Carewell Benefits Eligibility

Carewell Benefits Eligibility

Carewell SEIU 503 provides training and benefits for eligible Oregon Homecare Workers (HCWs), Personal Support Workers (PSWs), and Personal Care Attendants (PCAs).

Carewell benefits may include:

✓ Dental coverage
✓ Vision and hearing benefits
✓ Employee Assistance Program (EAP) services
✓ Healthcare Cost Assistance
✓ Paid Time Off (PTO) benefits

Different benefits may have different eligibility and enrollment requirements. Becoming eligible for one Carewell benefit does not necessarily mean that every benefit begins automatically.

This page explains the general rules for gaining, maintaining, losing, and regaining eligibility. Carewell SEIU 503 makes the final eligibility determination based on the work hours and information reported to it.

Always review your information in MyCarewell503 or contact Carewell Benefits if you have questions about your individual eligibility.

How You Initially Become Eligible

For Dental, Vision + Hearing, Employee Assistance Program, and Healthcare Cost Assistance eligibility, you generally must:

✓ Work at least 40 eligible hours per month
✓ Meet that requirement for two consecutive months
✓ Submit your time entries or payroll vouchers correctly and on time
✓ Keep your required personal information current with Carewell and the State

After you work at least 40 eligible hours in each of two consecutive months, there is generally a one-month waiting period while your hours are reported to and processed by Carewell.

Example

If you work at least 40 eligible hours in January and at least 40 eligible hours in February:

• March is generally the processing and waiting month.

• Your benefits may begin April 1 after Carewell confirms that you meet the requirements.

Carewell refers to qualifying work hours as eligible working hours or bargaining-unit hours. These generally include covered hours paid by Acumen, DHS, and/or PPL on behalf of a consumer.

Hours from covered HCW, PSW, or PCA work may be considered when Carewell reviews your eligibility. Check MyCarewell503 if your reported hours appear incomplete or incorrect.

Keep Your Information Current

Carewell must have the information it needs to confirm your identity and administer your benefits, including your:

✓ Legal name
✓ Gender
✓ Social Security number
✓ Date of birth
✓ Current mailing address

Keep this information current with both Carewell and the State or program connected to your provider work. Updating information in one system may not automatically update every other system.

Use MyCarewell503 to review or update the information Carewell has on file. Follow the provider-type instructions on Carewell’s official forms page when information must also be updated with the State.

Do not send your Social Security number or other sensitive personal information through ordinary email unless Carewell has specifically provided a secure method.

Which Benefits Begin Automatically?

Once Carewell confirms your eligibility and required information, enrollment in Dental, Vision + Hearing, and the Employee Assistance Program is generally completed automatically.

Healthcare Cost Assistance is different. It has additional health-plan and documentation requirements and must be requested according to the rules for the provider’s type of medical coverage.

Carewell Paid Time Off also follows separate earning and payment rules. It is not activated through the same 40-hour eligibility process.

Maintaining Your Eligibility

To maintain eligibility for Carewell Dental, Vision + Hearing, Employee Assistance Program, and Healthcare Cost Assistance benefits, continue submitting your time correctly and work at least 40 eligible hours per month whenever possible.

Working fewer than 40 eligible hours for one month does not, by itself, end your benefits if you work at least 40 eligible hours the following month.

If You Work Fewer Than 40 Hours for Two Months

If you work fewer than 40 eligible hours per month for two consecutive months, you may lose eligibility for these Carewell benefits.

Your benefits generally end after one additional processing month.

Example

If you work fewer than 40 eligible hours in October and fewer than 40 eligible hours again in November:

• December is generally the processing month.

• Your benefits may end January 1.

Carewell will normally send information when its records show that you may lose eligibility. Read all notices promptly and confirm that Carewell has received the correct work hours.

An approved Paid Leave Oregon absence follows a special Carewell rule. Carewell states that approved Paid Leave Oregon generally does not interrupt benefits if the provider returns to covered work after the approved leave ends.

Regaining Eligibility

If you lose eligibility, you can generally regain it by:

✓ Working at least 40 eligible hours per month for two consecutive months
✓ Submitting your time entries or payroll vouchers correctly
✓ Completing the additional one-month processing period

Example

If you work at least 40 eligible hours in January and February after losing eligibility, March is generally the processing month and benefits may begin again April 1.

If Your Benefits Are Ending or Have Ended

Read every notice from Carewell carefully. The notice should explain which benefits are affected, when coverage will end, and whether continuation options are available.

If you believe Carewell received incorrect or incomplete work-hour information:

✓ Review your reported hours in MyCarewell503
✓ Compare the reported hours with your time-entry and payroll records
✓ Contact Carewell Benefits promptly
✓ Contact the appropriate payroll or provider program if the underlying work-hour record must be corrected

Dental, Vision + Hearing, and EAP

If you lose eligibility for Dental, Vision + Hearing, and Employee Assistance Program benefits, you may be offered the option to continue eligible coverage through COBRA by paying the required premium yourself.

Review the COBRA notice for its deadlines, cost, payment instructions, and effective date. Contact Carewell if you do not understand the notice or believe it was sent incorrectly.

Healthcare Cost Assistance

If you lose Healthcare Cost Assistance, your Benefit Convenience Card may be temporarily turned off.

Continue paying any required health-insurance premiums yourself unless Carewell or your insurance plan gives you different instructions. Failure to pay the premium could cause your health-insurance coverage to end.

Do not discard your Benefit Convenience Card. If you regain eligibility, Carewell may reactivate the card.

A reduction in income may also affect eligibility for Oregon Health Plan programs, including OHP Bridge. Contact an authorized benefits or enrollment professional for help reviewing your health-coverage options.

Carewell Paid Time Off Has Different Rules

Carewell Paid Time Off (PTO) does not use the same initial 40-hours-per-month-for-two-months eligibility rule as Dental, Vision + Hearing, EAP, and Healthcare Cost Assistance.

Beginning in 2026, eligible care providers can earn:

✓ 1 hour of Carewell PTO for every 20 eligible hours worked
✓ Up to 5 hours of Carewell PTO per month
✓ Up to 60 hours of Carewell PTO per year

You must work at least 20 eligible hours during a single month to earn 1 hour of PTO for that month. Hours worked in different months cannot be combined to reach the 20-hour minimum.

If you work as more than one covered provider type, eligible HCW, PSW, and PCA hours may be combined when Carewell calculates the PTO earned during that month.

To receive a Carewell PTO payment:

✓ Carewell must have a completed Form W-9 on file for you
✓ You must have at least 8 hours of PTO available in your balance
✓ You must request the benefit through MyCarewell503 or Carewell’s approved process

Carewell PTO is taxable income. Review your available balance, reported work hours, payment method, and request status in MyCarewell503.

Carewell PTO is also separate from Paid Leave Oregon. Requesting one benefit does not automatically apply for or request the other.

Healthcare Cost Assistance Requires Additional Enrollment Steps

Healthcare Cost Assistance does not begin automatically merely because you meet Carewell’s work-hour requirement.

In addition to meeting the general Carewell eligibility rules, you must have qualifying medical coverage, such as:

✓ A Carewell-approved individual Marketplace plan
✓ Medicare coverage
✓ VA Benefits
✓ CHAMPVA
✓ TRICARE

The forms, supporting documents, eligible expenses, and available assistance depend on the type of medical coverage you have.

Providers with Marketplace coverage generally must request Healthcare Cost Assistance for each year they want to receive it and provide the required health-plan documents. Carewell may require proof such as a Marketplace Eligibility Notice and information showing the premium for the approved plan.

Medicare-connected and military-connected benefits have their own enrollment and documentation requirements.

Do not assume that your Benefit Convenience Card is active merely because you previously received it. Check MyCarewell503 or contact Carewell Benefits to confirm your current eligibility, enrollment, available balance, and required documents.

Getting Help With Carewell Eligibility or Enrollment

Contact Carewell Benefits if you:

✓ Do not know whether you are eligible
✓ Believe your reported work hours are missing or incorrect
✓ Have not received expected enrollment information or benefit cards
✓ Received a notice that your benefits may end
✓ Need help completing a benefits form
✓ Have questions about regaining eligibility
✓ Need language assistance

Carewell SEIU 503 Benefits

Phone: 1-844-503-7348
Hours: Monday–Friday, 8 a.m.–6 p.m. Pacific Time
Email: CarewellSEIU503Benefits@RISEpartnership.com

Carewell can provide assistance in your preferred language.

MHC provides general guidance but cannot determine eligibility, enroll a provider in benefits, correct reported work hours, activate a Benefit Convenience Card, or make benefit decisions.