Text Size:   A+ A- A   •   Text Only
Find     
Office of Private Health Partnerships

OPHP's Programs For Adults And Families
Get Help Paying For Health Insurance
Family Photo
The state of Oregon gives financial help to qualified adults and families who want to buy health insurance. This financial help is referred to as a "subsidy." A subsidy helps people purchase health insurance at work, or through an insurer. The subsidy is used to help pay the premium (monthly cost) of health insurance. Subsidies do not help with other costs. Subsidy programs available in Oregon include the Family Health Insurance Assistance Program (FHIAP) for adults and families; and the Healthy Kids program, for kids.
Family Health Insurance Assistance Program
The Family Health Insurance Assistance Program (FHIAP) helps Oregonians pay the monthly premium for high-quality health insurance plans. FHIAP is not an insurance company, or an insurance plan. FHIAP pays from 50 percent to 95 percent (100 percent for children up to age 19) of the premium for people who have been uninsured for the past two months and meet guidelines. FHIAP members pay for deductibles, co-payments, and other costs not covered by health plans. Adults and families use FHIAP subsidies to pay for insurance at work, or to help pay for a health plan if they cannot get insurance through an employer.
 
If an adult or family member has not had insurance for two months or more, they may qualify for FHIAP. However, FHIAP is not taking new applications at this time. You may put your name on the reservation list to receive an application as new openings occur. Click here to make a reservation.
Learn more at www.fhiap.oregon.gov, or call 888-564-9669.

Getting Health Insurance Coverage When Denied
Insurance companies may turn a person down for individual coverage based on the person's 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. Insurance companies use information from an application to decide if they will sell someone an individual policy. To avoid problems, a person should be honest on an insurance application.
 
Individuals can apply to the Oregon Medical Insurance Pool (OMIP) and the Federal Medical Insurance Pool (FMIP) if an insurance company turns them down for coverage.
 
Kids under the age of 19 are not be able to be turned down due to a pre-existing condition, because of Federal Health Care Reform (beginning date: September 23, 2010). The Healthy Kids program also provides options for kids with pre-existing conditions. Click here to apply to the Healthy Kids program.
 
Health insurance plans will be required to have no pre-existing condition exclusions for those of any age starting in 2014. With group (employer-sponsored) insurance, no one can be rejected based on their health.

Oregon Medical Insurance Pool/Federal Medical Insurance Pool
The state's "high-risk pools," the Oregon Medical Insurance Pool (OMIP) and the Federal Medical Insurance Pool (FMIP) provide health insurance for adults and kids who can't get medical insurance. 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.
 
Who qualifies for OMIP/FMIP?
 
Medical eligibility: People who can't get medical insurance because of pre-existing health conditions. People with certain medical conditions like diabetes, cancer, or other health conditions can apply directly to OMIP/FMIP without first applying to an insurance company.
 
Kids with medical conditions have additional options, click under kids for information about the Healthy Kids program. Or, click here to apply.
 
One application is used for both the FMIP and the OMIP pools. OMIP runs both pools. An individual's circumstances decide which pool they belong. 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. Because high-risk pools cover high-risk claims, they are not a low-cost option. Click here for an application (Pages 21-31 in the OMIP/FMIP Member Handbook) to OMIP/FMIP. If you would like help applying to OMIP/FMIP, call 800-542-3104 ext. 85244, and ask for a producer referral or e-mail ophp.mail@state.or.us, the service is free.
 
Who else qualifies for OMIP?
 
Portability eligibility: People who are leaving group coverage and exhaust COBRA benefits or can't get a portability plan from a commercial insurer. Individuals who are eligible for portability coverage must apply within 63 days of losing their group coverage or exhausting their COBRA coverage. There is no waiting period for coverage of pre-existing conditions.
 
Health Care Tax Credit (HCTC) eligibility: Those that are trade-affected workers, Pension Benefit Guaranty Corporation (PBGC) payees, and their families. The HCTC makes health insurance more affordable by paying 65 percent of health insurance premiums. The HCTC is available on a monthly basis to help pay for health insurance as they go or on a yearly basis when the federal tax return is filed.
 
Once registered for the monthly program, the person pays 20 percent of their premium, there will be 65 percent added for the person, and the full 100 percent will be paid for the health plan. The HCTC Program partners with various federal and state agencies and Health Plan Administrators (HPAs) to deliver the tax credit to eligible individuals.
 
If a person is eligible for the HCTC they can enroll or be enrolled in one of the following health plans:
  • Health care coverage from a state-qualified health plan (such as OMIP).
     
  • COBRA coverage, if they are responsible for paying more than 50 percent of the premiums; or
     
  • A spouse's employer-sponsored health plan, if the spouse pays more than 50 percent of the cost with after-tax dollars.
OMIP is the state qualified health plan in Oregon. OMIP's medical benefits are comparable to the benefits provided by employer-sponsored health plans with full comprehensive medical coverage. OMIP does not provide vision or dental benefits.
 
For more information on eligibility and how to receive HCTC, go to http://www.irs.gov/individuals/article/0,,id=185800,00.html or contact the HCTC Customer Contact Center at 866-628-4282. For those with hearing impairment, dial 866-626-4282 (TTY).