Oregon Continuation Payment Assistance

The following is a high-level summary of the program. This summary is not intended to be used as legal advice. If you have questions about your legal responsibilities under the law, you should consult one of the government sources listed below or a legal adviser.

Eligibility

You are eligible if the following apply:

You were involuntarily terminated from employment between Sept. 1, 2008, and Feb. 28, 2010. Dependents also are eligible and may elect coverage even if the subscriber does not. (Updated March 9, 2010: An extension of the eligibility period through March 31, 2010, is pending with the state.)
Domestic partners and children of domestic partners may be able to obtain Oregon continuation coverage; however, they are not able to obtain premium assistance.
Your employer's plan was not subject to COBRA (typically employers with fewer than 20 employees).
You were covered for three months on a group plan prior to your termination date.
You are not eligible for other group coverage or Medicare.
The amount of subsidy available is reduced if the adjusted gross income (AGI) is between $125,000 and $145,000 or between $250,000 and $290,000 if filing jointly and a portion of the subsidy received must be repaid on the 2009 tax return. If the AGI exceeds $145,000, or $290,000 if filing jointly, the entire subsidy received must be repaid as part of the applicable tax return.
(Updated March 9, 2010: The state is expected to extend eligibility to those who lost coverage due to a reduction in hours between Sept. 1, 2008, and March 31, 2010, and were subsequently involuntarily terminated on or after March 2, 2010.)

Timing

Subsidized coverage is generally available for up to 15 months for those who remain eligible. Note that individuals who are eligible for continuation coverage but not for the subsidy are only eligible for up to nine months of coverage.
Also note that for individuals who enroll after an involuntary termination that followed a reduction in hours, the maximum duration of coverage is calculated as if the reduction in hours was the qualifying event for coverage.
An individual ceases to be eligible for subsidized coverage when the individual becomes eligible for other group health plan coverage or Medicare. You must notify Providence Health Plan of eligibility for another plan or you will be subject to penalties under federal law.
Oregon continuation coverage under Providence Health Plan will end if the employer terminates the group insurance policy. However, further continuation coverage may be available if a replacement plan is offered with another insurance carrier.

What does this mean for you?

Affected individuals

Eligible individuals are obligated to pay only 35 percent of their Oregon continuation. Upon termination of coverage, employees will receive a notice regarding Oregon continuation coverage and subsidy in the mail from Providence Health Plan. The notice provides additional details and next steps on submitting completed forms to the employer to elect and request subsidized Oregon continuation coverage. If you are newly eligible and wish to enroll for subsidized coverage because you were involuntarily terminated after losing coverage due to reduced hours, please submit an Oregon continuation election form and a subsidy request form to your former employer.

For more information and forms, please follow the links at the bottom of this page. If you have questions, please call your former employer or Providence Health Plan.

Employers

Providence Health Plan sends all required notices to individuals eligible for Oregon continuation coverage. However, employers must notify carriers when employees are involuntarily terminated after losing coverage due to reduced hours so that they also can be mailed our ongoing notice. (Contact membership accounting by calling 503-574-5791.)

When Oregon continuation coverage is subsidized, Providence Health Plan will adjust your bill accordingly and Providence Health Plan will be reimbursed the subsidized amount, 65 percent, by the government. Employers are responsible for collecting premiums for continuation members and for paying continuation premiums to Providence Health Plan as billed. Providence Health Plan will adjust bills to reflect subsidized individuals. Former employees who choose to elect subsidized coverage will send an Oregon continuation election form and a subsidy request form to the employer. Please review these forms, complete the employer section and send Providence Health Plan signed copies. In some cases where the individual is determined to be ineligible for the subsidy, the request form will need to be returned to that individual. Links to these forms are listed below. Note that individuals who are currently enrolled in subsidized continuation coverage do not need to do anything to take advantage of the extension.

In addition, the subsidy law permits employers, at their discretion, to allow subsidy-eligible employees to switch to a lower or equal cost plan option to make Oregon continuation more affordable. When employers offer more than one option to a class of employees, an employee in that class may switch to a lower cost plan if desired.

Producers

When communicating with employers, it is important to alert them to the employers' responsibility of collecting and paying all Oregon continuation premiums to Providence Health Plan as billed. Providence Health Plan will adjust bills to reflect subsidized individuals. Employers also have a key role in completing the subsidy request form, as indicated on the form.

Regarding member communication, please inform individuals that Providence Health Plan will provide them with a notice with additional information regarding next steps. For instance, recently terminated individuals will receive forms to elect and request subsidized continuation coverage. Refer them to the employers or to Providence Health Plan with questions.

Producers also may direct employers and individuals to the Department of Labor, Internal Revenue Service and the Oregon Insurance Division's Web sites for more information. Links to these Web sites are highlighted below.

Forms

Oregon continuation election form (PDF)
Subsidy request form (PDF)

Additional resources

For more information please research the following Web sites: