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Frequently Asked Questions


General Information

Eligibility and Enrollment

Coverage and Benefits


Providers, Referrals and Prior Authorizations



Answers to Frequently Asked Questions


How is a community health improvement plan different from traditional insurance?

While community health improvement plans are similar to traditional insurance in terms of co-pays, benefits, and offering a network of providers, these community plans are not insurance products. Rather they are hybrid products that are better described as community cooperatives which blend some aspects of insurance products with community resources to deliver coordinated health care to members and reimburse providers for services. Here are some ways SharedCare differs from insurance:
  • Available only through eligible employers and coverage ends when employment is terminated
  • Covered health care services are available only through tri-county SharedCare providers
  • No exclusions for pre-existing conditions and no deductibles
  • Some covered benefits require referrals, prior authorizations, and/or protocols to be completed
  • Part of what makes SharedCare affordable is utilization of preventative care. Each member must have a Primary Care Provider (PCP) and members are encouraged to take an active role in their health through our Health Improvement Option

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Who is responsible for collecting the premiums from employees?

It is the Employer’s responsibility to collect premium payments from their participating employees (i.e. payroll deductions, etc). The Employer is liable for full payment of the monthly premiums and must pay SharedCare on one business check on a monthly basis.

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When are monthly premiums due?

Monthly charges are due on, and must be paid in full by, the 1st of the month for that month's coverage. For example premium payments for December are due on December 1st.

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What if I decide to cancel my business’s enrollment?

When you enroll your business in the SharedCare Plan, you are committed to continuing coverage for 12 months. After that time you may cancel your enrollment.

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What do you mean by "business does not currently offer health insurance coverage to all or some employees?

Many small businesses have a few or a group of employees who don't qualify for traditional group health insurance plans. For example, many group plans exclude part-time employees. SharedCare considers this a group of "some employees" who may not have health insurance now, thus being eligible for the SharedCare Plan. During the initial enrollment period at least 75% of eligible employees must sign up for the SharedCare Plan.

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I already have existing health coverage for my employees. Can I drop my current health coverage and enroll in SharedCare?

No. SharedCare is for small businesses who currently do not offer health coverage. You cannot have offered group sponsored health coverage for 12 months prior to enrolling in the SharedCare Plan

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Can my business be eligible for the SharedCare Plan if one of my business partner(s) or employees is a family member?

Yes.There are no restrictions regarding family members as long as he or she meets the employee eligibility requirements.

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As an owner, can I be eligible for coverage even if I am not an actual W2 employee?

For the owner to apply for the SharedCare Plan some additional financial documentation will be required in order to determine their eligibility. Documentation requested may include, but is not limited to, Balance Sheet, Income Statement and Tax Returns.

If you are eligible for coverage as an owner and have employees, your salary will be included in determining the median wage of the eligible employee group.

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When an employee becomes eligible, can I add them at any time?

In order for coverage to start effective the first day of the following month, all required enrollment materials must be completed and premiums paid by the 25th of the month prior.

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If I participate on the Standard Option why do I have to take an annual Health Risk Assessment?

The Health Risk Assessment helps us identify a member's specific health care needs. ALL MEMBERS, regardless of plan, that have a persistent or chronic health condition (such as diabetes, chronic pain, high blood pressure, or obesity) need to meet with our Nurse Care Manager and participate in educational classes related to your chronic health condition. If you are enrolling in the Standard Option and have class requirements, you may consider participating in the Health Improvement Option to save money on monthly premiums and co-pays.

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Are dependents eligible for coverage through the SharedCare Plan?

Uninsured, qualified dependents of an eligible employee may be eligible for coverage during the period in which an eligible employee is covered by SharedCare.  As a condition to enrollment of a dependent, the eligible employee will have the burden to establish that the dependent is a legal and qualified dependent of the employee as determined by the guidelines published in IRS Publication 501 and adapted for the purposes of eligibility screening for the SharedCare.  In SharedCare’s sole discretion, SharedCare has established the qualifying criteria.

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Does the SharedCare Plan have a pre-existing medical clause?

SharedCare does not have a "pre-existing condition clause". However, members have a 50% co-pay for covered surgical procedures in the first six months of participation regardless of their medical condition. Members must contact SharedCare first. A Referral and Prior Authorization are required for all surgeries.

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Does the SharedCare Plan cover pregnancy?

Pregnancy is only a covered benefit on the SharedCare Plan if the member is not eligible for the Oregon Health Plan or other public assisted programs. Members who become pregnant must screen to determine eligibility for the Oregon Health Plan program. You may contact SharedCare for assistance and we will facilitate enrollment in the program.

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Are prescriptions covered?

Yes. Members and providers should refer to the Prescription Formulary. This is a listing of covered medications. Co-pays for prescriptions vary based on the type of medication. There is an annual limit that SharedCare will pay out per member. To see if you are eligible for Pharmaceutical Assistance Programs please contact the SharedCare Nurse Care Manager at 541-647-1765 for assistance.

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What if my medication is not on the Formulary?

Medications not on the formulary are not covered by SharedCare. Members should first contact their physician to see if there is another medication that is on the formulary in the same classification. If not, the member should contact the SharedCare Nurse Care Manager for assistance in applying for the Pharmaceutical Assistance Program.

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I am having difficulty getting my prescription at the pharmacy, what do I do?

Contact SharedCare at 541-647-1765. Our staff would be happy to assist you. The pharmacy can also contact the MedImpact Customer Service number on the back of your member card to assist.

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Does the SharedCare Plan provide vision or dental benefits?

SharedCare does not offer vision or dental benefits within the plan. However, SharedCare is a "community-based program" and works in partnership with many community health care resources available in the tri-county region to connect members with valuable resources and to help contain costs. We will assist in identifying the appropriate resources that are available to you through agencies within our community.

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If I take the Tobacco Cessation Class, do I have to quit smoking?

If you are a smoker, the class is a requirement for those on the Health Improvement Option. If you are taking the class for a Health Improvement Option credit, you are not required to quit smoking, but it is encouraged because of the adverse health risks.

Members may take the class in order to assist them to quit smoking prior to a surgery or service that requires them to quit smoking based on Protocols.

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Can I see a provider outside of the tri-county region?

No services will be covered outside of Crook, Deschutes or Jefferson counties or by a provider not participating on our SharedCare Provider Network. This is a community health improvement plan for Crook, Deschutes and Jefferson Counties that relies on our community services and providers.

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Will I have to switch doctors?

St. Charles Health System has worked hard to secure a wide network of providers in the tri-county region. As long as your doctor is a SharedCare provider you will not need to switch doctors.

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I do not have a Primary Care Provider, can I still participate on the SharedCare Plan?

All members of the SharedCare Plan are required to have a Primary Care Physician (PCP). If you do not currently have a PCP you will need to choose a provider from the SharedCare Provider Network. Members must make an appointment and have a physical exam by their PCP within 60 days of enrolling in the SharedCare Plan.

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