Text Size:   A+ A- A   •   Text Only
Find     
Site Image

Insurance Options For Children
State Programs For Insuring Children Under The Age of 19
Healthy Kids Photo
If you have an uninsured child under the age of 19, there are state programs that may be the right option for you. Each program has it's own eligibility requirements, including family income, period of uninsurance and residency status.
 
When evaluating health care coverage programs, you may want to consider a few things to help you make the best choice for you child's care:
  • Cost
  • Regional Service Area
  • Accessibility

 
Healthy Kids/Healthy KidsConnect
Healthy Kids provides access to health insurance for all Oregon's uninsured children age 18 and younger, even those with medical conditions. Healthy KidsConnect covers children up to age 19.
 
Healthy Kids' comprehensive health care coverage includes medical, dental, vision, mental health services and prescription benefits. Preventative services are provided at no cost. Healthy Kids provides options for families at all income levels, removes barriers to access for health care coverage and builds on programs already available to Oregon families. Coverage lasts for one full year and is re-determined annually.
 
Qualifications for Healthy Kids:
  • Children must be age 18 or younger.
     
  • Children must live in Oregon and be a legal resident.
     
  • Household income must be at or below 300 percent of the Federal Poverty Level (FPL) to qualify for premium assistance. Households at 301 percent or above the FPL may purchase coverage by paying the full premium.
     
  • Children must be without health insurance for two months (some exceptions apply).
Although only one application is needed for Healthy Kids, there are three avenues of coverage. Program option availability depends on a family's household income and circumstances.
  1. Oregon Health Plan (OHP) Plus (Medicaid). Available to families the earn 200 percent or below the Federal Poverty Level.
     
  2. Employer Sponsored Insurance (ESI), also known as group insurance. If you have access to insurance at work, you may be able to receive assistance to enroll your child on your employer plan.
     
  3. Healthy KidsConnect, a private market insurance option. HKC is for families that earn too much to qualify for the Oregon Health Plan, but can't afford private health insurance. This option covers children up to age 19.
Ready to apply? Fill out the online application.
 
Need help with your application? Contact a Community Application Assister in your area.

 
Family Health Insurance Assistance Program (FHIAP)
If you have access to insurance at work, FHIAP may be able to assist with paying a portion of the premium for adding your child to your plan. FHIAP pays 100 percent for children up to age 19 (from 50 percent to 95 percent for adults) of the premium, if a child has been uninsured for the past two months and the family meets income and other guidelines. FHIAP members pay for deductibles, co-payments, and other costs of health plans. Individuals and families use FHIAP subsidies to pay for insurance at work or to help buy individual health plans if insurance is not available through an employer. Learn more: www.fhiap.oregon.gov

 
Pre-Existing Condition (Any Income Level)
Healthy Kids
 
Oregon's Healthy Kids program is available all children, even those with existing medical conditions. See program description below.
 
Oregon Medical Insurance Pool
 
The state and federal high-risk pools provide health insurance for kids and adults who can't get medical insurance due to an existing condition. There are three ways to be eligible to be eligible for OMIP, and one (medical) for FMIP. None are based on income. Family Health Insurance Assistance Program (FHIAP) subsidies may be used to help pay OMIP/FMIP premiums, when FHIAP has program openings. OMIP/FMIP contracts with Regence BlueCross BlueShield of Oregon to administer these programs.
 
Medical eligibility: Those individuals who can't get commercial medical insurance because of pre-existing health conditions (see below). Individuals can apply to OMIP/FMIP if an insurance company turns them down for coverage. People with certain medical conditions can apply directly to OMIP/FMIP.
 
One application is used for both pools. Although a child's circumstances decide which pool they belong, they do not need to figure this out. OMIP/FMIP's administrator will put the person in the correct pool based upon questions answered in the application.
 
Premiums vary by age and plan. OMIP/FMIP generally has higher expenses as a result of insuring those with greater health risks; therefore, premium rates are higher. OMIP/FMIP plans are not low-cost coverage, but are meant as an option for those who would otherwise be uninsurable.
 
Pre-existing conditions

Insurance companies may turn you down for individual coverage based on your health (a pre-existing condition). A "pre-existing" condition is health problem that existed before a health insurance policy takes effect. The pre-existing health condition may have resulted from a sickness, condition, or injury. Beginning January 1, 2011, those under the age of 19 will not be able to be turned down due to a pre-existing condition, because of Federal Health Care Reform. Health insurance plans will be required to have no pre-existing condition exclusions for those of any age beginning in 2014. With group (employer-sponsored) insurance, no one can be rejected based on their health. The companies use information from your insurance application to decide if they will sell you an individual policy.
 
If you are turned down for an individual policy, you can still get insurance through a state program called the Oregon Medical Insurance Pool (OMIP). In fact, if you have certain medical conditions such as diabetes, cancer, or other health conditions, you can apply directly to OMIP without first applying to an insurance company. For more OMIP information, click here.