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.

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.

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).

 

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.

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.

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

 

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