Frequently Asked Questions

Select a section to view FAQs

Eligibility
Enrollment
Benefit Details
Contact Information

Eligibility

Who is eligible for coverage under the Trust?

If you are a staff employee of a participating employer (Avamere, EmpRes Healthcare Management, Dakavia, Prestige Care, Inc.) and work 30 hours or more in a workweek and are considered full time by your employer. If you are currently eligible for benefits through your employer, you are automatically eligible for benefits through the Trust.

Eligible dependents include your:

  • Spouse or state-registered domestic partner
  • Child(ren) under age 26, without regard to marital, financial, or student status
  • Unmarried child(ren) age 26 or older, if dependent on you for support and medically certified as disabled, provided that the disability began before age 26.

Enrollment

How do I sign up for healthcare coverage?

You should receive an enrollment packet from your employer with information on coverage options, costs, and more. Your employer’s human resources or benefits staff can help you enroll or you can enroll online by following this link.

If I have coverage through my employer now, do I still have to sign up?

Yes! Your current employer coverage is being replaced. You must enroll during the open enrollment period (until Nov. 11) to have coverage in 2023.

When will my coverage begin?

If you sign up for coverage during this year’s open enrollment (until November 11, 2022), your coverage will begin January 1, 2023.

Will I be able to make changes to my coverage throughout the year?

There are two times you can make changes to your coverage, such as changing plans or adding or removing a dependent:

  • Open enrollment, which will take place each October. Changes made during open enrollment take effect the following January 1.
  • A qualifying life event such as a birth, adoption, marriage, death, divorce, or change in eligibility (like moving from less than 30 hours a week to more than 30 hours a week). If you have a midyear qualifying life event, you must make changes within 30 days of the event. Your coverage change will be effective as of the first of the month following the date of the life event (for birth, adoption, or placement for adoption, the change is effective as of the date of the event).

Benefit Details

What is the Essential Workforce Health Care Trust?

SEIU Local 503 and participating long-term care employers in the State of Oregon have come together to form the Essential Worker Healthcare Trust to provide new affordable and high-quality options for medical coverage in 2023.

  • The Trust sponsors these plans, making important decisions about program benefits and premiums.
  • A third-party administrator helps the Trust with day-to-day administrative processes like managing member eligibility and more.
  • Regence – The PPO plan uses the Regence medical provider network and Regence processes PPO plan claims on behalf of the Trust.
  • OptumRx– The Trust contracts with OptumRx to provide PPO plan prescription drug benefits and programs.
  • Kaiser Permanente – The Trust’s HMO plan is provided through Kaiser Permanente (medical and prescription drugs).
How can I see if my provider will be covered on one of the new plans or find a primary care provider?

The new coverage offers two plans. The Regence Preferred Provider Organization (PPO) and a Kaiser plan.
The Regence PPO plan covers providers across the country, but you will pay much less if you see an in-network provider.
To find a network provider for the Regence PPO plan, visit regence.com/provider/finding-doctors.
1. Click “Find a doctor”
2. Enter “Preferred Network” for the “Network name”
3. Search by provider type, name, location, and more.
With the Kaiser plan, only Kaiser providers are covered (with a few limited exceptions).
To find a Kaiser provider visit healthy.kaiserpermanente.org and select “Oregon / SW Washington” as your region at the top right of the page. Then, click on “Doctors & Locations.”

Contact Information

Where can I learn more about this coverage and who can I contact with questions?

For specific questions, please see who to call below.

For enrolling, eligibility, and midyear changes:

  • Contact the Trust Office: (833) 389-0027

To find an in-network provider:

  • PPO plan: Contact Regence at (866) 240-9580
  • HMO plan: Contact Kaiser Permanente at (800) 813-2000

For information about your prescription coverage:

  • PPO plan: Contact OptumRx at (844) 368-0083
  • HMO plan: Contact Kaiser Permanente at (800) 813-2000

 

Explore More Information

Eligibility

Find out if you’re eligible for coverage through the Trust.

Benefits

Learn more about the benefits available through the Essential Worker Healthcare Trust.