To ensure you continue receiving Healthcare Cost Assistance, please remember to:

• Turn in your timesheets and/or payroll vouchers on a regular basis.
• Avoid recording zero hours of work for two months in a row. Going two months in a row with no work could cause you to lose your Carewell SEIU 503 benefits, including Healthcare Cost Assistance. In that case, you would still have your Marketplace insurance plan but you would have to start paying for premiums yourself or look for alternative coverage (for example, through the Oregon Health Plan).
• Keep your personal information up to date with Carewell SEIU 503 and your employer.
• Pay your monthly premium to your insurance carrier on time, and monitor your premium payments. Your carrier may terminate your insurance plan if payments are missed.
• Report to the Marketplace any change in your information within 60 days. We’re here to help with this… call 1-844-503-7348 for assistance.
• Stay current on your tax filing.

The fastest way to get your reimbursement is by completing the following forms online!

Medical Reimbursement Claim Form

Medical Reimbursement Claim Form (Digital)

Use the Medical Reimbursement Claim Form for:

• Premium reimbursements if you are enrolled with family members onto your plan. You can only claim the portion of your premium corresponding to your individual coverage. If you need help calculating your individual premium amount, contact the Marketplace (1-800-318-2596), your insurance carrier, or Valley Insurance Professionals (1-844-507-7554, option 2). Please submit this form and a copy of your premium bill each month.
• Claiming reimbursement after March 31 for eligible costs from the previous calendar year.

Ameriflex Reimbursement Form

Ameriflex Reimbursement Form (PDF)

Use the Ameriflex Reimbursement Form to claim reimbursement:

• When you have paid for an eligible cost out of your own funds instead of using the Benefit Convenience Card (for instance, if you paid for a prescription medication out-of-pocket because you didn’t have your Card with you at the time).
• Claiming reimbursement until March 31 for eligible costs from the previous calendar year.

You may qualify for Healthcare Cost Assistance if you became eligible for Carewell SEIU 503 benefits after the end of the last Open Enrollment period and you are enrolled in a non-approved plan on a Healthcare Marketplace. In that case, you would receive a Benefit Convenience Card to pay covered out-of-pocket expenses, and you would be eligible for reimbursement of your premium costs up to the lesser of your actual premiums or the average premium amount received by eligible care providers on Healthcare Cost Assistance. To continue receiving Healthcare Cost Assistance after the end of the year, you must enroll into an approved plan at your first opportunity and no later than Open Enrollment (between November 1 and December 15). Otherwise, your Healthcare Cost Assistance will stop at the end of the calendar year. To check if you qualify for average premium reimbursements, call 1-844-507-7554, option 3, option 2.

Your net premium is the monthly amount that you must pay to your insurance company to maintain your insurance. For example, if your gross premium (the full cost of the premium from your insurance carrier) is $500 per month and your Advance Premium Tax Credit or APTC (the financial assistance from the Federal Government) is $200 per month, your net premium would be $300 per month.

Your Card works just like a regular debit card, with two important differences:

1. Your card is limited in use, meaning you can only use it for the covered expenses listed under “What can I use the Card to pay for?”

2. You cannot use your Card at an ATM or to obtain cash back when making a purchase.

There are two “accounts” on your Card. One account is preloaded with the annual amount for paying medical and prescription copays, deductibles and coinsurance expenses for covered services and prescriptions. In 2021, that amount is $6,500, but this may change from year to year. The other account is preloaded with the amount necessary to pay your net monthly premium: the portion of your individual health insurance premium that is not covered by your Federal tax credit (APTC).

The Advance Premium Tax Credit (APTC) is a tax credit issued by the federal government that you can use to lower your monthly insurance payment (called your “premium”) when you enroll in a plan through the Health Insurance Marketplace. Your tax credit is based on the income estimate and household information you put on your Marketplace application. If your estimated income falls between 100% and 400% of the Federal Poverty Line, you qualify for a premium tax credit.