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Oregon Medical Insurance
Pool (OMIP)
Home | Qualifying
Conditions | Eligibility | Provider
Directory | Exclusions | Plan
information and Enrollment Form
Benefits: OMIP Plan
750 | OMIP Plan 1000 | OMIP Plan 1500 | FMIP Plan 500 | FMIP Plan 750
Rates: OMIP Plan
750 | OMIP Plan 1000 | OMIP Plan
1500 | FMIP Plan 500 | FMIP Plan 750
Oregon Medical Insurance
Pool/Federal Medical Insurance Pool
OMIP Qualifying Medical Conditions
Click here for
more details. If you do not have one or more of the
qualifying conditions listed, you must first apply for
coverage with one of the Insurance Carriers that offer
individual/family coverage. We have a Body
Mass Index (BMI) Calculator here.
Federal Medical Insurance Pool (FMIP)
The Oregon Health Authority is launching the state's federally funded high-risk insurance pool on August 1,
2010. The new Federal Medical Insurance Pool (FMIP) is being administered by Regence BlueCross BlueShield of Oregon, alongside the Oregon Medical Insurance Pool. The federal program
provides another health insurance option for Oregonians with pre-existing medical conditions that have been denied coverage.
Eligibility Criteria
- Must be a U.S. citizen or lawfully
present in the U.S.; and
- Must not have had creditable coverage within the last six months prior to applying for risk pool coverage; and
- Must have either been denied health insurance
based on medical underwriting criteria; or has one of the medical conditions listed the new OMIP/FMIP application.
- If the applicant has one the medical conditions listed, they
MUST have their physician sign the application attesting to the diagnosis.
Application
- There will be one application for OMIP/FMIP eligibles.
- The current OMIP application will
no longer be accepted as of September 1, 2010 for coverage in OMIP and for coverage in FMIP.
- Applicants will need to sign attesting they have been without insurance for six
months prior to completing the FMIP application.
- Proof of residency, eligibility, and citizenship (FMIP only) are required with applications.
Oregon Medical Insurance Pool (OMIP)
Are you eligible for OMIP coverage?
You may be eligible for coverage if you are an Oregon resident and you meet any of the following medical or portability requirements.
Medical Eligibility
Within the last six months:
- I have one or more of the conditions listed here.
- I have received a declination of individual health
insurance coverage due to health reasons.
- I was offered individual health insurance coverage
that contained a restrictive waiver that substantially
reduced the coverage offered by excluding coverage
for a specific medical condition.
- I was offered individual health insurance coverage
but was limited by the choice of plans the carrier
was willing to offer me due to a specific medical
condition.
Portability Eligibility
To be eligible under Portability criteria, you must
apply to OMIP within 63 days of losing COBRA, losing
Portability coverage from another insurer in Oregon,
or losing group health benefits coverage because you
moved from another state to Oregon. Coverage must be
continuous from the termination of your prior coverage
and premium is due from the effective date of the OMIP
coverage.
You may be eligible if:
- I have exhausted my COBRA benefits.
- No COBRA or Portability coverage available through
my previous plan.
- I am eligible for Oregon Portability coverage but
moved from the prior insurance carrier's service area.
- I was covered by Portability coverage, but my insurance
carrier no longer serves the area where I live.
- I am moving to Oregon and have been continuously
covered by health insurance for 18 or more months,
with no single gap in coverage greater than 63 days
and the last coverage was group coverage.
You can obtain Certificates of Coverage (termination
letters) from your prior health insurance company. If
cancellation of your health insurance depends on obtaining
OMIP coverage, submit the OMIP application NOW and submit
a copy of the certificate of coverage after coverage
ends, or provide other documentation showing creditable
coverage.
Note: Your coverage will start from the termination
of your prior coverage and premium is due from the effective
date of the OMIP coverage.
Federal Health Coverage Tax Credit
Eligibility
- The US Department of Labor has certified me as being
affected by competition from foreign trade, and I
am eligible
to receive a Federal Health Coverage Tax Credit (HCTC)
under Section 35 of the Internal Revenue Code.
If you qualify for OMIP under this eligibility category,
OMIP is assuming you are eligible for a HCTC, which
pays 65% of the cost of your monthly OMIP premium. However,
the federal government will make the final determination
about eligibility for the HCTC.
You must apply for OMIP coverage within 63 days of losing
your most recent prior health insurance coverage and
you must have had the prior coverage in place for a
period of not less than 90 days. Please provide a
copy of your HCTC Eligibility Notice and a Certificate
of Creditable Coverage from your prior health insurance
carrier.
I am eligible for the HCTC because:
- The company I worked for went bankrupt & I receive
pension benefits from the Pension Benefit Guarantee
Corporation.
- I lost my job and I receive Federal Trade Adjustment
Assistance Benefits.
How do I apply?
It's simple. Just call 800.884.2343 and ask for an
"OMIP/FMIP Packet" or download the application from our site. When you get the packet,
read the booklet carefully and complete the enclosed
application.
As long as all required eligibility information and
documentation are sent with a complete, signed and dated
application, coverage will be effective the first day
of the month after we receive the completed and accepted
application. You will be notified in writing of acceptance
into the program.
The OMIP packet contains further details on eligibility
and coverage, including the application, premium rates,
and Provider Directory.
In some cases benefits will not be provided during
the first six months of enrollment for expenses resulting
from a pre-existing condition. Pregnancy is considered
a preexisting condition for determining whether OMIP
benefits are paid during the first six months of coverage.
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