! If you start working again, and you work at least 40 hours for two months in a row, you can become eligible again for Carewell SEIU 503 Dental, Vision and Hearing, EAP, and Healthcare Cost Assistance benefits. After your 2 months of 40 hours, there is a one-month waiting period before benefits start again.  

Your Dental, Vision and Hearing, and EAP coverage will begin on the first day of the month right after your waiting period ends. 

Healthcare Cost Assistance benefits once you regain your eligibility

If you are on Medicare

If you’re on Medicare, you should start receiving reimbursements for your premiums in the same amount as you did previously. If you were receiving HCA for Medicare in a past year (not the current year) and your premiums or any other information have changed, you’ll need to fill out the Medicare HCA paperwork and a Medicare Reimbursement Claim Form (go here for more information and to fill out the forms). Once your documents are processed, you’ll start receiving premium reimbursements and you’ll be able to use the BCC for your out-of-pocket expenses.  

  • If you kept your 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 the Benefits Administrative Office at 1-844-507-7554 (option 3, then option 2) to order a new card.  
If you have a Marketplace plan

If you have a Marketplace plan, you’ll have to fill out the Enrollment Information Form to let us know about your plan and your premiums. We also recommend you call 1-844-503-7348 to ensure your HCA benefits start again without delays. Read more about Healthcare Cost Assistance for Approved Plans here. 

If you have no medical coverage

If you have no medical coverage, you may not be able to enroll into a medical insurance plan on the Healthcare 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 HCA benefits. We’re here to help: call 1-844-503-7348 to talk with the Member Assistance Center so we can help you enroll as soon as possible.  

Questions about your eligibility for Carewell SEIU 503 benefits? Do you have hours to report? 

The Benefits Administrative Office receives a monthly report from the payroll vendors reflecting the number of hours you have worked under the SEIU contract. We use this information to determine your eligibility for Carewell SEIU 503 benefits. If you believe that our records are in error, please contact the Benefits Administrative Office immediately at 1-844-507-7554, option 3, option 2. 

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