The Oregon Insurance Exchange (Marketplace) is called Cover Oregon. The State of Oregon administers Cover Oregon.
General information about the Cover Oregon can be found at: http://www.coveroregon.com/.
PATIENTS
The Cover Oregon is essentially a marketplace for individuals and small businesses with up to 100 employees to shop for health insurance if they do not already have insurance coverage from another source. If they have insurance from another source (such as employment, retirement benefits, or spousal benefits), they do not need to obtain it from the Marketplace
HIV PROVIDERS
Providers must contract with each of the plans in the marketplace individually in order to fully participate in the Alabama Health Benefit Exchange.
This process is similar to enrolling in insurance or managed care organization provider networks. See below for a list of insurers participating in the state marketplace, and information on contacting them.
As an HIV provider, you may qualify for designation as an “Essential Community Provider (ECP).” The Qualified Health Plans participating in the Insurance Exchange (Marketplace) are required to contract with a minimum number of ECPs and Specialists to ensure network adequacy.
Visit our Provider Resources Section for more specific instructions to assist you in contacting health plans.
REPORTING PROBLEMS
The state office of insurance is primarily responsible for examining and addressing issues with the plans offered within the state Exchange (Marketplace), and the companies that offer them.
If you are experiencing problems as a medical provider with the plans or companies in the state exchange, or if your patients are experiencing problems with the plans or companies in the state exchange, including trouble with access to medications, access to preferred providers, navigating the appeals process, excessive costs, or possible discriminatory policies, or any otherproblems related to the Affordable Care Act, please report these problems to the state office of insurance:
Department of Consumer and Business Services
Oregon Insurance Division
350 Winter St. NE
Salem, OR 97301-3883
503-947-7980
www.oregon.gov/dcbs/insurance/
Complaints: http://www.oregon.gov/DCBS/insurance/gethelp/Pages/fileacomplaint.aspx
Additionally, if you are experiencing these or other problems, please report these problems to AAHIVM, so that we may track issues affecting our members, and seek additional policies remedies.
QUALIFIED HEALH PLANS PARTICIPATING IN THE EXCHANGE
Below is a list of the Qualified Health Plans that have publicly announced that they will offer plans in the Alabama Health Benefit Exchange.
Alabama has established Blue Cross Blue Shield of AL as the “benchmark” plan.
This list is being routinely updated, and may change as insurers join or drop out of the exchange. Please check back for updates
Atrio Health Plans
Plan Website: http://www.atriohp.com/
Provider Enrollment: http://www.atriohp.com/ATRIO-Exchange/For-Providers.aspx
Plan types offered: Individual, SHOP
BridgeSpan Health Company
Plan Website: https://www.bridgespanhealth.com/about-us
Provider Enrollment: https://www.bridgespanhealth.com/web/bridgespan_provider/home
Plan types offered: Individual, SHOP
Health Republic Insurance
Plan Website: http://www.healthrepublicinsurance.org/
Provider Enrollment: https://www.healthrepublicinsurance.org/support/
Plan types offered: Individual, SHOP
Kaiser Permanente
Plan Website: http://www.kp.org/
Provider Enrollment: http://www.kaiserpermanentejobs.org/default.aspx
Plan types offered: Individual, SHOP
Lifewise
Plan Website: https://www.lifewiseor.com/
Provider Enrollment: https://www.lifewiseor.com/provider/
Plan types offered: Individual, SHOP
Moda Health
Plan Website: https://www.modahealth.com/
Provider Enrollment: https://www.modahealth.com/medical/contactus.shtml
Plan types offered: Individual, SHOP
Oregon’s Health Co-op
Plan Website: http://www.ohcoop.org/
Provider Enrollment: https://www.ohcoop.org/providers/provider-portal/
Plan types offered: Individual, SHOP
PacificSource Health Plans
Plan Website: http://www.pacificsource.com/
Provider Enrollment: http://www.pacificsource.com/provider/forms-and-materials.aspx
Plan types offered: Individual, SHOP
Providence Health Plan
Plan Website: http://www.providencehealthplan.com/
Provider Enrollment: https://healthplans.providence.org/pages/providers.aspx
Plan types offered: Individual, SHOP
Trillium Community Health Plan
Plan Website: http://www.trilliumchp.com/
Provider Enrollment: http://www.trilliumchp.com/providers.php
Plan types offered: Individual, SHOP