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OPHP's Programs For Adults And Families
Get Help Paying For Health Insurance
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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
Important Notice: The FHIAP reservation list has been closed effective July 18, 2013.

FHIAP will continue to pay subsidies to current members through December 31, 2013. Current members will be notified in the coming months about how to transition into a new plan through Cover Oregon or the Oregon Health Plan beginning January 1, 2014.

Contact information for people on the FHIAP Reservation List now, will be transferred to Cover Oregon for follow up.​

More about Cover Oregon​

Cover Oregon is making health coverage more accessible and easier to understand. Cover Oregon is a new online marketplace where Oregonians can compare and enroll in health and dental coverage that fits their needs and budget. More Oregonians will be able to get health coverage, even if they already have a health condition, and in some cases access financial help.​

Open Enrollment begins in October. Learn more, check eligibility for financial help and sign up for updates at CoverOregon.com, or call 1-855-CoverOR (1-855-268-3767) to talk to a trained specialist on the phone or in person.

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) 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
The state's "high-risk pools," the Oregon Medical Insurance Pool (OMIP) 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. None are based on income. Family Health Insurance Assistance Program (FHIAP) subsidies may be used to help pay OMIP premiums, when FHIAP has program openings. OMIP contracts with Regence BlueCross BlueShield of Oregon to administer these programs.
 
Who qualifies for OMIP? 
 
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 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'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 Member Handbook) to OMIP. If you would like help applying to OMIP, 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/HCTC:-Eligibility-Requirements-and-How-to-Receive-the-HCTC- or contact the HCTC Customer Contact Center at 866-628-4282. For those with hearing impairment, dial 866-626-4282 (TTY).

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