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Client FAQs: Benefits
Other client FAQs: Benefits • Enrollment • Rights • Premiums • Copayments
How do I know which benefit package applies to a member of my household or to me?
What happens when a change occurs that affects my eligibility for benefits? How do unpaid premiums affect my eligibility?
Am I eligible for preventive services, including help to stop smoking?
Do all the OHP benefit packages cover the same services?
Q. How do I know which benefit package applies to a member of my household or to me?
A. Your maroon-and-white OMAP Medical Care Identification shows this information. It gives information for each eligible household member. It shows their name, recipient identification number, and date of birth. It also lists their benefit package, dates of coverage, and copayments. It names their OHP managed care plans and any private insurance (“third party resources”).
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Q. What happens when a change occurs that affects my eligibility for benefits? How do unpaid premiums affect my eligibility?
A. You must report changes to your worker that affect your eligibility. Talk to your worker if you have questions about what changes you need to report.
If your situation changes, your eligibility for medical assistance may change. As a result, you may become ineligible for medical assistance or may become eligible for a different program with a different benefit package. When this occurs, your worker will send you a notice telling you how your eligibility has changed.
Your eligibility may change from the program that provides the OHP Standard benefit package to a program that provides the OHP Plus benefit package. Medical programs that provide OHP Plus do not require premiums. Unpaid premiums do not affect your eligibility for programs that provide OHP Plus.
If your eligibility for a program that provides the OHP Plus benefit package ends because of a change, your worker will evaluate your eligibility for all medical programs. You may have to provide additional information to your worker to determine your eligibility for another program.
If your worker is evaluating your eligibility for OHP Standard and you have outstanding premiums from being on OHP Standard previously, you will be asked to pay those premiums before you can qualify for OHP Standard. Unpaid premiums do not affect a child’s eligibility for medical assistance.
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Q. Am I eligible for preventive services, including help to stop smoking?
A. Yes. You are eligible under both the OHP Plus and OHP Standard Benefit packages for preventive services, which include immunizations, check-ups, and screening tests (such as mammograms and PAP tests). Services to help you stop smoking are also available. You can call the Oregon Quit Line at toll-free at 1-877-270-7867 or talk to your health care provider. Our Spanish Quit Line number is 1-877-2NO-FUME (1-877-266-3863) and TTY is 1-877-777-6534.
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Q. Do all the OHP benefit packages cover the same services?
A. No. All OHP benefit packages are based on the Prioritized List of Health Services. (The Health Services Commission creates the list. The Oregon Legislature adopts the list.) The OHP Standard benefit package does not cover some services covered by the OHP Plus or OHP with Limited Drug benefit packages.
The OHP Standard benefit package only covers:
• A limited hospital benefit
• Physician services
• Emergency transportation by ambulance
• Prescription drugs
• Lab and x-ray services
• Some medical equipment and supplies
• Outpatient chemical dependency services
• Outpatient mental health
• Emergency dental
• Hospice
Your revised Client Handbook (PDF) tells you more about services not covered by the OHP Standard benefit package.
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This page updated Sept. 2006.
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