Home

Claims

Providers

Plans

Pharmacy

Resources

FAQ

Contact us

FREQUENTLY ASKED QUESTIONS (FOR INDIVIDUAL PRODUCT ONLY)

Who is eligible to apply?
How do I apply for a plan?
Does it cost more to buy through an Insurance Producer?
When will my coverage begin?
Can I change plans?
What is the difference between the "Select" and the "Custom" prescription drug benefits?
How do I pay my plan premiums?
Will my rate change?
What are the policy's benefits and limitations with respect to pregnancy?
What if I want to add a dependent in the future?
Can my employer pay the premium for my policy?
What are my options if I am declined coverage?

Q. Who is eligible to apply?

A. Oregon residents living in Deshchutes, Klamath and Lake Counties. Applicants may apply from birth to under the age of 65, if currently eligible for Medicare. Eligible individuals include you, your legal spouse, and any unmarried dependent children under the age of 23.

Q. How do I apply for a plan?

A. Complete the enclosed application and return it directly to us or to an insurance producer appointed by PHP. Complete instructions are included on the application for your convenience. Do not include premium with your application.

Q. Does it cost more to buy through an Insurance Producer?

A. Insurance Producers appointed to represent PHP products provide a valuable service to their clients. Insurance Producers can help you decide which of our products are best for your situation. There is no extra cost or obligation associated with using an appointed producer.

Q. When will my coverage begin?

A. We will begin to process your application immediately upon receipt, however we must receive the application by the 15th of the month for the next month's effective date; applications received after the 15th will be processed for the subsequent month's effective date. If the application is incomplete, it will be returned to you and your effective date may be delayed. If approved, we will send you ID cards and a policy so that you may review the details of your plan.

Q. Can I change plans?

A. You have 10 days from the time you receive your policy to return it, if you decide not to accept the coverage as provided. If you accept the policy, you may change to another plan or deductible amount at another time by submitting a new application. The new application will be subject to the same approval process as your original application and may be accepted or rejected based on your health status.

Q. What is the difference between the "Select" and the "Custom" prescription drug benefits?

A. A drug formulary is a list of medications used to treat various medical conditions. The Select (open formulary) has only limited drug product exclusions. The Custom (closed formulary) is a formulary that contains only specific medications. The Custom formulary contains only the most cost-effective medications, there-fore saves in premium costs.

A prescribing physician, member or prospective member may contact PHP for information on whether any particular drug is included or excluded from the formulary.

You may call PHP Customer Service whenever you have a question at (541) 882-1466 or (800) 303-8680. Bend residents please call (541) 312-0018. If your questions require the intervention of a pharmacist, the Customer Service Department will direct you to that person.

Q. How do I pay my plan premiums?

A. You have a choice of receiving monthly billings or payment by automatic bank deductions. Do not send money with the application. We will bill you for the premium payment.

If you choose monthly automatic bank deductions, it may take a month or two to get your bank deduction set up. So, please be sure to pay monthly bills that you receive until the bank deduction is finalized.

Q. Will my rate change?

A. The rates for individual plans are subject to change upon renewal of the plan. This will occur every October 1st, regardless of when your coverage began. Additionally, you may experience a rate change as you get older and move from one age category to another. We will notify you in advance of any rate change.

Q. What are the policy's benefits and limitations with respect to pregnancy?

A. Maternity benefits are only available after 12 continuous months of coverage with PHP. However, you will receive credit if you are eligible for Creditable Coverage from another carrier.

Q. What if I want to add a dependent in the future?

A. As a member, you may add newborns or recently adopted children to your policy within 31 days of the event. Complete details are provided in your contract.

To add a spouse or other children, you can send us a completed application form. Upon receipt of your dependent's application, we will begin the review process.

If the dependent's application is approved, benefits for pre-existing and other specified conditions will be subject to limitation periods. However, the new dependent will receive credit if eligible for Creditable Coverage from another carrier.

Q. Can my employer pay the premium for my policy?

A. No. This is an Individual plan and payments may not be made by an employer. In accordance with Oregon insurance regulations, should the employer pay any or all of the premium, the plan would need to qualify as a group plan and would need to meet several requirements that are not applicable to Individual plans. Therefore, we cannot issue an Individual policy under these circumstances.

Q. What are my options if I am declined coverage?

A. You may be eligible to apply with OMIP. Please call their Customer Service Department at (800) 848-7280 for an OMIP packet.