Coinsurance
The cost of a covered service that is shared by the plan and the member usually expressed in percentages. For example: 70% carrier and 30% member.

Copayment or Copay
A fixed dollar amount such as $20 that is paid by the member to the medical provider when service is received.

Deductible
A dollar amount of covered expense the member must pay before the plan pays.

Eligible Employee
An Oregon Homecare Worker who is a full-time, part-time, hourly or live-in and is employed through the Client Employed Provider (CEP), Spousal Pay Providers, or Oregon Project Independence and is compensated by the Department of Human Services (DHS). Eligible homecare workers are those who work 80 hours or more for two consecutive months and are not covered by other medical insurance coverage except Medicare and Veteran’s Benefits.

Family Members

a) If you are married, your legal spouse is eligible for insurance. Your domestic partner of  the same or opposite gender is eligible for coverage if he or she meets the eligibility criteria on the Domestic Partner Affidavit.

b) Any child under age 23 who meets all criteria in (1) and (2) and either criterion (3) or (4) of the following:

1. Is unmarried and without a domestic partner, and,

2. Meets the criteria of a dependent child under Section 152 of the Internal Revenue Code of an eligible employee, the employee’s spouse or the employee’s domestic partner whether or not the employee, spouse or domestic partner actually claims or receives a dependent exemption from federal income tax for the child.

3. Is a biological or adopted child, or a child placed for adoption, of the eligible employee, or the employee’s spouse, or the employee’s domestic partner, or,

4. Is a child living in the home of the eligible employee,
employee’s spouse or employee’s domestic partner, due to a
court or administrative order.

FHIAP

The State of Oregon’s Family Health Insurance Assistance
Program helps pay for private health insurance. FHIAP pays from
50% to 95% of monthly health insurance premiums when you
qualify. The subsidy is good for one year and you may re-apply
every year.

Health Maintenance Organization (HMO)
A type of health plan in which members must receive all care from network providers, usually under the care of a primary care physician.

Homecare Union Benefits Board, LLC (HUBB)
The administrator of the health insurance program for Oregon Homecare Workers.

Maximum Benefit
The total amount payable by the plan for covered expenses.For example, the lifetime maximum benefit for medical care in the ODS Managed Care Plan is $1 million.

Out of Pocket Maximum
The annual amount a member must pay for deductibles and coinsurance before the plan covers all remaining eligible expenses at 100% for the remainder of the calendar year.

Portability of Medical Insurance
Ongoing medical coverage available from the employee’s current medical carrier after termination of coverage with HUBB.

Pre-authorization
A plan requirement that a covered service is approved by the plan prior to the date of service.

Pre-existing Condition
A physical or mental condition that was diagnosed and for which you received medical advice or treatment during the six-month period immediately before your enrollment date. A condition is diagnosed whenever a physician tells a person that he or she has that condition or makes an entry to that effect in the person’s medical records. This applies even if the physician is examining or treating the person for a different condition.

Primary Care Provider (PCP)
A physician participating in the plan’s network of providers whom you choose to be responsible for your continuing medical care. Your PCP must approve your treatments, services and referrals to other participating specialists for benefits to be paid by the plan.

State Contribution
The amount of money paid by the State of Oregon for eligible homecare workers for purchase of medical insurance provided through HUBB.