Open Enrollment 2025 Frequently Asked Questions

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

If you enroll your dependents, you will receive a letter from the Essential Worker Healthcare Trust (EWHT), asking you to submit documents to verify your dependents directly to EWHT (not just to your employer). You must complete the dependent verification process within 90 days from the time they get covered. If you don’t send us the required documents on time for the dependents on your plan, their eligibility for EWHT benefits will end. Learn more about the Dependent Verification process. 

Typically, you and your dependents may only join this health insurance plan when you’re a new full-time employee or during an annual open enrollment period. The EWHT open enrollment usually happens sometime during the month of November. Check with your employer for their specific open enrollment dates.   

During open enrollment, you can enroll yourself, add/remove dependents, or change your plan. Changes made during a November open enrollment become effective January 1. Sometimes, you can make changes at other times of year when you have a qualifying life event.  

To make changes to your coverage, you must notify your employer so they can send the changes to EWHT. Most changes to your benefits need to be made during open enrollment.  

• Learn more about when to enroll…
• Learn more about how to enroll… 

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

1. Open enrollment, which will take place each fall. Changes made during open enrollment take effect the following January 1.

2. A qualifying life event such as a birth, adoption, marriage, death, divorce, in some cases a change of address, 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, your employer must notify the Essential Worker Healthcare Trust of changes within 60 days of the event. Please notify your employer early so they have time to submit the change before the 60-day deadline. 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). 

These types of changes will be effective the first day of the month following the status change (except newborns who are effective the date of birth). If you are outside this window, you can enroll them during the next open enrollment.   

To make changes to your coverage, you must notify your employer so they can send the change to EWHT. 

If you sign up outside of open enrollment (for example, becoming a new full-time employee or having a qualifying life event), your coverage will begin on the first day of the month after the month when you enrolled. 

If you sign up for coverage during your employer’s November open enrollment dates, your coverage will begin January 1 of the following year. 

You can check your enrollment status and securely upload documents to verify your dependents by setting up your online EWHT member portal account. Register for your online account here. You can use your Social Security number. You can also download the mobile app at that link. 

Unfortunately, EWHT doesn’t have access to your employer’s portal. You’ll need to contact your employer. 

When you use in-network providers, your annual deductible is $800 for an individual and $1,600 per family plan. 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 max out-of-pocket is $2,000 per individual and $4,000 per family plan. For specific cost scenarios, please contact your health plan. 

Your out-of-pocket-max is different than 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 office visit is a $20 copay  

• Specialist, physical therapy, chiropractic office visit copay is $40  

• Urgent care visit copay is $60  

• 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 labs and X-rays, 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. 

 Prescription copays range from $0 to $100 for a monthly supply depending on the type of prescription.  

•  Generic prescriptions are $0 for a monthly supply.  
• Preferred brand prescriptions are $30 for a monthly supply, and a 3-month supply for only $60 through the mail-order pharmacy.  
• Non-preferred brand prescriptions are $80 for a monthly supply and a 3-month supply for only $160 through the mail-order pharmacy.  
• Specialty drugs (cancer treatment, etc.) are $100 for a monthly supply.  

For specific cost scenarios, please contact your health plan.

For specific cost scenarios, please contact your health plan.

These are the employers who currently participate in the Essential Worker Healthcare Trust:  

• Avamere  
• PACS Post Acute Care Facilities in Oregon (formerly Prestige) 
• EmpRes managed by Evergreen  
• Sapphire Tigard Rehab  
• Sapphire at Fernhill  
• Sapphire at Myrtle Point  
• Sapphire at Rivers Edge  
• Healthcare Services Group (Union members only)  
• Arete Living 
• Oregon Supported Living Program  
• Addus Home Care Inc. (Union members only) 
• Alvord-Taylor, Inc.

Eligible dependents include:  

• Spouse or domestic partner (as defined by EWHT) 

• Children under age 26, without regard to marital, financial, or student status (biological children, stepchildren, adopted children, children placed with you for adoption, foster children, or children for whom you are the legally appointed guardian).  

• 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.  

• A dependent for whom you have an adoption decree, legal guardianship order, Qualified Medical Child Support Order, National Medical Support Order, or other court order documentation that proves the relationship between you and your dependent.
   

After you enroll your dependents, you will receive a letter from the Essential Worker Healthcare Trust (EWHT), asking you to submit documents to verify your dependents directly to EWHT (not just to your employer). You must complete the dependent verification process within 90 days from the time they get covered. If you don’t send us the required documents on time for the dependents on your plan, their eligibility for EWHT benefits will end. Learn more about the Dependent Verification process. 
 

You can enroll eligible dependents or a spouse the same way you enroll yourself. Please contact your employer to enroll them. 

Yes, you are still eligible for EWHT healthcare benefits if you live in Washington State as long as you meet the eligibility criteria:

1. You are considered full-time and work more than 30 hours per week, and
2. Work for one of our participating employers. 

 You can talk to your employer to confirm if you are eligible for EWHT. View the list of participating employers. 

Losing OHP is a qualifying life event to enroll in insurance through your employer. Contact your employer to see if you qualify for EWHT. It’s important that you contact your employer as soon as possible. View the list of employers participating in EWHT.

Not at this time. We facilitate the medical portion of your benefits only. Dental and vision insurance are separate plans. 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.

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 choose Kaiser Permanente HMO, 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 Kaiser would refer you to outside providers and facilities. For instance, urgent and emergency services are covered at out-of-network facilities.  Learn more about the Kaiser plan.

• If you’re enrolled in Regence Preferred Provider Organization (PPO), you can choose to use an in-network provider or an out-of-network provider each time you receive care. However, you will save money by using an in-network provider. 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 can have EWHT and Medicare, but the federal government requires EWHT to be billed first (meaning it is the primary insurance). You’ll need to assess 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 to search for doctors and locations. Contact Kaiser directly. 

 If you’re enrolled in Regence, you will save money by seeing a Regence in-network provider. For more information, call the number on the back of your member ID card or visit regence.com to search for doctors. Contact Regence directly. 

You can find and be assigned to a primary 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. Contact Kaiser or Regence directly. 

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. Contact Kaiser or Regence directly.

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. Contact Kaiser directly. 

If you’re enrolled in Regence, you’ll be using Optum for pharmacy/medication services. You can contact Optum directly to find out if a medication is covered. Here’s a link to the “Optum RX Formulary and Available Medications.” 

 You can also call member services. Contact Optum directly. 

If you’re enrolled in Kaiser, you’ll want to go to a Kaiser pharmacy to fill your prescriptions. You can also contact Kaiser by calling the number on the back of your member ID card. Contact Kaiser directly. 

 If you’re enrolled in Regence, you’ll be using Optum’s list of in-network pharmacies. You can contact Optum directly to find out if a pharmacy is in-network. Contact Optum directly. 

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 during normal business hours.  
 

You may or may not need an online account. If you want to view what information your employer has sent to EWHT, your enrollment status, or securely upload documents to verify your dependents, setting up your online member portal account directly with us is the best way to do this. 

You can call EWHT at (833) 389-0027 and talk to a live person Monday – Friday from 8 am-5 pm PST. Or visit essentialworkerhealth.org for additional information. You can also contact your health plan for more information.