Health Plans

  • 57% of uninsured Oregonians may qualify for a subsidy.*

    Answer a few questions to find out if you might qualify. What is your age? 

    Adult

    18 to 64

    Senior

    65 and over

    * Source: Kaiser Family Foundation.  
  • 2014 Medical Plans

    On Wednesday, March 26, the Oregon Insurance Division (OID) announced they will extend the open enrollment period for individuals until April 30, 2014. For Oregon individuals, this means you have until April 30 to purchase a new health plan.

    It’s easy to compare plans, determine your monthly rate or apply online. Simply visit our online enrollment portal.

    Individual and Family Plans

    We offer plans from three metallic levels – bronze, silver or gold. Monthly health plan costs vary by:

    • Metallic level
    • Number of people on the plan
    • Ages of people covered
    • Tobacco usage
    • Location

    All plans have the same benefits. The amount you pay for your medical care will vary depending on the plan you choose.

    Medical Care Pay Chart 

    10 Essential Benefits

    Healthcare reform says all health plans must include ten essential benefits. The basic benefits include:

    1. Outpatient Care – the care you receive without being admitted to a hospital
    2. Emergency Room – trips to the emergency room
    3. Inpatient Care – treatment in the hospital for inpatient care
    4. Maternity and Newborn Care – care before and after your baby is born
    5. Mental Health and Substance Use Disorder Services – this includes behavioral health treatment, counseling, and psychotherapy
    6. Prescription drug coverage
    7. Rehabilitative and Habilitative Services – services and devices to help you recover if you are injured, or have a disability or chronic condition. This includes physical and occupational therapy, speech-language pathology, psychiatric rehabilitation, and more
    8. Laboratory Services – lab tests
    9. Preventive and Wellness Services – services including counseling, screenings, and vaccines to keep you healthy and to manage a chronic illness
    10. Pediatric Services – including dental and vision care for children*

    *Plans offered both inside and outside Cover Oregon (except for the state-designed Standard plans) have pediatric dental benefits built into them, regardless of dependents being covered on the plan. The additional cost for this benefit is minimal. 

    2014 Open Enrollment

    You can enroll in a new health plan until April 30, 2014. The next opportunity to buy a plan is during the open enrollment period starting November 15, 2014 for a January 1, 2015 effective date.

    One of the new rules started in 2014 is that you can only join or make changes to a plan during the open enrollment period. There are some exceptions though a qualifying life event such as if you get married, have a child or lose your job, for example, you'll be able to make changes to your plan. If you’ve had a qualifying life event, call us at (855) 339-9700 to discuss plan options.

    It’s easy to compare plans, determine your monthly rate or apply online. Simply visit our online enrollment portal.

    Information on our new 2014 Health Plans 

    LifeWise Essential Plans

    LifeWise Standard Plans

    Sales Brochure– includes high-level comparison of plan benefits

    Enrollment Application – be sure to review Eligibility and Enrollment information.

    Call us at 877-203-5851 with questions or to discuss your plan options.

    Dental Plans

    Children under age 19 will be covered as part of your new medical plan. If you're interested in adding adult dental coverage, or have questions, call us at 877-203-5851 to discuss your options. You can also apply with our Adult Dental Copay Plan application. You can also review our adult individual dental brochure.

    We also offer a special dental open enrollment period June 1, 2014 to June 30, 2014. You have time to review your dental options and make a decision during that timeframe as well.

    2014 Health Plan Rates

    You can review any of our rate sheets based on county of residence.

    Clackamas, Multnomah, Washington, Yamhill (Area 1) 

    Deschutes, Klamath, Lake (Area 4) 

    All Other Counties (Areas 2,3,5,6,7) 

  • Help with Cost

    You can get help paying for your new plan if you qualify.

    Financial help comes in the form of the federal health premium tax credit, also referred to as a subsidy. You can use it to lower your monthly health plan amount or lower the amount you pay at tax time.

    If you qualify for help with your costs, you will need to enroll through Cover Oregon, the state’s online market place. Your producer can help you do this or you can contact Cover Oregon directly at 855-COVEROR (855-268-3767).

    If you apply for coverage through Cover Oregon, you will need to do so by the 15th of the month for your coverage to begin on the 1st day of the following month.

    Call us at 877-203-5851 for help. We’ll help you figure out if you’re eligible for the health premium tax credit.

    More Information

    We’re committed to helping you make the right health plan choices for you and your family.

    Getting your preventive exams, screenings and immunizations is the best way to help you and your family stay healthy. These important screenings help your doctors detect diseases early when they are easiest to treat. Our wide range of health plans covers all the ways to help you stay healthy.

    You'll also have access to member discounts on health products and services, including gym memberships.

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