Frequently Asked Questions about Oregon Health Insurance

Q. What is the difference between HMO and PPO coverage?

A. The level of benefits (i.e., generosity of coverage, deductible and co pays), and the amount of freedom to choose among physicians and hospitals are usually the two main differences. See below . . .

HMO: A Health Maintenance Organization provides benefits for preventive care coverage and low out-of-pocket costs. There is typically no coverage for care from doctors or hospitals outside your HMO. Plans usually offer comprehensive benefits and affordable premiums with no deductibles. You choose a Primary Care Physician from a network; This Doctor oversees all your care, and may provide referrals to specialist if needed.

PPO: A Preferred Provider Organization is a network of physicians and hospitals that have agreed, by contract, to discount their rates to members. The networks are typically very large, and the members are free to seek care from any physician or provider within the network, including specialists without a referral. Members may also access non-contracted providers, but at a higher out-of-pocket cost. Typically PPO plans might offer some front-end co-payments for such services as doctor visits and prescriptions. Most other covered services (i.e., inpatient hospital services and surgeries) are typically subject to a calendar year deductible and/or coinsurance (where applicable).

Q. How long does the application process take?

A. This will vary slightly depending on the plan you select, however on average you usually will hear back within two to three weeks. The process could take longer sometimes, if additional information and/or medical records are requested.

Q. When will my coverage take effect?

A. Unlike some other types of insurance, Oregon health insurance cannot be bound for coverage immediately. Your application for coverage will go through an underwriting process and does need to be approved by the insurance company you are applying with. With some plans, coverage can only be started on the 1st of the month - with others you may be able to specify a requested effective date on or after the date you sign your application. See specific plan for details.

Q. What if I only need coverage for a few months?

A. Oregon health insurance does not typically have a specific term associated with it. As long as you continue to pay your premium, you policy will continue. If you need temporary insurance for a short period of time you may want to consider Short-Term Coverage. This type of coverage is generally easier to apply for, quicker to process, and also less expensive than permanent coverage. This is a non-renewable policy and is applied for with one premium payment for the term you select.