Oregon Medical Insurance Pool (OMIP)

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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.

Qualifying Medical Conditions for 2007

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.

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. Please call 1-800-848-7280 for more details.

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 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.

Choosing a plan

When selecting a plan, you may also want to consider the following:

• What plans are available in your area?
• Is your doctor a preferred provider, a managed care provider, or would you change doctors to save premium costs?
• How much premium can you afford to pay? See the premium rates listed above to find out how much the plans cost.
• What are your prescription drug needs?
• Do your family members need to be covered by OMIP or can they obtain less expensive coverage elsewhere?

Each of the above points is worth consideration when choosing a plan. But please remember to read through the OMIP packet carefully before making a decision.

This information is taken from the Oregon Department of Consumer and Business Services web site. Every reasonable effort is made to assure the accuracy of the information provided here.  InsuranceQuest, LLC is a licensed and independent agency that can assist consumers in securing this coverage.