Frequently Asked Questions (FAQs)

Health Benefits

Although we strive to provide you with the best insurance at the lowest cost, at this time only eligible Agency Providers can add dependent children and must pay the full-premium price.

Individual Providers: Dependents are not covered. The Individual Provider benefits do not allow coverage for dependents under this plan.

Agency Providers: If you are covered by the Health Benefits Trust through your employer, you can cover dependent children by paying the full premium for them through payroll deduction. Dependent children can only be added when they are initially eligible or during the annual open enrollment period. Check with your employer for more information.

No, participants may not have health care benefits or insurance through other individual, family, employment-based, military or veterans coverage or insurance. The only exception is Medicare and Medicaid. If enrolled in Medicare or Medicaid, you may enroll in the Trust, and then your Medicare or Medicaid coverage becomes secondary to your Trust coverage.

After your coverage begins, you must work at least 80 hours each month to have continuous coverage. Training hours and accrued vacation hours can be used to satisfy the 80-hour requirement.

No (with the exception of emergency services). To access your comprehensive coverage, you must use a Kaiser Permanente provider/facility.
Click here to find Kaiser Permanente Providers near you.

You have the right to send appeals to the SEIU Health Benefits Trust Appeals Committee for reasons such as:

  1. Adverse eligibility and enrollment decisions

  2. Delta Dental claims decisions

Learn more about how to file your appeal here»

Was your claim denied? You have the right to appeal Group Health, Kaiser Permanente and Delta Dental.

Learn more about each carriers’ appeal process here »

Looking to appeal a HBT eligibility or enrollment decision? Find more information here»

The request must be made in writing and can be faxed or mailed. Requests received before the 15th of the month will stop further payroll deductions.

Fax:

(206) 859-2637

Mail:

SEIU Healthcare NW Health Benefits Trust

PO Box 6
Mukilteo, WA 98275

 

Call Kaiser Permanente Membership Services toll free: 1-888-901-4636

You can use this line to:

  • Choose a primary care provider
  • Ask specific benefit questions
  • Address complex medical care case management
  • Address Inpatient care case management
  • Speak to an advice nurse
  • Ask about Kaiser Permanente facilities across the country

There are several ways for you to enroll for HBT coverage if you are a qualifying Individual Provider.

  • If this is the first time you are enrolling in Health Benefits Trust, then you can apply online today through the portal that you use to manage training.
  • If you have been previously enrolled in HBT coverage within the last 12 months, then you can download our application and mail in your information. The Member Resource Center is also available to help you get started at 1-866-371-3200.

Agency Providers Contact your employer to coordinate your enrollment.

Check out our Coverage Finder to see if you qualify.

Find a provider is through the Group Health website, www.ghc.org.

  1. Look on the right-hand side of www.ghc.org
  2. Look for “Find a Doctor or Medical Facility”
  3. Click on “Provider and Facility Directory”
  4. Click on “Doctors and Other Providers”
  5. Find “Health plan provider network”
  6. Finally, select your plan by choosing either
  7. “Group Health” for the HMO plan
  8. “Options PPO” for the PPO plan
  9. “Options” for the POS plan

You can also call Group Health Customer Service toll free at 1-888-901-4636.

Group Health no longer accepts cash payments at Group Health Medical Centers. Group Health expects payment at time of service, and will gladly accept:

  • Visa
  • MasterCard®
  • American Express
  • Discover® credit
  • Debit cards
  • Personal checks will be scanned, converted to electronic transactions and immediately deducted from your checking account
  • Prepaid debit cards (purchased at stores such as Safeway, QFC, Target, Walmart or wherever gift cards are sold)
  • Prepaid debit cards from banks or credit unions

You can reload prepaid debit cards at any time.

For more info:

  • Go to www.ghc.org/payment
  • Ask one of our cashiers
  • Call Customer Service toll-free at 1-888-901-4636.

After your coverage begins, you must work at least 80 hours each month to have continuous coverage. Training hours and accrued vacation hours can be used to satisfy the 80-hour requirement.

We recommend you visit your primary care provider at least once a year for preventive care visits. If you don’t feel well, see your provider right away. It’s much better for your health to have any concerns addressed sooner rather than later, and it also helps avoid the higher co-pays at emergency rooms.

 

You will need to notify the Health Benefits Trust and mail in a check or money order for $25 payable to SEIU Healthcare NW Benefits Trust, PO Box 6, Mukilteo, WA 98275. You will also need to send a copy of your paycheck stub (also known as your Remittance Advice) and invoice showing you claimed at least 80 hours for that month.

To avoid having to make a payment by mail, it is very important to report your hours to Individual Provider One in a timely manner. Your health insurance provider may not be able to verify your eligibility, and your coverage will be considered lapsed until we receive your check and supporting documentation.

If you are enrolled in Medicare or Medicaid, you may enroll in the Trust and your Medicare or Medicaid coverage becomes secondary to your Trust coverage.

If your lapse in coverage has been shorter than 12 months, you will not have to meet the initial eligibility requirements. If you’ve been out of the plan for 12 months or more, you will have to meet initial eligibility requirements again. Initial eligibility requirements are met by working two months of 80 hours and waiting the one-month administrative period.

Under the Health Benefits Trust plan, you can receive mental health support to help you deal with any life circumstances you might be experiencing in your personal or professional life. These visits are meant to provide you with the outlets and resources you need to feel supported. Support can include a one-on-one visit with a therapist, a group session or help from a psychologist or psychiatrist.

The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances such as voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events.

If you work less than 80 hours in a month after enrolling in the Health Benefits Trust plan, your coverage will end. If you lose coverage, you may choose to pay the full monthly (COBRA) premium. In this case, the Health Benefits Trust will send you a COBRA notice and election form explaining your coverage options and the costs associated in staying insured.

No, HBT provides packaged benefits only. However, please call the SEIU 775 Member Resource Center for dental coverage options.

If you are an Agency Provider, please contact your employer about open enrollment or qualifying events. Typically, this is only allowed during the annual open enrollment period that takes place in July of each year and has an August 1 effective date.

If you are an Individual Provider, please call the Member Resource Center toll-free at 1-866-371-3200 about options for changing dental insurance providers.

Yes, but please keep in mind the initial eligibility requirements when determining your cancellation date with your agency employer’s plan. You should keep your current plan until your coverage as an Individual Provider begins.

NOTE: You cannot be covered under both the Health Benefits Trust as an Individual Provider and another employer’s plan at the same time.

 

This incentive program ended on July 31st, 2015. We are no longer offering this program.

 

Yes, but if you have voluntarily cancelled your coverage, you will have to meet the initial eligibility requirements again in order to regain coverage. If you are an Agency Provider, you must wait until the next annual open enrollment. If not, then this would be the same process as someone losing coverage (less than/more than 12 months).

 

Yes, but please keep in mind the initial eligibility requirements when determining your cancellation date.

If you do not receive your card by the 15th of the month that your coverage starts contact:

Individual Providers: Call the MRC 1-866-371-3200

Agency Providers: Talk with your employer

The main difference between Urgent Care and the Emergency Room is the cost to you. Urgent Care costs just $15 per visit for GH and $30 per visit for KP, while the Emergency Room costs $200 per visit. Call the consulting nurse lines for support on where to go.

  • Group Health: 1-800-297-6877
  • Kaiser Permanente: 1-866-454-8855

The list below offers a quick-reference guide to help you choose between the two.

URGENT CARE

  • Allergies
  • 
Asthma Attack
  • (Minor) Cold,
  • Flu,
  • Fever
  • 
Cough
  • 
Dizziness
  • 
Fractures
  • 
Nausea
  • 
Minor Burns
  • 
Minor Cuts/Lacerations
  • Sore Throat
  • 
Sprains
  • 
Stitches
  • 
Headaches
EMERGENCY ROOM

  • Chest pain
  • Compound Fractures (Bone visible)
  • High Fever
  • 
Ingestion of Poison
  • 
Major Head
  • Injury
  • 
Seizures
  • 
Severe
  • Asthma
  • Attack
  • 
Severe Burns
  • 
Shock
  • 
Uncontrollable Bleeding

You have two great resources for this:

  • Call your primary care provider — you can often schedule a same-day visit. Many providers give over-the-phone advice about where to go after business hours, or they can direct you to a nurse line.
  • Call your Health Plan’s 24/7 nurse line.
    • Group Health members can call: 1-800-297-6877.
    • Kaiser Permanente members can call: 1-800-813-2000.
    • This number is also printed on your insurance card for easy reference.

No.

If you are an Individual Provider, request for an address change must be made to either your DSHS case worker or to Individual Provider One directly. If you are an Agency Provider, contact your employer to make this change.

You must work at least 80 hours per month for at least two months in a row. After your coverage begins, you must work at least 80 hours each month to have continuous coverage. Training hours and accrued vacation hours can be used to satisfy the 80-hour requirement.

Check out our Coverage finder to see if you qualify!

  • E-mail your doctor’s office
  • View select test results
  • Order prescription refills (and have them mailed to you, with free shipping)
  • Request or cancel routine appointments
  • Review recent past office visits
  • See a list of your recent immunizations and allergies
  • Act for a family member (e-mail your child’s doctor, and more)
  • Receive a monthly e-newsletter

Register with Kaiser Permanente here.

  • If you enrolled in the HBT plan prior to 8/1/2012, your coverage is through the POS plan.
  • If your coverage begins 8/1/2012 or later (and you live within 30 miles of a Group Health facility or contracted provider), you will automatically be enrolled in the HMO plan.
  • If you live beyond 30 miles, you will automatically be enrolled in the PPO plan.
  • In the POS and PPO plans, you have the choice of in-network or out-of-network providers each time you seek service.

 

Which Plan and Network Applies to Me?

Group Health Cooperative –
HMO Plan
for members who enroll 8/1/2012 or later
Group Health “Options Select”
– POS Plan
if you have been previously enrolled prior to 8/1/2012 and are re-enrolling:
Group Health “Options” – PPO Plan
Your network is called: “Group Health Cooperative”
If you are enrolling effective 8/1/2012 or later, you will be automatically enrolled in this plan if you live within 30 miles of a Group Health Facility or Contract- ed Provider.
Your network is called: “Group Health Options Select” If you are enrolling effective 8/1/2012 or later, you will be automatically en- rolled in this plan if you live within 30 miles of a Group Health Facility or Contracted Provider. Your in-network is called: “Options Select” Your in-network is called: “Op- tions”
You will be automatically enrolled in this plan if you live farther than 30 miles from a Group Health Facility or Contracted Provider or live in Montana.
All care is provided at Group Health Medical Centers and from other Group Health contracted providers
No out-of-network coverage is available.
In-Network care is provided at Group Health Medical Centers and from other Group Health contract- ed providers.
Out-of-Network care is provided by First Choice Health Network Providers.
The First Choice Health Net-
work has an extensive panel of preferred providers in WA, OR, ID, AK and MT.
In-Network care is provided by Group Health Medical Centers; other Group Health contracted providers; First Choice Health Net- work Providers and First Health Network Providers The First Choice Health Net-
work has an extensive panel of preferred providers in WA, OR, ID, AK and MT.
Out-of-Network care is any other licensed provider
Click here to find Group Health Providers near you.

Your coverage will end. If you lose coverage, you may choose to pay the full monthly (COBRA) premium. In this case, the Health Benefits Trust will send you a COBRA notice and election form explaining your coverage option and the cost.

Yes. Please contact the Health Benefits Trust with questions on the COBRA benefit at 1-866-771-7359.

If you are a new enrollee in the Health Benefits Trust effective 8/1/2012 or later, and you live within 30 miles of a Group Health Medical Center or contracted provider, your health care coverage is only for using Group Health Medical Centers or contracted providers. There is no out-of-network coverage.

For all other enrollees, each time you seek health care services, you can choose to use your in-network providers or to see providers out of your network. Your highest level of benefits ($0 deductible) will be found using in-network providers: for the POS (Options) plan this means Group Health Physicians, and for the PPO (Options PPO) plan it means First Choice Health Network of Providers. You will pay more out-of-pocket costs by using an out-of-network provider — a $500 deductible, for example.

Call the Customer Service Department of your insurer, or for the Trust’s self-funded dental plan, call Delta Dental:

Group Health
1-800-542-6312
www.ghc.org

Kaiser Permanente
1-888-901-4636
www.kp.org

Self-funded Dental Plan
Claims Administered by Delta Dental
1-800-547-9515
www.deltadentalwa.com

 

When You Have an Appeal:

An appeal is a request to reconsider a decision to deny, modify, reduce or end payment, coverage or authorization of coverage (known as an “adverse decision”).

The appeal process for each of the Trust’s health and dental plans is different. You should review the Summary Plan Description of appeals procedures in the Benefits Summary provided by your insurer (or, in the case of the Trust’s self-funded dental coverage, by Delta Dental). The Summary Plan Description contains a full explanation of the appeals process.

You may also call the Customer Service Department of your insurer (or, in the case of the Trust’s self-funded dental coverage, Delta Dental) for specific information about the appeals process. Those numbers are listed on the previous page.

Your Rights in an Appeal:

  • You must submit your appeals within 180 calendar days of the date you received notice of an “adverse decision.” Keep track of these deadlines, because appeals that are filed late may not be considered.
  • You may request an expedited 72-hour review of your appeal when the adverse determination could jeopardize your life or health.
  • You may request all of the documents relevant to your request and the decision by the insurer or administrator.
  • You may submit additional comments, documents or other information to support your appeal.

 

More information about how to file an appeal can be found at “How to Appeal a Health Care Insurance Decision: A Guide for Consumers in Washington State,” on the Office of the Insurance Commissioner’s website.

Only if you cancel your coverage. You cannot have both.

If you live in any of the following counties/ZIP codes, your medical coverage will be provided by Kaiser Permanente’s HMO plan.

Washington counties:

  • Clark
  • Cowlitz

Oregon counties:

  • Multnomah
  • Polk
  • Washington
  • Yamhill

Your online Health Profile (Group Health) or Total Health Assessment (Kaiser) helps you and your doctor take better care of your health. You’ll find custom information on how to stay healthy, get resources and support if you want to improve your health in any particular area, and track your progress year after year.

Individual Providers: You can pre-apply as soon as you have authorization to work as an Individual Provider and are under contract to work 80 hours or more per month. Enroll online today or download the application and mail it in.

Agency Providers: Contact your employer to coordinate your enrollment.

Yes, but you must contact the health insurance provider for specific benefits and claim submission procedures at:

  • Group Health 1-888-901-4636
  • Kaiser 1-800-813-2000
  • Delta Dental 1-800-554-1907
  • Willamette (contact the clinic where the services were provided)

This program ended on July 31st, 2015. We are no longer offering this incentive. Here is some helpful information if you completed the 3 steps before this date and are awaiting your check.

If you’re with Group Health, you will receive a check from the Health Benefits Trust for $100 within 6-8 weeks.

If you’re with Kaiser Permanente, Contact the Health Benefits Trust at 1-866-771-7359 after completing all incentive activities.

This incentive program rewarded HCAs with $100 cash for taking positive steps to stay healthy. It was possible to earn $100 by completing all three of the following things:

  • Registering online at www.MyGroupHealth.org or www.kp.org.
  • Completing a Health Profile if you’re with Group Health or a Total Health Assessment 
if you’re with Kaiser.
  • Completing a preventive care visit with a Primary Care Provider.

 

Individual Providers: You must work at least 80 hours per month for three consecutive months. After you have met this requirement, it takes two months before your coverage starts. See the example below:

February March April May June July
You worked at least 80 hours You worked at least 80 hours You worked at least 8o hours Administrative period Coverage begins on July 1st
You worked at least 80 hours You worked at least 80 hours

Submit an enrollment application anytime before May 20th

Agency Providers: Contact your employer to coordinate your enrollment.

Individual Providers: You must work at least 80 hours per month for two consecutive months. After you have met this requirement, it takes one month before your coverage starts. See the example below:

February March April May
You worked at least 80 hours You worked at least 80 hours Administrative period  Coverage begins on July 1st

Agency Providers: Contact your employer to coordinate your enrollment.Submit an enrollment application anytime before April 20th.

Contact your insurance provider directly for an explanation of benefits and/or questions you have about claims.

Eligibility and Enrollment

Although we strive to provide you with the best insurance at the lowest cost, at this time only eligible Agency Providers can add dependent children and must pay the full-premium price.

Individual Providers: Dependents are not covered. The Individual Provider benefits do not allow coverage for dependents under this plan.

Agency Providers: If you are covered by the Health Benefits Trust through your employer, you can cover dependent children by paying the full premium for them through payroll deduction. Dependent children can only be added when they are initially eligible or during the annual open enrollment period. Check with your employer for more information.

No, participants may not have health care benefits or insurance through other individual, family, employment-based, military or veterans coverage or insurance. The only exception is Medicare and Medicaid. If enrolled in Medicare or Medicaid, you may enroll in the Trust, and then your Medicare or Medicaid coverage becomes secondary to your Trust coverage.

After your coverage begins, you must work at least 80 hours each month to have continuous coverage. Training hours and accrued vacation hours can be used to satisfy the 80-hour requirement.

The request must be made in writing and can be faxed or mailed. Requests received before the 15th of the month will stop further payroll deductions.

Fax:

(206) 859-2637

Mail:

SEIU Healthcare NW Health Benefits Trust

PO Box 6
Mukilteo, WA 98275

 

There are several ways for you to enroll for HBT coverage if you are a qualifying Individual Provider.

  • If this is the first time you are enrolling in Health Benefits Trust, then you can apply online today through the portal that you use to manage training.
  • If you have been previously enrolled in HBT coverage within the last 12 months, then you can download our application and mail in your information. The Member Resource Center is also available to help you get started at 1-866-371-3200.

Agency Providers Contact your employer to coordinate your enrollment.

Check out our Coverage Finder to see if you qualify.

After your coverage begins, you must work at least 80 hours each month to have continuous coverage. Training hours and accrued vacation hours can be used to satisfy the 80-hour requirement.

You will need to notify the Health Benefits Trust and mail in a check or money order for $25 payable to SEIU Healthcare NW Benefits Trust, PO Box 6, Mukilteo, WA 98275. You will also need to send a copy of your paycheck stub (also known as your Remittance Advice) and invoice showing you claimed at least 80 hours for that month.

To avoid having to make a payment by mail, it is very important to report your hours to Individual Provider One in a timely manner. Your health insurance provider may not be able to verify your eligibility, and your coverage will be considered lapsed until we receive your check and supporting documentation.

If you are enrolled in Medicare or Medicaid, you may enroll in the Trust and your Medicare or Medicaid coverage becomes secondary to your Trust coverage.

If your lapse in coverage has been shorter than 12 months, you will not have to meet the initial eligibility requirements. If you’ve been out of the plan for 12 months or more, you will have to meet initial eligibility requirements again. Initial eligibility requirements are met by working two months of 80 hours and waiting the one-month administrative period.

The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances such as voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events.

If you work less than 80 hours in a month after enrolling in the Health Benefits Trust plan, your coverage will end. If you lose coverage, you may choose to pay the full monthly (COBRA) premium. In this case, the Health Benefits Trust will send you a COBRA notice and election form explaining your coverage options and the costs associated in staying insured.

Yes, but please keep in mind the initial eligibility requirements when determining your cancellation date with your agency employer’s plan. You should keep your current plan until your coverage as an Individual Provider begins.

NOTE: You cannot be covered under both the Health Benefits Trust as an Individual Provider and another employer’s plan at the same time.

 

Yes, but if you have voluntarily cancelled your coverage, you will have to meet the initial eligibility requirements again in order to regain coverage. If you are an Agency Provider, you must wait until the next annual open enrollment. If not, then this would be the same process as someone losing coverage (less than/more than 12 months).

 

Yes, but please keep in mind the initial eligibility requirements when determining your cancellation date.

No.

Your coverage will end. If you lose coverage, you may choose to pay the full monthly (COBRA) premium. In this case, the Health Benefits Trust will send you a COBRA notice and election form explaining your coverage option and the cost.

Yes. Please contact the Health Benefits Trust with questions on the COBRA benefit at 1-866-771-7359.

Only if you cancel your coverage. You cannot have both.

Individual Providers: You can pre-apply as soon as you have authorization to work as an Individual Provider and are under contract to work 80 hours or more per month. Enroll online today or download the application and mail it in.

Agency Providers: Contact your employer to coordinate your enrollment.

Individual Providers: You must work at least 80 hours per month for three consecutive months. After you have met this requirement, it takes two months before your coverage starts. See the example below:

February March April May June July
You worked at least 80 hours You worked at least 80 hours You worked at least 8o hours Administrative period Coverage begins on July 1st
You worked at least 80 hours You worked at least 80 hours

Submit an enrollment application anytime before May 20th

Agency Providers: Contact your employer to coordinate your enrollment.

Individual Providers: You must work at least 80 hours per month for two consecutive months. After you have met this requirement, it takes one month before your coverage starts. See the example below:

February March April May
You worked at least 80 hours You worked at least 80 hours Administrative period  Coverage begins on July 1st

Agency Providers: Contact your employer to coordinate your enrollment.Submit an enrollment application anytime before April 20th.

Plan Specifics

If you are an Agency Provider, please contact your employer about open enrollment or qualifying events. Typically, this is only allowed during the annual open enrollment period that takes place in July of each year and has an August 1 effective date.

If you are an Individual Provider, please call the Member Resource Center toll-free at 1-866-371-3200 about options for changing dental insurance providers.

If you do not receive your card by the 15th of the month that your coverage starts contact:

Individual Providers: Call the MRC 1-866-371-3200

Agency Providers: Talk with your employer

If you are an Individual Provider, request for an address change must be made to either your DSHS case worker or to Individual Provider One directly. If you are an Agency Provider, contact your employer to make this change.

Call the Customer Service Department of your insurer, or for the Trust’s self-funded dental plan, call Delta Dental:

Group Health
1-800-542-6312
www.ghc.org

Kaiser Permanente
1-888-901-4636
www.kp.org

Self-funded Dental Plan
Claims Administered by Delta Dental
1-800-547-9515
www.deltadentalwa.com

 

When You Have an Appeal:

An appeal is a request to reconsider a decision to deny, modify, reduce or end payment, coverage or authorization of coverage (known as an “adverse decision”).

The appeal process for each of the Trust’s health and dental plans is different. You should review the Summary Plan Description of appeals procedures in the Benefits Summary provided by your insurer (or, in the case of the Trust’s self-funded dental coverage, by Delta Dental). The Summary Plan Description contains a full explanation of the appeals process.

You may also call the Customer Service Department of your insurer (or, in the case of the Trust’s self-funded dental coverage, Delta Dental) for specific information about the appeals process. Those numbers are listed on the previous page.

Your Rights in an Appeal:

  • You must submit your appeals within 180 calendar days of the date you received notice of an “adverse decision.” Keep track of these deadlines, because appeals that are filed late may not be considered.
  • You may request an expedited 72-hour review of your appeal when the adverse determination could jeopardize your life or health.
  • You may request all of the documents relevant to your request and the decision by the insurer or administrator.
  • You may submit additional comments, documents or other information to support your appeal.

 

More information about how to file an appeal can be found at “How to Appeal a Health Care Insurance Decision: A Guide for Consumers in Washington State,” on the Office of the Insurance Commissioner’s website.

Yes, but you must contact the health insurance provider for specific benefits and claim submission procedures at:

  • Group Health 1-888-901-4636
  • Kaiser 1-800-813-2000
  • Delta Dental 1-800-554-1907
  • Willamette (contact the clinic where the services were provided)

Contact your insurance provider directly for an explanation of benefits and/or questions you have about claims.

Group Health

Find a provider is through the Group Health website, www.ghc.org.

  1. Look on the right-hand side of www.ghc.org
  2. Look for “Find a Doctor or Medical Facility”
  3. Click on “Provider and Facility Directory”
  4. Click on “Doctors and Other Providers”
  5. Find “Health plan provider network”
  6. Finally, select your plan by choosing either
  7. “Group Health” for the HMO plan
  8. “Options PPO” for the PPO plan
  9. “Options” for the POS plan

You can also call Group Health Customer Service toll free at 1-888-901-4636.

Group Health no longer accepts cash payments at Group Health Medical Centers. Group Health expects payment at time of service, and will gladly accept:

  • Visa
  • MasterCard®
  • American Express
  • Discover® credit
  • Debit cards
  • Personal checks will be scanned, converted to electronic transactions and immediately deducted from your checking account
  • Prepaid debit cards (purchased at stores such as Safeway, QFC, Target, Walmart or wherever gift cards are sold)
  • Prepaid debit cards from banks or credit unions

You can reload prepaid debit cards at any time.

For more info:

  • Go to www.ghc.org/payment
  • Ask one of our cashiers
  • Call Customer Service toll-free at 1-888-901-4636.
  • If you enrolled in the HBT plan prior to 8/1/2012, your coverage is through the POS plan.
  • If your coverage begins 8/1/2012 or later (and you live within 30 miles of a Group Health facility or contracted provider), you will automatically be enrolled in the HMO plan.
  • If you live beyond 30 miles, you will automatically be enrolled in the PPO plan.
  • In the POS and PPO plans, you have the choice of in-network or out-of-network providers each time you seek service.

 

Which Plan and Network Applies to Me?

Group Health Cooperative –
HMO Plan
for members who enroll 8/1/2012 or later
Group Health “Options Select”
– POS Plan
if you have been previously enrolled prior to 8/1/2012 and are re-enrolling:
Group Health “Options” – PPO Plan
Your network is called: “Group Health Cooperative”
If you are enrolling effective 8/1/2012 or later, you will be automatically enrolled in this plan if you live within 30 miles of a Group Health Facility or Contract- ed Provider.
Your network is called: “Group Health Options Select” If you are enrolling effective 8/1/2012 or later, you will be automatically en- rolled in this plan if you live within 30 miles of a Group Health Facility or Contracted Provider. Your in-network is called: “Options Select” Your in-network is called: “Op- tions”
You will be automatically enrolled in this plan if you live farther than 30 miles from a Group Health Facility or Contracted Provider or live in Montana.
All care is provided at Group Health Medical Centers and from other Group Health contracted providers
No out-of-network coverage is available.
In-Network care is provided at Group Health Medical Centers and from other Group Health contract- ed providers.
Out-of-Network care is provided by First Choice Health Network Providers.
The First Choice Health Net-
work has an extensive panel of preferred providers in WA, OR, ID, AK and MT.
In-Network care is provided by Group Health Medical Centers; other Group Health contracted providers; First Choice Health Net- work Providers and First Health Network Providers The First Choice Health Net-
work has an extensive panel of preferred providers in WA, OR, ID, AK and MT.
Out-of-Network care is any other licensed provider
Click here to find Group Health Providers near you.

If you are a new enrollee in the Health Benefits Trust effective 8/1/2012 or later, and you live within 30 miles of a Group Health Medical Center or contracted provider, your health care coverage is only for using Group Health Medical Centers or contracted providers. There is no out-of-network coverage.

For all other enrollees, each time you seek health care services, you can choose to use your in-network providers or to see providers out of your network. Your highest level of benefits ($0 deductible) will be found using in-network providers: for the POS (Options) plan this means Group Health Physicians, and for the PPO (Options PPO) plan it means First Choice Health Network of Providers. You will pay more out-of-pocket costs by using an out-of-network provider — a $500 deductible, for example.

Kaiser Permanente

No (with the exception of emergency services). To access your comprehensive coverage, you must use a Kaiser Permanente provider/facility.
Click here to find Kaiser Permanente Providers near you.

Call Kaiser Permanente Membership Services toll free: 1-888-901-4636

You can use this line to:

  • Choose a primary care provider
  • Ask specific benefit questions
  • Address complex medical care case management
  • Address Inpatient care case management
  • Speak to an advice nurse
  • Ask about Kaiser Permanente facilities across the country
  • E-mail your doctor’s office
  • View select test results
  • Order prescription refills (and have them mailed to you, with free shipping)
  • Request or cancel routine appointments
  • Review recent past office visits
  • See a list of your recent immunizations and allergies
  • Act for a family member (e-mail your child’s doctor, and more)
  • Receive a monthly e-newsletter

Register with Kaiser Permanente here.

If you live in any of the following counties/ZIP codes, your medical coverage will be provided by Kaiser Permanente’s HMO plan.

Washington counties:

  • Clark
  • Cowlitz

Oregon counties:

  • Multnomah
  • Polk
  • Washington
  • Yamhill

Have a Coverage Question or Appeal?

For questions or to file an appeal regarding your health or dental coverage, call the Customer Service Department of your insurer.

Group Health
1-800-542-6312
www.ghc.org

Kaiser Permanente|
1-800-813-2000
www.kp.org

Delta Dental
1-800-547-9515
www.deltadentalwa.com

Willamette Dental
1-855-433-6825
www.willamettedental.com