Business/Employer Eligibility Criteria

For a business to participate in the SharedCare plan, it must qualify as an “Eligible Employer” by meeting all of the following criteria both at the time of application and, except as specified otherwise below, throughout the entire period of its participation:

1. The business must operate on a full-time basis and cannot be a hobby or seasonal business, as reasonably determined by SharedCare.
2. The business must have at least one employee and no more than 50 employees. Uninsured Owners, Sole Proprietors and 1099 contractors are eligible to participate.
3. The business must be located and operated in either Crook, Deschutes or Jefferson County.
4. Employers must provide the Oregon Quarterly 132 to SharedCare for review.  To determine wage eligibility, additional financial documentation will be required for sole proprietors, owners and 1099 contractors. For further information, please call (541) 647-1765.
5. The median wage of all employees at the date of application must meet the present wage qualifier established by SharedCare. (Median wage is determined at 300% of Federal Poverty Level; please refer to the attached Federal Poverty Level Chart.pdf for the qualified wage).
6. The business must not have offered employer based commercial health insurance to some or all of its employees, in which employer contributes at least 50% of the cost of premiums, for 12 months prior to enrollment in the community health improvement plan (SharedCare), or for the duration of the employer’s operation if the employer has been in operation for less than 12 months. However, if not ALL employees are eligible for the existing group insurance plan, those employees without insurance coverage may be eligible to participate in the SharedCare Plan.
7. The business must offer coverage to all uninsured Permanent Employees. For purposes of determining employer and employee eligibility for the SharedCare plan, reference to “Permanent Employee” means: An employee who works an average of 15.4 hours or more per week for the most recent 12 calendar weeks, and who the employer does not reasonably anticipate terminating either at the end of any season or upon completion of a specific project. Employees on family medical leave or an unpaid medical leave of absence are considered permanent employees.
8. Dependent coverage must be offered to uninsured dependents who reside within the tri-county region regardless of health status and who are dependents of an eligible employee.  Employer is NOT required to pay either portion of dependent’s share of coverage. 
9. SharedCare requires all children to screen for OHP and Healthy Kids programs before enrolling.  SharedCare staff will assist the member to fill out the paperwork for this process.
10. The employer must pay at least 50% of the monthly cost of the plan for its employees. The employee will never pay for more than 50% of their coverage. The employer is NOT required to contribute to the dependent monthly cost. 
11. The employer must agree to participate in the SharedCare plan for at least 12 months.
12. The employer agrees to comply with care coordination guidelines within the SharedCare plan (Health Improvement Option and Standard Option).  All members will be required to complete a Health Risk Assessment upon enrollment and annually thereafter. All members will be required to meet with a SharedCare Nurse Manager annually or as needed.
13. A minimum of 75% of eligible employees must elect coverage at initial enrollment, or as reasonably determined in writing by SharedCare administration.
14. The employer must execute the SharedCare Employer Contract and comply with its terms.
15. The employer must notify SharedCare immediately upon discovering that the employer fails to meet any of the employer eligibility criteria or that any employee fails to meet any of the employee eligibility criteria.
16. SharedCare may formally review a business’s eligibility for continued program participation at least annually and may terminate a business’ participation at any time that it fails to meet any of the employer eligibility criteria.
17. SharedCare only partners with healthcare providers in Crook, Deschutes or Jefferson counties.  Therefore, the plan does not provide coverage for medical services or prescription drugs that are provided outside of our partner providers in those three counties.

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The SharedCare Plan is available to uninsured owners, sole proprietors and 1099 contractors.