The Top Reasons to Enroll in Oregon Family Health Insurance Assistance Program

Oregon began enrolling people into its new Family Health Insurance Assistance Program on July 1, 1998. The program is shaped to build on the private insurance sector and to assist uninsured families and individuals in gaining health insurance coverage. Oregon is in the process of developing a FHIAP pilot project which will enroll children into Title XXI-qualified employer coverage through the consumer-choice health purchasing group, Health Choice.

1996 Oregon Population Survey shows that 340,500 Oregonians do not have health insurance. From them 42% (144,100) earn more than 200% FPL, 19% (64, 500) earn less than 100% FPL, and 39% (131, 800) earn between 100 and 200% FPL.2 It is the last group that the FHIAP program is specially designed to serve. Present funding is projected to cover 15,000 to 17,000 people. The percentage of people having no health insurance varies highly within the state by region. In the Portland metro area, less than 10% of the population lacks health insurance while in other counties, which are rural, 14% or more of the population is uninsured. In recent years, an increasing percentage of Oregon employers are offering health insurance coverage to their employees. Both the Governor and the Legislature are committed to building upon this employer-sponsored insurance base.

The purpose of FHIAP is to eradicate economic barriers to health insurance coverage for residents of the State of Oregon with family income less than 200 percent of the federal poverty level. Encouraging individual responsibility, advancing health benefit plan coverage of children, building on the private sector health benefit plan system and encouraging employer and employee participation in employer sponsored health coverage.

Policy design for Health Insurance Program

Three state agencies as responsible for making of the principles and policies of the Family Health Insurance Assistance Program. These agencies are: the Office for Oregon Health Plan Policy and Research, which is responsible for policy recommendations and counsel to the Governor, as well as program monitoring; the Oregon Health Council, which is responsible for program concept and policy recommendations to the Governor; and the Insurance Pool Governing Board, which is responsible for policy formulation, program design, program management, marketing and outreach, and program investigation. Most of the staff was adopted from other backings within government including the three as above. Furthermore FHIAP staff members were rented from different departments, such as Medicaid, to assist during the starting process.

The first duty of the enactment team was to sketch the mission and the principles of the new program that would guide policy decisions. The legislation defined the mission of the program: to remove economic fences to health insurance coverage by providing a subsidy to low-income individuals and families earning too much to qualify for Medicaid. The program is also intended to held on the private sector and encourage self-assurance through participation in and access to the health benefit system. The FHIAP staff felt that founding the principles underlying the new program was vital to the program growth process that followed.

The principles of FHIAP are to:

  •  Foster independence and autonomy
  •  Encourage cost notice, comparison shopping, and user choice
  •  Respect secrecy and maintain personal poise
  •  Assure organizational simplicity and efficiency
  •  Not a prerogative
  •  Extend health treatment to the uninsured
  •  Accentuate health insurance for children
  •  Stimulate equity in health care financing

When mission and principles of the program were agreed upon, the team made intensive struggle to include the most outspoken critics of the program to integrate a horde of views and ideas. Because the basic principles of the program were already recognized, the team was able to refer back to them in modifying particular decisions. The team used several methods to obtain public input: surveys of potential clients; focus group sessions with clients and agents; and public hearings throughout the state.

The team established issue briefs for each policy area, based on public input. These briefs gave circumstantial on each issue, described various policy choices, suggested a policy and provided basis for that recommendation. Among the many issues considered were: eligibility criteria, period of time uninsured, benefits standards, federal poverty level edge, and subsidy levels and prospective vs. retrospective subsidy payments. From this rules were established and public hearings were held to attain public comment on these projected rules. Comments from individuals and groups attending the public hearings were taken into contemplation and used to enhance the administrative rules of the program.

The Family Health Insurance Assistance Program is a funding program to help frequently uninsured people obtain health treatment. Private health insurance is obtained in the group marketplace through a company or in the individual market through an insurance agent. To qualify for a subsidy an applicant must:

  • be a inhabitant of Oregon
  • be a trained resident of the United States
  • have regular monthly income for the past three months below 170% of FPL
  • have fluid assets less than $10,000
  • not be qualified for receiving Medicare
  • Not have had health coverage for at least six months

Before an adult can obtain a funding payment, all children in the family must be enclosed under some form of health insurance.

Reservation List

A reservation list is used to achieve membership in FHIAP.  An applicant must place his/her name on the reservation list before an application to the program can be finalized. Candidates to the program must fill and mail a reservation card to the FHIAP office to gain a place on the reservation list. The list is sustained on first-attended basis. FHIAP will to accept booking requests after the program is full. When the program is full, the reservation list will become a waiting list. Names will be removed from the list in the order that they were acknowledged. If an applicant has been without treatment for at least six months prior to assignment on the reservation list, she may purchase coverage in either the individual or group market while pending space in the program without threatening her suitability status.

Booking cards can be attained from the FHIAP office, employers, and other groups, such as Medicaid offices, community health centers, etc. The card demands basic data from the applicant, such as name, address, contact number and ages of family members wishing to be covered. Suitability resolve later in the application process. If a person loses eligibility or is denied enrollment to the program and wishes to reapply, she must restart the process by placing her name on the reservation list.

The Application Process

          When the space is available then applicant can sent a request which is skilled and resumed to the FHIAP office. An aspirant must provide copies of: proof of income, photo identification, Migration and Service card (for non-citizens), and most recent federal tax return (for self-employed applicants). If it is unwavering that the applicant is eligible for the program, she can receive the subsidy in one of two ways. If the aspirant has access to employer-based health insurance and the employer makes any impact towards employee or reliant on treatment, the applicant and dependents, unless eligible for Medicaid look-alike CHIP, must enroll in the employer’s plan.

 If the candidate does not have access to health insurance reportage through her employer or has missed her employer’s open enrollment period, she may use the subsidy to purchase coverage through an individual plan.7 Insurance carriers are certified by the state to participate in this program and applicants choose from among their offering of health benefit plans. Applicants may enroll in one of the plans offered by the certified carriers with the assistance of their own insurance agent or with the assistance of a FHIAP approved insurance agent to which they have been referred. However, they are not required to use an agent. If an applicant is denied enrollment in a plan because of health status, she may use her subsidy to purchase coverage through the Oregon Medical Insurance Pool (OMIP).

An enrollee is unwavering to be qualified for the program for year. However, she must report any variations to the FHIAP office. Changes that are obligatory to be described include: new name or address, dropping or changing health insurance coverage, loss or addition of family member(s), a change of employer, change in employer contribution amount, or if a child is no longer eligible to be covered under the health insurance plan. It is only during the redetermination process that the subsidy percentage will be recalculated. The subsidy amount may be recalculated to respond to premium increases and changes in health insurance coverage. As long as an enrollee continues to meet eligibility requirements, there is no limit to the length of time that she may participate in the program.

Payment of Subsidy

           The subvention an enrollee obtains is a percentage of the enrollee’s share of the premium, based on salary and family size. The subsidy percentage that enrollees receive is not based on the total price of the health plan in which the applicant enrolls. Candidates may enroll in any of the plans offered by the FHIAP-certified carriers in the individual market or by their employer. Therefore, unlimited funding amount that FHIAP will pay.

 Enrollees must remain current in their payments to the carrier. Despite the risk of misused program dollars, it was decided to implement a payment system in the group market in order to eliminate cash-flow barriers to FHIAP coverage that many low-income families may face.10 Subsidy amounts are set at 95%, 90% or 70% of the enrollee’s share of premium, depending on income and family size. By offering funding amounts and certifying carriers, FHIAP intends to provide an incentive for people to purchase a plan with adequate benefits.

Initial Activities

            On July 28, 1997 FHIAP was designed by governor. In addition to defining the program’s rules and actions, the execution team needed to complete four main tasks in order to move towards the actual membership of applicants. These four chores were: authorization of carriers for participation in the program, advertising of the program to participants and potential customers, preparation of insurance agents for participation in the referral program, and the choice of a 3rd party to track the operations of FHIAP.

Certification of Carriers

             FHIAP will sponsor any employer’s treatment. For individual health insurance carriers are specialized for contribution in the Family Health Insurance Assistance Program.  A request for suggestions for participation as a Certified Health Insurance Carrier for FHIAP was referred to all shippers operating in the state.

     The criteria to contribute in FHIAP are:

  • Must be an Oregon health care service contractor.
  • Must have health insurance for 3 years in Oregon.
  • Must offer one or more health benefit plans that include (as part of the plan or as an optional benefit): prescription drug, preventive services, maternity benefits, mental health and chemical dependency, hospice and palliative care.
  • Must agree to provide 6 months’ notice of extract from FHIAP.
  • Must agree to bill arrangements with the 3rd party manager.
  • Must uphold an individual market refusal rate not to exceed 20%.
  • Must agree to develop health benefit plan and funding application for FHIAP applicants.
  • Must meet the minimum financial requirements by the Insurance Division, Department of Consumer and Business Services.

Marketing and Outreach

The marketing of FHIAP started early in the program design process. Over the months that followed the signing of the legislation, the implementation team had discussions with and gave informal presentations about the program to: insurance agents and associations, employer groups, community action programs, state agencies, and other stakeholder groups. In addition, surveys and focus groups were conducted with employers, agents, and potential applicants. The feedback from these meetings and surveys was used to design the program, to raise general awareness of the program among the agencies and organizations who have contact with clients, and grow the phases of the FHIAP.                                    

In September of 1998, the first membership were reported. At that time, the majority of enrollees were obtaining coverage through the individual market.15 Subsidizing members who are enrolled in individual plans is more costly for the state than subsidizing the employee’s premium share of an employer-based plan. In order to reverse this trend, which will limit the total number of people who can be covered, the FHIAP staff plans to intensify marketing efforts directed at employers. These efforts will include: designing a group application process and directly assisting agents in working with employers, a continuation of presentations to Chambers of Commerce and other employer groups, the writing and distribution of articles for business-oriented newsletters an publications, and, with the assistance of business and industry associations, a direct mail campaign to employers.16 Other methods of increasing enrollment which were and will continue to be used include: the development and distribution of radio reports, assisting news reporters in finding a local angle to the story, the creation of public service announcements, targeted mailings to food stamp recipients and those denied by Medicaid, and the placing of posters, table tents, and reservations cards in schools, churches, community centers, community colleges, chambers of commerce, libraries, and city and county government offices.

Training of Insurance Agents

                 Insurance mediators are used by FHIAP both to market the program to potential clients and, for those enrolling in an individual plan, to help applicant’s applications and choose health insurance plans. Through its voluntary agent referral program, FHIAP matches agents with applicants who request help with the enrollment process. Agents who speak a language other than English are matched with customers who may need brochures and application materials interpreted for them. All agents in the state are able to assist applicants with enrollment in the program but only those agents who have undergone training and are part of the referral program will receive referrals. Agents who have been in contact with a prospective member prior to the submission of a reservation card are able to identify themselves on the card so that when space is available, and the person is ready to be enrolled, the agent can assist in the application completion process. The carrier pays commissions to the agent at a rate agreed upon between them.

The agent participant requirements are:

  • An Oregon inhabitant health coverage
  • Complete FHIAP training program
  • Have Errors and Omissions Insurance
  • Have an appointment with  FHIAP
  • Provide FHIAP members with data on Children’s Health Coverage  and Oregon
  • Assist FHIAP members in enrolling in the state’s high-risk pool if they are turned down for insurance in the individual market.
  • Agree to provide the same level of contact or service to FHIAP members as is provided to other clients

Selection of 3rd party Administration

             The selection of 3rd superintendent for FHIAP was of serious importance to the application team. Because the TPA has the most direct contact with enrollees, the team wanted to ensure that the administrator chosen would provide excellent customer service. Meetings were conducted with potential bidders to explore ideas for program administration and match FHIAP needs and expectations against what TPAs are capable of providing.

The implementation team based their review of the proposals on the following criteria:

  • Licensed TPA
  • Ability to manage a database and size of FHIAP
  • Productivity of payment procedures
  • Ability to run the program profitably
  • Established commitment to customer service

FHIAP in Operation

              FHIAP staff is responsible for administration of program policy, quality assurance, data analysis, program evaluation, eligibility appeals, and marketing and outreach activities conducted for the program. In addition, the staff switches the progress and apprising of marketing and tender resources. The TPA is responsible for the day-to-day operations of FHIAP. Its responsibilities include:

  • Management of the reservation list
  • Management of the agent referral program
  • Sending applications to prospective applicants
  • Resolve and renewal of eligibility and funding expanse
  • Premium collection and billing
  • Data collection and reporting
  • Front-line customer service and initial complaint resolution

Reservation List

            The reservation list is preserved by the TPA. FHIAP staff is accountable for the marketing resources and public consciousness operation that is essential to shape the list. Latent clients can place their name on the list by either mailing a reservation card to the FHIAP office (staffed by the TPA) or calling the office using a toll-free number. The TPA, at the direction of the FHIAP staff, is responsible for sending reservation list information as well as program applications to individuals on the reservation list. Individuals on the reservation list can obtain information about where they are on the list and the approximate waiting time for the program by calling a toll-free number.

Application Process

                               TPA takes names from the booking list, in the order that they were received, and mail a request package to the suitable people. The claim package includes: the presentation; a member manual, which explains FHIAP; and a health protection controller, which explains health insurance terms and options. Applications are mailed on a monthly allotment basis in order to manage growth in program enrollment. The applicant must indicate whether or not she has access to coverage through her employer and whether or not she would like to be mentioned to a health cover manager. The TPA is accountable for provided that application resources in substitute organizations, such as audio, Braille, or large print, if necessary. The TPA also supports applicants in finalizing the application. The TPA must objectively explain the health insurance coverage options available to the applicant, while encouraging the customer to seek or retain coverage. When filled requests are expected, the TPA must answer within 10 days. If a request is comprehensive, the TPA determines whether or not the applicant is eligible and the subsidy amount she should receive. If an application is incomplete, the TPA must notify the applicant as to what information is missing.

FHIAP Program Principles

In designing the concept for FHIAP, the Legislature wanted to develop a model program that not only protects the well-being of economically disadvantaged Oregonians, but helps them to become self-reliant. Toward that goal, the program is considered on the following ideologies:

  • Fosters independence and self-reliance – The subsidy amount will decrease as family income increases, so the affordability of health coverage will not end when families work their way off of well-being.
  • Encourages cost consciousness, comparison shopping, and consumer choice – Eligible families without employer-sponsored coverage may apply the subsidy to their choice from among a variety of health benefit plans.
  • Respects confidentiality and maintains personal dignity – Oregonians using the subsidy are not stigmatized in any way.
  • Assures administrative simplicity and efficiency – Program administration will not require the development of a new government agency and the program design encourages participation and is easily accessible to the customer.
  • Not an entitlement – Program expenditures are limited to the funding allocated and the expenditures authorized by the Legislature. Being eligible for the program doesn’t guarantee that a person or family will receive the subsidy.
  • Responds to “real life” issues of maintaining a household budget on a modest income – Subsidies will be adequate to make health insurance more affordable, as well as recognize a family’s cash flow needs.
  • Builds on strengths of the current system – Encourages and builds upon employer based coverage, and recognizes that providing access to health care to all Oregonians requires collaboration between the private and public sectors.
  • Extends health coverage to the uninsured – The goal of the program is to remove economic barriers and increase the number of Oregonians with access to health care.
  • Emphasizes health insurance for children – Adults are eligible for the subsidy only if all children in the family are covered by a health benefit plan.
  • Promotes equity in health care financing – The program targets those working Oregonians who through their tax dollars help pay for both Medicaid and Medicare, yet cannot afford health coverage themselves.

Faqs

Q: Who is eligible to enroll in the Oregon Family Health Insurance Assistance Program?

A: Families who meet certain income requirements are eligible to enroll in this program. To learn more about eligibility requirements, visit the Oregon Health Insurance Marketplace website.

Q: How much does it cost to enroll in the Oregon Family Health Insurance Assistance Program?

A: The cost of enrolling in this program varies based on income and family size. However, financial assistance is available to help offset the cost of premiums.

Q: What types of healthcare services are covered by the Oregon Family Health Insurance Assistance Program?

A: This program covers a wide range of healthcare services, including doctor visits, hospital stays, prescription medications, and more. To learn more about covered services, visit the Oregon Health Insurance

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