sent you about your plan and premium for next year and take steps to ensure you have coverage for 2017.

Transcription

1 Dear Participant, We are pleased to announce the 2017 updates to the Oregon Homecare Workers Benefit Trust and the Oregon Homecare Workers Supplemental Trust approved by that Trusts Board of Trustees. Please note that all benefits listed below are only provided to eligible Participants for as long as they are eligible. This letter is a summary -- for more information please visit the Trust website at orhomecaretrust.org or contact the Trust s Healthcare Enrollment Team at For help finding information on the Trust website or if you cannot access the Trust website or have additional questions, you can also call the Trust s Healthcare Enrollment Team at or toll free The Trust s website is accessible via smart phone, tablet or computer and translates into Russian, Spanish and Vietnamese. Benefit Trust There are no benefit changes to Dental, Vision, Employee Assistance Program benefits or Paid Time Off at this time. You will not be receiving new Dental or Vision cards for For more information, please visit the Trust website or call the Trust s Healthcare Enrollment Team. Supplemental Trust If you are currently enrolled in or are enrolling into an individual medical plan through your State s Health Insurance Marketplace (aka Exchange), or if you are currently enrolled in or enrolling into Medicare, you will want to review this letter very closely as there are several important updates that will apply to you. Exchange and Medicare Plan Deductibles, Copayments and Coinsurance. The Board of Trustees is excited to announce an increase on the out-of-pocket reimbursement amount from $3,000 to $4,000 beginning January The Trustees know that there have been significant increases to the out-of-pocket expenses on individual medical plans since 2015, and there is no longer a plan option that limits your individual out-of-pocket responsibility to $3,500 a year with the Oregon Health Co-op ending. If you are enrolled in a Trust-approved qualified health plan and are eligible for coverage under the Supplemental Trust, the Trust will pay up to $4,000 per calendar year of your covered out-of-pocket deductible, copayment and coinsurance expenses relating to any claims you incur that are covered under your Trust-approved Exchange or Medicare plan. The process has not changed. You may pay for

2 covered deductible, copayment and coinsurance expenses at the point of service using the Benefit Convenience Card issued to you by the Trust. If you have not received your Benefit Convenience Card, please submit a completed Reimbursement Form along with a copy of your explanation of benefits ( EOB ). You can learn more about this at the Trust website at Exchange Plan Options. You can review the medical plan summaries online at orhomecaretrust.org/resources as they become available. You will want to review the plan summary for 2017 to understand the changes made by the medical insurance carriers, such as larger deductibles and out-of-pocket responsibilities for individuals enrolling into these plans. Your insurance carrier, if you are currently enrolled, sent you a summary letter notifying you about your yearly premium increase and whether or not your plan is offered next year. If you reside in Oregon, the Trust-approved plans for 2017 are as follows: Participants that reside within the Kaiser service area: the Kaiser Permanente Silver $2,000 Deductible plan. On Exchange: KP OR Silver 2000/30 Plan ID 71287OR Participants that reside in the part of Clackamas County not covered by Kaiser: the PacificSource Silver $2,500 Deductible Legacy Health Network (LHN) plan. On Exchange: PacificSource Oregon Standard Silver Plan LHN, Plan ID 10091OR Participants that reside in Crook, Deschutes or Jefferson County: the PacificSource Silver $2,500 Deductible SCN (Central Oregon Smart Choice) plan. On Exchange: PacificSource Oregon Standard Silver Plan SCN, Plan ID 10091OR Participants that are currently enrolled in the MODA Silver $1,550 Deductible Be Prepared Beacon plan: the MODA Silver $2,250 Be Prepared plan. On Exchange: Moda Health Beacon Be Prepared, Plan ID 39424OR This is a change. If you are currently enrolled in PacificSource $2,500 deductible plan you should be automatically enrolled into this plan if you also reside in this area. Refer to the letter PacificSource sent you about your plan and premium for next year. 2 This is a change. If you are currently enrolled in PacificSource $2,500 deductible plan you should be automatically enrolled into this plan if you also reside in this area. Refer to the letter PacificSource sent you about your plan and premium for next year. 3 This is a change. MODA is no longer offered in several counties for You will want to review the letter MODA sent you about your plan and premium for next year and take steps to ensure you have coverage for 2017.

3 Participants that reside outside of the Kaiser service area, and outside of Crook, Deschutes or Jefferson Counties: the BridgeSpan Oregon Standard Silver $2,500 Deductible plan. On Exchange: Bridgespan Standard Silver Plan RealValue, Plan ID 63474OR If you reside in Washington, the Trust-approved plans for 2017 are as follows: Participants that reside within the Kaiser service area: the Kaiser Permanente Silver $2,000 Deductible plan. Participants that reside outside of the Kaiser service area: the BridgeSpan Silver $3,500 Deductible Essential plan. 5 If you reside in Idaho, the Trust-approved plan for 2017 is as follows: The PacificSource Silver $3,000 Deductible BrightPath plan. 6 IMPORTANT INFORMATION FOR CURRENT AND NEW EXCHANGE PARTICIPANTS: You can enroll into any plan on the Marketplace that you would like to. However, if you are eligible and would like to receive premium assistance and out-of-pocket assistance under the Trust, you must enroll into one of the Trust-approved plans mentioned above on the Health Insurance Marketplace. Refer to your plan booklet for more information. If you would like to continue to receive benefits from the Trust and are otherwise eligible and you received a letter from your current medical insurance carrier that you are being automatically enrolled into a new plan you need to make sure that plan is the Trust-approved plan for your area. You do need to complete steps to update your information with the Health Insurance Marketplace and the Trust Administrative Office to continue to receive benefits. Visit the 2017 Open Enrollment page on the Trust website to learn more and review the enrollment process checklist for 2017 to make sure you do not miss any steps in the process. If you would like to continue to receive benefits from the Trust and are otherwise eligible and you received a letter from your current medical insurance carrier that your plan is no longer available next year, you will need to enroll into a new Trust-approved plan for your area with the Health Insurance Marketplace and update your information with the Health Insurance Marketplace and the Trust Administrative Office. Visit the 2017 Open Enrollment page on the 4 This is a change to the network name from Value PPO to RealValue. You will want to confirm your provider is available. Refer to the letter BridgeSpan sent you about your plan and premium for next year. 5 This is a change. UnitedHealthCare is no longer offered next year in your area. You will want to take steps to ensure you have coverage for This is a change. The previous PacificSource plan is no longer offered for You will want to review the letter PacificSource sent you and take steps to ensure you have coverage for 2017.

4 Trust website to learn more and review the enrollment process checklist for 2017 to make sure you do not miss any steps in the process. If you would like to continue to receive benefits from the Trust and are otherwise eligible and you received a letter from your current medical insurance carrier that you are being automatically enrolled into the same plan you need to make sure that plan is the Trust - approved plan for your area. You do need to complete steps to update your information with the Health Insurance Marketplace and the Trust Administrative Office to continue to receive benefits. Visit the 2017 Open Enrollment page on the Trust website to learn more and review the enrollment process checklist for 2017 to make sure you do not miss any steps in the process. If you would like to receive benefits from the Trust and are otherwise eligible and you are enrolling into your individual medical insurance through the Health Insurance Marketplace for the first time visit the 2017 Open Enrollment page on the Trust website to learn more and review the enrollment process checklist for 2017 to make sure you do not miss any steps in the process. You will want to schedule your phone enrollment appointment as soon as possible. Exchange Plan Premiums. If you are covered under one of the Trust-approved Exchange plans through the Exchange and you are eligible for benefits under the Supplemental Trust, the Trust will continue to pay that portion of your individual premium amount that would not be covered by the maximum federal advance premium tax credit you are entitled to receive. If you enroll as an individual into one of the Trust-approved Exchange plans through the Oregon Exchange, the Trust will send you a welcome packet with specific instructions for how that premium will be paid. If you enroll into family coverage under a Trust-approved Exchange plan, the Trust will not pay your premium to the carrier. Instead, you will need to pay the premium directly to the insurance carrier and then submit a copy of your premium bill to the Trust administrative office for reimbursement of the premium amount relating to your individual coverage. In order to receive monthly premium reimbursements from the Trust in 2017, you will need to submit a new Reimbursement Form and proof of premium payment to the Trust administrative office. Medicare Reimbursement Renewals. For 2017, if you are currently receiving Part B reimbursements, you do not need to resubmit a reimbursement form to continue to receive that Part B premium benefit as long as you remain eligible. You do need to submit a reimbursement form to the Trust Administrative Office for any Supplemental/Advantage or Part D premium benefit in The monthly reimbursement for Supplemental/Advantage or Part D premiums is increasing from up to $41 to up to $44 beginning in 2017.

5 Reimbursement Submission. For eligible Medicare premiums and premium reimbursement for eligible members on Family plans, please use the reimbursement process. For faster processing, visit the 2017 Reimbursement page on the Trust website. Reimbursement requests should be submitted to your Trust Administrative Office: By Mail: Oregon Homecare Workers Trust PO Box 6 Mukilteo, WA By Fax: , Subject OHCWT Reimbursement For eligible Exchange premium and Exchange or Medicare out-of pocket expenses incurred prior to receipt of the Benefit Convenience Card, please use the Ameriflex reimbursement process. Benefit Convenience Card reimbursement requests should be submitted to Ameriflex: By Mail: By Fax: Ameriflex Claims Department PO Box Plano, TX , Subject: Attention: Claims Department More Information or Questions. If you have any questions about benefits that you may be eligible to receive through your Oregon Homecare Workers Supplemental Trust or Oregon Homecare Workers Benefit Trust, you can visit or call your Healthcare Enrollment Team at v1 7OE v1