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Guide to Fill Out the Enrollment Information Form
The Trust will need to know your monthly premium information to update your benefits on your Benefit Convenience Card or send you a Benefit Convenience Card. Submit the Enrollment Information Form to the Trust Administrative Office after you reenroll into your individual medical insurance, anytime your premium changes or anytime your medical coverage changes. The Trust Administrative Office needs this information so that they can start processing or updating your benefits.
What you will need to complete this formThe information you need to provide to the Trust Administrative Office includes your current medical coverage insurance plan name, your premium amount (gross premium), Advanced Premium Tax Credit (APTC) amount, and the start date of your coverage for that premium amount. You can get this information from your insurance carrier or your Health Insurance Marketplace. Note: Once you submit this information and it is received by the Trust Administrative Office, it can take up to 20 business days to see that information reflected on your Benefit Convenience Card.
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Oregon: How to Update Your Information and Change or Renew Your Medical Coverage on Healthcare.gov
WelcomeUse this guide if you are updating your information and changing or renewing plans to the Trust-Approved Plan available for your area next year.
The Oregon Homecare Worker Supplemental Trust and the Oregon Homecare Worker Benefit Trust provide premium assistance, out-of-pocket expense assistance, dental, vision, hearing, employee assistance program (“EAP”) benefits, and paid time off (“PTO”) benefits to eligible homecare and personal support workers.
This unofficial guide provides step-by-step instructions for navigating www.Healthcare.gov and letting the Trust know your new medical plan information. As a Trust-eligible homecare worker, you may be eligible to receive assistance from the Supplemental Trust in paying for your medical premiums and certain out-of-pocket medical expenses.
Any insurance that you sign up for through www.Healthcare.gov is not a group plan or an employer-sponsored plan; rather, it is individual insurance. If you move, stop doing homecare or personal support work or your hours decrease, your insurance will not be automatically canceled. However, these events may impact your eligibility to receive premium assistance from the Supplemental Trust and your eligibility to receive dental, vision, hearing, EAP, and PTO benefits under the Benefit Trust. You are responsible for ensuring your information on file with the Marketplace and with the Trusts is correct, your monthly premium payment is made to the insurance carrier on time, and you have updated the Trust with any new information about your medical coverage.
If you have any questions refer to the Trust website at www.orhomecaretrust.org or call the Healthcare Enrollment Team at 503-303-5668 (Portland Metro Area) or toll free at 1-855-437-2694.
October 1, 2018 <Name> <Company> <Address> <City, State Zip> Dear _________: <Body of Letter> Sincerely,
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Finding your premium informationWhere you find your premium information will depend on whether you are renewing a plan through the Marketplace or enrolling for the first time.
Finding your premium information in a letter from your carrier. You can find your 2019 premium information on the letter from your insurance carrier that talks about your 2019 plan information. If you had a phone enrollment appointment with Valley Insurance Professionals or the Healthcare Enrollment Team, check to see if they are submitting this information for you.
In this case:
And would be reported on the Enrollment Information Form as:
Your new plan for 2019
We found another Marketplace plan that may meet your needs. Starting in January, you’ll automatically be enrolled in Kaiser OR Silver 2500/30.
Your new premium
• Your 2018 monthly payment is $400.This reflects a monthly premium of $500 minus $100 of financial help per month.
• Starting in January your estimated monthly payment will be $450.This reflects an estimated monthly premium of $550 minus the same amount of financial help you’re getting now. You’ll see your new monthly payment when you receive your January bill.Important: This is only an estimate based on current information we have, including the amount of financial help you got in 2018. It also doesn’t reflect any changes to your enrollment, such as adding additional members to your coverage. To find out how much financial help you qualify for in 2019 and your new premium amount, update your Marketplace application. See below for more information.
The 2019 Insurance Plan Base Premium (Gross) is $550
The 2019 Advanced Premium Tax Credit (APTC)
is $100
The 2019 Insurance Plan Premium after Tax Credit (net)
is $450
550.00
100.00
450.00
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Finding your premium information online in the Marketplace. If you have a healthcare.gov account, you can also find your premium information online by following these steps:
1. Go to www.healthcare.gov. Click “Log In” in the upper right corner
2. Enter your login information and click “Log In”
3. Once you’re logged in, click “My Profile” on the left side of the screen.
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4. Now click “My Applications & Coverage”
5. You’ll now be able to view a summary of your needed premium information.
In this case:
500.00
100.00
400.00
The 2019 Insurance Plan Base Premium (Gross) is $500
The 2019 Advanced Premium Tax Credit (APTC) is $100
The 2019 Insurance Plan Premium after Tax Credit (net)
is $400
And would be reported on the Enrollment Information Form as:
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Completing the Enrollment Information Form
1. Carefully read through the “Get Started” section of the form—there is important information in this.
2. Scroll down the page and note the action you have taken.
3. Use the calendar to set up an appointment time.
Please Note: The appointment you are scheduling is only to fill out the form on the next page. You are not setting an appointment here to call or meet with anyone.
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4. Fill in required information, which is noted by a red asterisk (*).
5. Fill out remaining Personal Information. Please note the two agreements at the top of this section. Required information is indicated by red asterisk (*).
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6. Complete your Insurance Plan Information, using the drop-down menus to select Carrier Name, Plan Name, your reason for completing the form, and insurance start date. If you are re-enrolling for 2019, your “Insurance Start Date” is January 1, 2019.
7. Next, enter your Premium Information. For information on where to find these amounts, please see “Finding your premium information” on page 2 of this guide. Your premium information allows the Trust Administrative Office to determine and correctly administer assistance.
8. Complete the Family Information questions to let the Trust Administrative Office know if anyone else is enrolled on your same plan.
9. If you have any questions or further information to note, you can enter that in the “Notes” section (you can also contact your Healthcare Enrollment Team with questions at 1-503-303-5668 (Portland Metro Area) or toll-free at 1-855-437-2694). Check the boxes to show you have read and understood the statements. Click “Complete Appointment” to finish the form.
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