You sent me a letter saying that I got a rebate, but I didn't receive a check. Why?
You didn't receive a check because you get your health coverage through an active employer group. Your rebate will be sent to your employer. Your employer will then deliver the rebate to you and other employees according to federal law.
Why are we issuing a rebate?
The medical loss ratio or MLR rule of the Affordable Care Act states that a healthcare plan must spend at least 80 percent (or 85 percent for large employer group plans) of its members' payments on healthcare quality improvements. If not, the plan must refund its members.
Last year, LifeWise Health Plan of Oregon spent less than 80 percent of health plan payments on medical claims and healthcare quality improvements. We are issuing rebates to make up the difference. Note that the rebate calculations are based on the entire population of that applicable market. The rebate is not based on individual subscriber or plan totals.
How do I know if I'm getting a rebate?
The current rebate is going out to LifeWise Health Plan of Oregon employer groups only. It's for people who have their healthcare plan through work, not for those who purchased their healthcare coverage on their own as an individual. If you work for an employer, they will deliver the rebate to you and other employees according to federal law.
What do I need to know to use the new bill pay system?
Some important information to note:
If you have not yet used the LifeWise secure member website, you will need to create an account.
You may be prompted to accept the new terms and conditions.
To use our pay-by-phone system, you need the group number (not your ID number) from your LifeWise card to select the correct pay-by-phone option. You'll then need your ID number to complete your payment.
To make your pay-by-phone payment: If you bought your plan from Healthcare.gov and your group number starts with 11, press 1. If your group number starts with 10, press 2.
Some helpful improvements you'll find:
Who can pay for my health plan?
LifeWise does not accept payments from third parties for individual health plans except where required by law. This means that in most cases, you or another family member must pay for your health plan, rather than an employer or organization.
This may affect you if your individual health plan is paid for by another organization, such as a charity, healthcare provider, employer or your own business if you are self-employed.
You can review more information about our policy in the Pay My Bill section under Member Services.
I just bought a new health plan and need to cancel my old plan. How do I cancel it?
You can cancel your plan several ways:
PO Box 91120
Seattle, WA 98111
Fax number: 425-918-3727
LifeWise Health Plan of Oregon announced on April 21 that we will exit the Oregon market. As a customer, you can be assured we will support you through the duration of your plan, with most plans ending by Dec. 31, 2016.
See below for answers to common questions about this change.
LifeWise Health Plan of Oregon has announced it is leaving the insurance market in Oregon. We are ceasing new sales in the group market and will remain on healthcare.gov in the individual market through the remainder of the year. Our focus is on making this transition as smooth as possible for our customers.
What happens to LifeWise Health Plan of Oregon's customers?
LifeWise will continue to service its customers while they have active coverage with us. For many customers, including those in the individual market, the last date of coverage will be Dec. 31, 2016. Some employer groups may continue into 2017 based on the date of their last renewal.
Does this affect LifeWise Health Plan of Washington?
No, LifeWise Health Plan of Washington is continuing to operate in Washington.
Why is this happening?
LifeWise chose to exit the state after careful and thorough consideration of current and projected market conditions.
Is LifeWise in financial trouble? Will it keep paying claims?
LifeWise has strong financial resources to pay claims and serve our customers well through their last day with us. LifeWise is notifying healthcare professionals, such as hospitals, doctors, and dentists, about this change. LifeWise will continue to pay claims to its existing contracted provider network for customers who have active coverage with us. We want to make this transition as smooth as possible for everyone involved.
What about transitioning care for customers when they change plans?
We plan to work with providers and other insurers as appropriate to support customers in ensuring continuity of care as they transition to new coverage in the coming months.
If I'm an individual customer, can I change plans with LifeWise or move to another health plan right now?
No. You will be able to move to another health insurer during the next open enrollment period, which begins on November 1.
Does this affect other LifeWise affiliates?
Partly. Vivacity will continue to serve their customers in Oregon. LifeWise Assurance Company will work with their clients in Oregon with stop-loss coverage as those employers move to other carriers.
Does this mean there will be layoffs at LifeWise? Is your Portland office closing?
Yes, some employees are immediately impacted, with additional job eliminations by the end of the year. Our Portland office will close later this year as well.
Who do I contact with further questions?
LifeWise customers can call us at 800-596-3440.
Where do I go to find specific information about my plan online?
You can create and register your account on lifewiseor.com. You'll need your member ID number and suffix (see your ID card). First, create an account. Then, log in and associate your account with your health plan by entering your ID number.
By logging in, you'll find specific information about your plan. You can track claims and spending toward your deductible or pay bills. You can also log in to find in-network doctors, dentists, pharmacies, urgent care centers, hospitals, and emergency rooms.
I need to use my health plan, but I don't have my ID card. What should I do?
In-network, hospitals, and pharmacies can confirm your coverage directly with us. You can still get care if you need it, even if you don't have your ID card. You can also call us at 800-596-3440 and we'll give you your ID number.
If you have your member ID number and would like to print a temporary card, log in at lifewiseor.com. Under Member Services, navigate to Manage My Account, then choose Print and Order ID Card.
What is a special enrollment period?
On December 31, 2016, all individual LifeWise medical and dental coverage will end because LifeWise Health Plan of Oregon is leaving the Oregon health plan market.
However, if you qualify, you may be able to apply for 2016 coverage, in a special enrollment period. If you or your family have experienced a qualifying life event such as a marriage or the birth of a child, you may qualify for special enrollment in a 2016 individual health plan.
What should I do if I qualify for a special enrollment?
If you qualify for special enrollment, LifeWise can help you sign up for a health plan. We can also help you learn whether you qualify for financial help with your health plan costs. As part of the application process, you'll be asked to provide proof that you're an Oregon state resident. Call us at 800-596-3440 with any questions.