Frequently Asked Questions

Yes. You need to send the required documents directly to the Essential Worker Healthcare Trust within 90 days. If EWHT doesn’t receive them within the 90-day window, your dependent’s coverage will end. For more information visit our Dependent Verification page. 

• • For a spouse: You need to submit a copy of your certified record of marriage (sometimes called marriage certificate or marriage license) that’s been issued from your state, county, federally recognized tribal government office, or similar authority, showing the filed application, license, and record of marriage. Any document with “commemorative,” “heirloom,” or “for display purposes only” cannot be used as legal proof of marriage. If you’re no longer married to a spouse who is enrolled in the healthcare plan, submit a copy of your divorce decree(s) for the spouse(s) you are no longer married to. 
  • For domestic partners: submit either a state-issued certificate of domestic partnership or a signed EWHT domestic partnership affidavit, which you can download here. 
  • For children: You need to submit a copy of the birth certificates, adoption decrees, legal guardianship orders, Qualified Medical Child Support Orders, National Medical Support Orders, or other court order documentation that proves the relationship between you, the primary subscriber, and your dependent(s). If your child is married, you must also include a copy of the child’s certified record of marriage. 

Please reach out to EssentialWorker@RISEpartnership.com if you have questions about dependent verification. 

You can enroll eligible dependents or a spouse the same way you enroll yourself. Please contact your employer to enroll them.  If you have questions about how to enroll, your monthly premium, or your eligibility, please check in with your employer.

If you enroll dependents, you must complete the dependent verification process within 90 days. If you don’t send us the required documents within the 90-day window, your dependents will no longer be covered by EWHT benefits. For more information visit our Dependent Verification page. 

Typically, you and your dependents may only join this health plan when you are a new full-time employee or during an annual open enrollment period. The EWHT open enrollment period usually happens during the month of November. Changes made during a November open enrollment typically take effect the following January 1.  Check with your employer  for their specific open enrollment dates. 

Outside of open enrollment, you may be eligible to make changes if you have a qualifying life event, such as: the birth of a child, adoption, marriage, death, divorce, in some cases a change of address, a change in your eligibility (for example, going from part-time to full–time), or the loss of other medical coverage.

If you have a midyear qualifying life event, your employer must submit changes to the Essential Worker Healthcare Trust within 60 days of the event. Notify your employer early so they can meet this deadline. Most coverage changes begin on the first day of the month after the event, while births and adoptions begin on the event date. If you miss the 60-day deadline, you won’t be able to enroll your dependents until the next open enrollment.

There are 2 situations where you can make changes to your coverage: 

1. Open enrollment is the time when most people enroll or make changes and usually happens in November. Changes made during November open enrollment typically take effect the following January 1. 
2. Sometimes, you can make changes outside of open enrollment if you have a qualifying life event such as the birth of a child, adoption, marriage, death, divorce, in some cases a change of address, a change in your eligibility (for example going from part-time to full-time), or the loss of other medical coverage. 

If you have a midyear qualifying life event, your employer must submit changes to the Essential Worker Healthcare Trust within 60 days of the event. Notify your employer early so they can meet this deadline. Most coverage changes begin on the first day of the month after the event, while births and adoptions begin on the event date. If you miss the 60-day deadline, you need to enroll during the next open enrollment. 

If you enroll during your employer’s November open enrollment period, your coverage will take effect the following January 1. 

If you enroll outside of open enrollment, such as becoming a new full-time employee or because of a qualifying life event, your coverage usually begins on the first day of the month following your enrollment. 

Create (or log in to) your EWHT Member Portal account. You can check your (or your dependent’s) enrollment status and securely upload any required verification documents there. You can also download the MyCreateHealth mobile app here. 

Unfortunately, EWHT doesn’t have access to your employer’s portal. Please contact your employer for assistance.

When you use in-network providers, your annual deductible is $800 per individual and $1,600 per family. For specific cost scenarios, please contact your health plan. Your deductible is different from your out-of-pocket max. Learn more about your out-of-pocket max.

When you use in-network providers, your annual out-of-pocket max is $2,000 per individual and $4,000 per family. For specific cost scenarios, please contact your health plan.

Your out-of-pocket max is different from your deductible. Learn more about your deductible.

For specific cost scenarios, please contact your health plan.  Copay amounts depend on the type of doctor’s visit.   

When you use in-network providers:   

• Preventive care office visit is a $0 copay.
• Primary care and behavioral health office visits are $5 for the first 3 visits (in any combination). Additional visits are $20 each.
• Specialist, physical therapy, massage therapy, and chiropractic office visit copay is $40.
• Urgent care visit copay is $60.
• You pay 20% for the cost of labs and X-ray services. You don’t have to meet the deductible first. 
• Emergency room visit for Kaiser members is 20% of procedure costs after you meet the deductible until you reach your out-of-pocket max.  
• An emergency room visit for Regence members is a $160 copay then 20% of the remaining procedure costs after you meet the deductible until you reach your out-of-pocket max. If you’re admitted to the hospital, your $160 copay is waived.  

For most other services with in-network providers (such as surgery, hospital stays, etc.), you pay the full cost until you meet your deductible. After your deductible is met, you then pay 20% of the remaining procedure costs until you reach your out-of-pocket max. 

For specific cost scenarios, please contact your health plan. Each plan can tell you whether your medication is on their list of covered medications. For covered medications, prescription copays range from $0 to $100 for a monthly supply depending on the type of prescription.   

• Generic prescriptions are $0.  
• Preferred brand prescriptions are $30 for a 30-day supply, and $60 for a 90-day supply through the mail-order pharmacy.   
• Non-preferred brand prescriptions are $80 for a 30-day supply and $160 for a 90-day supply through the mail-order pharmacy.   
• Specialty drugs (cancer treatment, etc.) are $100 for a 30-day supply.   

To reach your deductible, you must pay for certain healthcare expenses out-of-pocket until you meet the deductible amount specified by your medical benefits plan. You can log into your health plan’s portal to view your progress towards your deductible and out-of-pocket max.

For specific cost scenarios, please contact your health plan. 

Coverage costs can differ based on various factors. For cost-related questions and specific scenarios, please contact your health plan. 

Currently, 12 employers are part of the Essential Worker Healthcare Trust (EWHT). Confirm your eligibility by checking the detailed list of participating facilities or contact your employer. 

Eligible dependents include:   

• Spouse or domestic partner (submit a state-issued or federally recognized tribal government certificate of domestic partnership or a signed EWHT Domestic Partnership Affidavit, which can be found here).  
• Children under age 26, without regard to marital, financial, or student status. This includes biological children, stepchildren, adopted children, children placed with you for adoption, foster children, or children for whom you are the legally appointed guardian, Qualified Medical Child Support Order, National Medical Support Order, or other court order documentation that proves the relationship between you and your dependent. 
• Unmarried child(ren) who are age 26 or older, depend on you for support, and are medically certified as disabled. This disability must have started before age 26.  
• After enrolling your dependents, the Essential Worker Healthcare Trust will mail you a letter with instructions on how to submit documents to verify your dependents directly to EWHT (not just to your employer). You must submit dependent verification to EWHT within 90 days. If you don’t send us the required documents within the 90-day window, your dependents will no longer be covered by EWHT benefits.

Learn more about how to enroll your dependent, spouse, or domestic partner at our Dependent Verification page.

Yes, you are still eligible for EWHT health plan benefits even if you live in Washington State but must meet all 3 criteria below: 

1. Work at an EWHT participating facility, and 
2. Work 30 hours or more in a workweek, and 
3. Are considered full-time by your employer. 

 To see if you work at a participating facility, check the full list here or contact your employer. 

Losing OHP counts as a qualifying life event. Tell your employer right away so they can confirm your eligibility and submit your enrollment within 60 days.

To see if you work at a participating facility, check the full list here or contact your employer. 

Not at this time. Please speak to your employer to learn more about your other benefits.

No. We only cover the medical portion of your benefits. Your FSA is a separate plan. Please speak to your employer about your other benefits. 

Both plans cover the same kinds of services, with the same costs to you when you need care. How they work is different.    

• If you‘re enrolled in the Kaiser Permanente Exclusive Provider Organization (EPO), in most instances, you must use Kaiser healthcare providers for your services to be covered. Kaiser’s service area consists of certain geographic areas in the Northwest designated by zip code. Kaiser’s service area may change. Click here for a complete listing of service area zip codes. Contact Kaiser for details on allowable exceptions when they would refer you to outside providers and facilities. For instance, emergency services are covered at out-of-network facilities. Learn more about the Kaiser plan.

• If you’re enrolled in the Regence Preferred Provider Organization (PPO), you can use in-network or out-of-network providers to receive care, but you’ll save money using in-network providers. Emergency treatment for life-threatening conditions at out-of-network hospitals, including care received outside the US is paid as if in-network. The plan gives you access to a comprehensive network of providers in Oregon and across the country. Learn more about the Regence plan.

Yes. You may keep both, but the federal government requires EWHT to be billed first (meaning it is the primary insurance). You should decide for yourself whether that will benefit you. 

No. You cannot be enrolled in both OHP and EWHT. If you are on OHP, we recommend you remain on OHP.

If you’re enrolled in Kaiser, you will need to see a Kaiser doctor at a Kaiser facility. In most cases, your plan does not cover out-of-network doctors. For more information, call the number on the back of your member ID card or visit kp.org/locations to search for doctors and locations in the Kaiser Classic Plan. Click here for Kaiser’s contact information.

If you’re enrolled in Regence, you will save money by seeing a Regence in-network provider. You may receive care from an out-of-network provider, but it may cost you more. For more information, call the number on the back of your member ID card or visit regence.com/provider/finding-doctors to search for doctors in Regence’s Preferred Network. Click here for Regence’s contact information.

You can check if a particular procedure or service is covered or find an in-network care provider by logging in to your health plan member portal. Or you can call the phone number on the back of your member ID card. Click here for Kaiser or Regence’s contact information. 

If you’re enrolled in Kaiser, you’ll want to go to a Kaiser pharmacy to fill your prescriptions. Your Kaiser doctor can tell you if a medication is covered by Kaiser. You can also contact Kaiser by calling the number on the back of your member ID card.  Click here for Kaiser’s contact information.

If you’re enrolled in Regence, you will use Optum’s list of in-network pharmacies. Click here to search if a pharmacy is in-network and if your medication is covered. You can also click here for Optum’s contact information.

To update your mailing address, phone number, or email address, contact your employer or EWHT customer service at EssentialWorker@RISEpartnership.com or call 833-389-0027 Monday-Friday 8 a.m. to 5 p.m. 

Setting up your online EWHT Member Portal account is the best way to view information your employer sent to EWHT, check your (or your dependent’s) enrollment status, or securely upload dependent verification documents. Visit the EWHT Member Portal to get started! You can also download the MyCreateHealth mobile app here.