Private Insurance Basics
If you do not qualify for the Oregon Health Plan, or your employer does not provide insurance, you may purchase it from the State of Oregon's Insurance Marketplace.
Employer-provided insurance plans
Even if your employer provides insurance for your family, you may have to pay part of the monthly premium. Your employer may offer more than one plan to choose from, so compare your choices during the enrollment period. Your employer will let you know when that is. The enrollment period is usually only a few weeks long.
Usually your employer determines what your insurance covers. Decisions about what is covered in your plan are generally made annually. If you do not think the plan covers what you need, contact your human resources department to make suggestions to improve it.
Care coordination help
If your child requires a lot of providers, medications, or appointments, you may be eligible for assistance from a care coordinator that works for the insurance company. See our tip sheet: How to Request Care Coordination.
Appeals and denials
Insurance sometimes does not cover what you think it should. There is help for you if you have difficulties with your provider or insurance company. You have a right to appeal the insurer's decision. Many families succeed in their appeals. The first step is call your insurance company customer service line. There are always people who can help you with an appeal process.
In order to start an appeal, it is important for you to know the type of plan you have. If your employer pays for it, you probably have a "group plan." If you work for a big company that buys their own insurance, it may be called a "self-insured plan." You can find out, which you have by asking the human resources department of your job. The type of insurance you have will determine who will help you with the appeal process.
If you have a group plan, you can get help from the Oregon DCBS Division of Financial Regulation at 1-888-877-4894 or e-mail email@example.com.
If you have a self-insured plan, you can get help from Large Group Plan Online Assistance or call 206-757-6632.
If you do not know what kind of insurance you have, we can help you. Call the OR F2F HIC 855-323-6744
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