This is not the official
website for Cover Oregon,
but as a Certified Agent with Cover Oregon I can answer your questions. Please visit
http://www.coveroregon.com for complete information and
Melissa J Cunningham, my sister's first novel "Reluctant
CITIES: Brightwood, Camp
Cascade Locks, Cascadia, Chemult,
Chiloquin, Crescent, Crescent Lake, Detroit, Diamond Lake, Drew,
Estacada, Fort Klamath, Gates, Gilchrist, Government Camp, Idanha,
Klamath Agency, La Pine, Lakeview, McKenzie Bridge, Mill City, North
Umpqua, Oakridge, Prospect, Rhododendron, Sandy,
Sunriver, Warm Springs,
Welches, Westfir, Zigzag AREAS: Crater Lake National Park, Deshutes National Forest,
Fremont National Forest, Mount Hood National Forest, Rogue River
National Forest, The Three Sisters, Umpqua National Forest, Willamette
National Forest, Winema National Forest
Northeast Oregon CITIES: Adams, Arlington,
Baker City, Boardman, Canyon City, Condon,
Cove, Dayville, Echo, Elgin,
Enterprise, Fossil, Greenhorn, Haines, Halfway,
Heppner, Hermiston, Huntington, Imbler, Imnaha, Irrigon, Island City, John Day,
La Grande, Lexington, Long Creek, Lostine,
Medical Springs, Milton-Freewater, Monument, Mt Vernon, North Powder, Oxbow,
Pendleton, Pilot Rock, Prairie City,
Richland, Seneca, Summerville, Sumpter, Ukiah, Umatilla, Union, Unity,
Wallowa, Weston AREAS:
Adel, Adrian, Burns, Diamond, Drewsey,
Frenchglen, Hines, Jordan Valley, Juntura, Lakeview, Nyssa,
Ontario, Plush, Vale
Southern Oregon CITIES:
Ashland, Butte Falls, Cave Junction,
Canyonville, Central Point, Dillard, Drain, Eagle Point, Elkton, Glendale,
Glide, Gold Hill,
Grants Pass, Jacksonville, Klamath Falls, Malin,
Merlin, Myrtle Creek, Oakland, Phoenix,
Prospect, Riddle, Rouge River, Roseburg, Shady Cove, Sutherlin, Talent,
Umpqua, White City, Winchester, Winston, Wolf Creek, Yoncalla AREAS: Applegate Valley, Illinois Valley
Albany, Alsea, Amity, Aumsville,
Brownsville, Canby, Canyonville, Carlton,
Corvallis, Coburg, Cottage Grove, Creswell,
Culp Creek, Dallas, Dayton, Detroit, Donald,
Eugene, Falls City, Gates, Gervais, Halsey,
Harrisburg, Independence, Jefferson, Junction City, Keizer, Lebanon, Lowell,
McMinnville, Mill City, Millersburg, Mt.Angel,
Molalla, Monmouth, Newberg, Oakridge, Oregon City, Philomath,
Salem, Scio, Scott Mills, Sheridan,
Silverton, Sodaville, Springfield, Stayton, St. Paul, Sublimity, Sweet Home,
Tangerit, Turner, Veneta, Walterville, Waterloo, Willamina, Woodburn, Yamhill
Key words when looking for information
on the CoverOregon Health Insurance Exchange. Most people search
for Free Obama Health Care in Oregon, or Obama Care Oregon, or Low
Cost Obama health insurance, or Obama free health insurance oregon.
This site has all the information needed at this time with Low Cost
options prior to Free Low Cost Obama care health insurance.
the Cover Oregon software and website portal to see plans and rates,
including Tax Credits are only available to Agents and Community
Assisters, and the public will have access later in October 2013
As a Certified Agent with
Cover Oregon I can explain Obama Care Plans available October 1st, 2014
and let you know if Tax Credits and Reduced premiums are available, and
what Health Insurance will cost for you!
If you would like my help
just click the link below and e-mail your request for help in
October, or any questions that I can answer now! If you call I will
Starting October 1st, 2013 I will have
access to the Cover Oregon Health Insurance Exchange Portal as a
Certified Agent and can answer your questions, and show you the plan options
and rates which will go effective January 1st, 2014.
Prior to Oregon's Health Insurance
Exchange, Health Benefits Solution, Inc can offer and explain the
best health insurance options available in Oregon for Child Only,
Individual, Family and Small Business offering major health coverage,
vision, prescriptions and dental coverage.
Health Benefits Solution, Inc is a leader in offering health
insurance coverage for all individuals, and small business in Oregon.
The Affordable Care Act and CoverOregon will offer affordable health
insurance options to all Oregonians.
The purpose of this webpage is to help
share the information on the Oregon Health Insurance Exchange, and the
Affordable Care Act signed by President Obama. All information on this
webpage is collected and shared from websites currently explaining
progression of the Oregon Health Insurance Exchange including but not
http://www.CoverOregon.com Please visit this official
website for all and current information.
Key dates in the future:
October 2013Open enrollment starts. This is when you’ll be able
to start shopping for insurance plans at
Coverage begins for plans purchased through Cover Oregon
Every plan offered through Cover Oregon covers essential health
benefits, including doctor visits, hospital stays, maternity care,
emergency room care, prescriptions, preventive care, mental health
services, vision coverage for kids and more. Some plans even cover
alternative care. And you'll be able to compare plans side by side so
you can make the best choice for you.
Individuals and businesses can get help paying for their coverage.
Financial help for individuals and families includes no-cost coverage
through the Oregon Health Plan (OHP) and Healthy Kids, or APTC to help
pay for private health insurance. Businesses that purchase health
insurance through Cover Oregon may be eligible for the Small Business
Health Care Tax Credit.
Exemptions from the requirement to have insurance
Starting in 2014, an individual must (1) have minimum essential
coverage, or (2) have an exemption from the shared responsibility
payment or (3) make a shared responsibility payment when filing
federal income tax.
What is a shared responsibility payment?
It is the payment imposed by the federal government to an
individual who does not have
and does not qualify for an exemption.
What does 'exemption' mean?
An exemption from the shared responsibility payment means a person
isn't required to have coverage or make a payment if they don't
have minimum essential coverage.
Who can qualify for an exemption?
There are nine categories of people who are exempt from the
requirement to have health coverage and any penalties that may
result from not having coverage. These categories are:
Individuals who cannot afford coverage. Individuals are exempt
if their monthly contribution toward coverage exceeds 8 percent
of household income. In the individual market, a person's
contribution is based on the premium for the lowest cost bronze
plan after any APTC.
Individuals with household income below the tax filing
threshold. Individuals are exempt if their annual household
income is so low that they are not required to file a tax
Enrolled members of federally recognized Tribes, descendant ofenrolled
Tribal member, and individuals eligible for the Indian
Health Service are exempt.
Individuals who experience a hardship. Individuals who have
experienced a hardship in their capability to obtain coverage
under a qualified health plan are exempt.
Individuals who experience a short coverage gap. individuals do
not have to pay any penalties if they are uninsured for a period
up to three months during the year.
Members of certain religious groups. Members of a recognized
religious group or division who, by reason of adherence to the
tenets of teaching of the group or division, are conscientiously
opposed to the acceptance of any private or public insurance
that makes payments or provides services for medical care.
Incarcerated individuals. Does not include individuals who are
incarcerated pending the disposition of charges.
Non-citizens. Individuals who are not citizens or nationals of
the United States or aliens lawfully present in the United
How do I get an exemption?
To receive a certificate of exemption, you must either claim an
exemption on your federal tax return or apply to the federal
Department of Health and Human Services (HHS). Which of these two
methods you must use will depend on which of the above categories
apply to your situation. In some cases, you may choose either of
the two options. The table below shows which process to use for
each category of exemptions. (When more information is available
on how to apply for an exemption, we will provide further details
about the process. Please check back.)
CATEGORY OF EXEMPTION
CLAIM ON TAX RETURN
APPLY TO HHS
Income below filing threshold
Member of Indian Tribe
Short coverage gap
Health care sharing ministry
What is a hardship exemption?
These exemptions are granted to individuals determined to have
suffered a hardship with respect to the capability to obtain
coverage in a qualified health plan. Hardship exemptions will be
available to the following groups of individuals:
Individuals who have no offer of affordable coverage in a month
based on their projected annual income
Individuals who in addition to one or more employed members of
their family have been determined eligible for affordable
self-only employer-sponsored coverage, but for whom the
aggregate cost of employer-sponsored coverage for all the
employed members of the family is unaffordable
Certain individuals who are not required to file an income tax
return but who technically fall outside the exemption for those
with household income below the income tax filing threshold
Individuals who are American Indians, as well as their spouses
and descendants, who are eligible for services through an Indian
health care provider
Why can't I apply for an exemption through Cover Oregon?
State-based exchanges such as Cover Oregon were given the option
to either directly process the exemptions or use the federal
service to process exemptions. Cover Oregon has chosen to use the
federal service. In the first year (prior to October 15, 2014),
individuals seeking an exemption will need to apply to and receive
a certificate of exemption from HHS. Starting October 15, 2014, an
individual will be able to submit an application to Cover Oregon,
which will be forwarded to HHS for processing. HHS will handle all
appeals of exemption eligibility decisions.
When will my exemption expire?
Exemptions for religious reasons and members of Indian Tribes are
ongoing, meaning the people who receive these exemptions are not
required to annually renew the exemption. However, if a person
under the age of 21 is granted a religious conscience exemption,
he or she must submit a new application for an exemption upon
reaching the age of 21. The duration of hardship exemptions varies
based on individual circumstances. Exemptions for being
incarcerated and for being a member of a health care sharing
ministry apply only for months when the individual was actually
incarcerated or actually a member of the health care sharing
ministry. All other exemptions are good for the calendar year in
which an applicant submitted an application for such exemption.
Glossary of terms
Actual rates are developed and presented to individuals or group
applicants after they have provided specific demographic
Adjustments are deducted from income on Federal tax returns in
order to arrive at your Modified Adjusted Gross Income (MAGI).
Advance payment of premium tax credit (APTC)
If a person qualifies for advance payment of premium tax credits (APTC),
the amount will be applied right away and sent directly to the
insurance company each month to reduce the premium. See also "APTC."
Affordable Care Act (ACA)
The Affordable Care Act (ACA) is the health care reform law
enacted in March 2010 that mandates all Americans have health
insurance coverage. It puts individuals, families, small
businesses and Tribal organizations in control of selecting and
managing their insurance coverage. It also provides other reforms,
including guaranteed coverage regardless of an individual’s health
Agents affiliated with Cover Oregon are licensed health insurance
agents who have also completed the Cover Oregon training and
certification program. They help individuals and small employers
by guiding them through the complexities of purchasing and
enrolling in health insurance coverage to get the best price based
on specific situations and needs. Agents also act as advisors when
clients need help navigating claims processing after they incur
services. Agents are paid a commission for their work, which does
not increase the cost of insurance coverage.
Allowed amount, also known as 'eligible expense,' 'payment
allowance' or 'negotiated rate,'' is the maximum amount a carrier
will pay for covered health care services. If services cost more
than the allowed amount, the insured individual may have to pay
Annual income is the total amount an individual received via
wages, salary and various investments throughout a calendar year.
Annual maximum, or 'annual max,' is the total dollar amount that
an insurer will pay toward services in a coverage year. Once the
annual maximum is reached, the insurer will not cover additional
services until the beginning of the next plan year.
An appeal is a request to review a decision.
APTC refers to advance payment of premium tax credits. If a person
qualifies for APTC, the amount will be applied right away and sent
directly to the insurance company each month to reduce the
premium. See also "Advance payment of premium tax credit."
Assisters are staff members or volunteers at community partner
organizations who are trained and certified to help educate
individuals and families about health coverage plans and assist
them with the Cover Oregon application and enrollment processes.
Assisters include application counselors, consumer assisters,
in-person assisters, navigators and non-navigators as defined by
the Department of Health and Human Services.
An authorized representative is a person, such as a guardian or an
individual who has power of attorney, who is authorized to help
make decisions for others. These decisions include enrolling in a
health coverage plan or handling claims and payments. An
authorized representative may sign the application on behalf of
Balance billing occurs when a provider bills the insured
individual for the difference between the provider’s charge and
the allowed amount. A preferred provider may not balance bill for
Benefits refer to any available services under health coverage.
Calendar year is the period from January 1 through December 31 of
the same year.
A carrier is a licensed company that provides health and/or dental
insurance coverage for individuals, families and groups. A carrier
may also be referred to as an 'insurer' or 'insurance company.'
As defined in the Affordable Care Act (ACA), a catastrophic plan
will provide individuals with coverage for essential health
benefits only after they have paid for cost sharing equal to
maximum out-of-pocket limits. Catastrophic plans are available to
individuals who are under the age of 30 prior to the start of the
plan year, or who have received an exemption from the individual
mandate because they do not have an affordable coverage option or
because they qualify for a hardship exemption. In 2014, the annual
maximum out of pocket cost will be $6,350 for self-only coverage
and $12,700 for family coverage.
See: 'Employee census.'
Change In Circumstance
A change in circumstance allows individuals, families and
employees to change their health coverage enrollment outside of
the open enrollment period because of a qualifying event such as
marriage, childbirth, adoption, legal separation, death or loss of
employment, among others. Also see: 'qualifying event.'
Children's Health Insurance Program (CHIP)
The Children’s Health Insurance Program (CHIP) provides health
coverage for children whose families can’t afford private
insurance. CHIP is administered by each state and jointly funded
by the federal and state governments. In Oregon, the program
operates under the name “Healthy Kids.” Also see: 'Healthy Kids.'
CCOBRA is a type of continuation coverage that allows employees
and their families to temporarily continue their health coverage
offered through an employer, even if they have changed or lost a
job, or experienced a change in their eligibility status. Also
see: 'continuation coverage.'
Coinsurance is the insured individual’s share of costs for a
covered health care service. This is calculated as a percentage
(e.g., 20 percent) of the allowed amount for the service before or
after the deductible is met. The insurer pays the rest of the
Community partner organizations are provider clinics, local
governments, non-profits and community-based groups that conduct
outreach and/or enrollment assistance on behalf of Cover Oregon.
This assistance is provided at no cost to individuals and
Continuation coverage allows individuals to temporarily continue
their health coverage offered through an employer, even if they
have changed or lost a job, or experienced a change in their
eligibility status. Companies with 20 or more employees are
subject to COBRA Continuation. Companies with fewer than 20
employees are subject to State Continuation.
Coordinated Care Organization
A coordinated care organization (CCO) is a network of all types of
health care providers (physical health care, addiction and mental
health care and sometimes dental care providers) who have agreed
to work together in their local communities to serve people who
receive health care coverage under the Oregon Health Plan
A copayment, also called “copay,” is the fixed dollar amount
(e.g., $15) an insured person pays for a covered health care
service. Copayment amounts can change depending on the type of
Cost sharing refers to any expense paid by an individual for
essential health benefits such as deductibles, copayments and
coinsurance. These costs are above and beyond the amount the
individual pays for a premium.
Cost-sharing reductions lower the maximum out-of-pocket limits,
and they reduce Silver plan deductibles, co-pays and coinsurance
amounts for certain qualified applicants.
The coverage year is the calendar year in which a health coverage
plan is effective (e.g., the period from January 1 through
December 31 of the same year.)
2012 Health Benefits Solution, Inc -