IMPORTANT: Providers and pharmacies should not turn Health Share members away if there is a discrepancy in their member assignments. All claims will be paid during this transition. All medical, dental, and pharmacy services are guaranteed up to 90 days, and behavioral health is guaranteed up to 180 days, after January 1, 2020.

Health Share Plan Partnerships in 2020

Health Share now has even more plan choices for members. As Health Share positioned itself to realize the goals of CCO 2.0, we found opportunity with our partners to rethink how we operate and refined our structure.

As of January 1, 2020, members now have access to 5 physical health plans, including CareOregon, Kaiser Permanente, Legacy Health-PacificSource, OHSU Health, and Providence Health Assurance.

2020 plan choices

Physical Health*
Dental Health
Mental Health & Substance Use Care
CareOregon
Advantage Dental
CareOregon**
Kaiser Permanente
CareOregon Dental
CareOregon
Legacy Health-PacificSource
Kaiser Permanente
CareOregon
OHSU Health
ODS
CareOregon
Providence Health Assurance
Willamette Dental Group
CareOregon

**CareOregon now manages behavioral health contracts. Health Share’s network of mental health providers is the same and members can keep their same mental health and substance use providers.

*More information about each physical health plan partner’s provider network is below.

Health Share Member Assignments

Members were assigned to physical health plans based on their primary care providers. Health Share sent members temporary ID cards with their 2020 plan assignments beginning in November 2019. Cards indicated physical health and PCP assignments, dental plan assignments, and CareOregon as the contact for mental health and substance use care. Members’ plan assignments went into effect January 1, 2020.

The primary objective of plan assignments was to ensure patient safety and to maintain continuity of care. Except as noted below, all members assigned to community primary care physicians (providers not in one of the health systems), were assigned to CareOregon. All members assigned to primary care providers associated with one of the other health plans were assigned to that plan.

These changes do not impact Medicare Dually Eligible members.

Example: If a member was assigned to a Legacy primary care physician under a CareOregon contract in 2019, they are still assigned to Legacy. If a member was assigned to Virginia Garcia through Providence Health Assurance in 2019, that member is now assigned to Virginia Garcia through CareOregon. If members were not engaged with a primary care provider, they were assigned to one of the plans based on the same algorithm used in 2019.

Changing Plan Assignments

If a member wants to switch their physical or dental health plans, they can do so by calling Health Share Customer Service. Members can also request a change by filling out a Plan Change Request Form. The member’s current health plan can help with this process.

Contact Health Share Customer Service at 503-416-8090, or toll free at 888-519-3845 (TTY/TDD 711) or at info@healthshareoregon.org.

Medical Plan Change Request Form

Dental Plan Change Request Form

Plan Partner Customer Service Contacts

Plans & Primary Care Access

Plan
Primary Care
Legacy Health-PacificSource
Legacy Medical Group
Kaiser Permanente
Kaiser Permanente
Providence Health Assurance
Providence Medical Group (approx. half of Children’s Health Alliance members will be assigned to Providence)
OHSU Health
OHSU, Adventist, Tuality and Tuality’s provider network (some members will be assigned to Virginia Garcia and Hillsboro Pediatrics through the OHSU Health network)
CareOregon
Any provider group that is currently in CareOregon’s network, including community-based, FQHCs and other provider groups such as Children’s Health Alliance. It will exclude the PCPs now on the OHSU Health, Legacy Health PacificSource, Kaiser Permanente, and Providence Medical Group networks. CareOregon’s hospital and specialty network remains unchanged.

Mental Health & Substance Use Care

Benefits for mental health and substance use care are still the same. As of January 1, 2020, CareOregon now manages behavioral health provider contracts. Health Share’s network of mental health providers is the same and members can keep their same mental health and substance use providers.

To find the 2020 Metro Area Behavioral Health Provider Manual, Utilization Management Procedure Handbook and all other Behavioral Health forms and authorizations – visit careoregon.org/bhproviders.

Dental Health

Dental health benefits and plan options are the same for 2020. Starting January 1, 2020, CareOregon now manages the dental health plan contracts on behalf of Health Share.

NOTE: Members engaged with dental care in 2019 stayed with their same dental plan and provider. If a member was not engaged with dental care in 2019 it’s possible they were assigned to a different dental plan based on their physical health plan assignment. Members can request to change their dental health plan by calling Health Share Customer Service or by filling out a Plan Change Request form with their dental plan.

Ride to Care | Non-Emergent Medical Transportation

Administration of Ride to Care, Health Share’s non-emergent medical transportation vendor, is transitioning to CareOregon by March 2020. The goal is to improve service delivery to members and providers.

Ride to Care will keep the same contact information as today, but administration and delegated responsibilities is delegated to CareOregon. Members can still request rides by contacting Ride to Care at 503-416-3955 (toll-free 855-321-4899) or online at ridetocare.com.

Medicare

These changes do NOT affect Medicare or dual eligible members. For their Medicare coverage, all duals will continue to be assigned to their current primary care provider and health plan regardless of the changes described above for OHP members.  For their OHP secondary coverage, we will align members’ OHP provider assignment with their Medicare primary care provider.