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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. Anyone with questions about legal responsibilities under the law 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 Dec. 31, 2009. Dependents also are eligible and may elect coverage even if the subscriber does not.
- 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.
- You are still eligible for the special election described below if you were previously enrolled in Oregon continuation coverage, as long as you meet all other criteria.
- 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 2009 tax return.
Timing
The start date for your subsidized coverage depends on the date of your termination from employment, as follows:
| Date of employment termination | Start date for subsidized coverage |
|---|---|
| Sept. 1, 2008 through Feb. 28, 2009 | March 1, 2009 |
| March 1, 2009 through March 31, 2009 | April 1, 2009 |
| April 1, 2009 through April 27, 2009 | May 1, 2009 |
| April 28, 2009 through Dec. 31, 2009 | The day following the date your group coverage terminated |
- Subsidized coverage is generally available for up to nine months for those who remain eligible.
- 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 premium beginning with their first affected payment as indicated above. Individuals whose coverage terminated on or after Sept. 1, 2008, will receive a notice regarding Oregon continuation assistance in the mail from Providence Health Plan. The notice provides additional details on next steps, for instance submitting completed forms to former employers to elect and request subsidized Oregon continuation coverage.
An individual involuntarily terminated between Sept. 1, 2008, and April 27, 2009, who previously declined or elected and terminated Oregon continuation coverage, will have 31 days from the date that they receive their notice to elect subsidized Oregon continuation coverage. Individuals who have state continuation coverage and want to apply for the subsidy must fill out the forms and send them to their 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 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 their former employer. Please review these forms, complete the employer section and send Providence Health Plan signed copies. In some cases the subsidy request form will need to be returned to the requesting individual as no subsidy will be available. Links to these forms are listed below.
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 individual communication, please inform individuals that Providence Health Plan will provide them with a notice with additional information regarding next steps, for instance submitting completed forms to elect and request subsidized continuation coverage. Refer them to their former 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
Additional resources
For more information please research the following Web sites:
