Member Resources

On this page, you’ll find important information about your plan and benefits. Click on a topic below to learn more.

Member Handbook

The Jackson Care Connect Member Handbook is available in the following languages:

If you would prefer a printed copy of the handbook, call Customer Service at 541-500-0567 or toll-free at 855-722-8208 (TTY 711). There’s no charge, and you’ll receive a copy within five business days. You may also receive a copy in large print or in languages other than English..

Easy Guide

The Jackson Care Connect Easy Guide is available in the following languages:

If you would prefer a printed copy of the handbook, call Customer Service at 541-500-0567 or toll-free at 855-722-8208 (TTY 711). There’s no charge, and you’ll receive a copy within five business days. You may also receive a copy in large print or in languages other than English.

Oregon Health Plan Handbook

The OHP Handbook is available in the following languages.

Call the Oregon Health Authority (OHA) at 800-699-9075 to have a copy of the OHP Handbook mailed to you.

Your Member ID card

When you become a Jackson Care Connect member, we’ll mail you a Member ID card within 30 days. Your Member ID card lists your PCP. It also lists important contact information. The card looks like this:

Take your Jackson Care Connect Member ID card to all your physical, dental and mental health care appointments and to the pharmacy when you fill a prescription.

Reasons to take your card with you:

  • It’s easier to check in for appointments.
  • It’s easier to get medicine at a pharmacy.
  • Your provider will know whom to bill.
  • Providers use information on Member ID cards to make sure you have benefits with us.

If you or a family member changes PCPs, we’ll automatically send you a new Member ID card. If you lose your card, call Customer Service and we’ll send you a new one.

Are my prescriptions covered? View the drug list.

Click here to read an update about Bi-Mart pharmacy closures.

Jackson Care Connect pays for many prescription drugs. The ones we cover are on a drug list called a “formulary.” When your provider prescribes a medicine, ask if it’s on the covered drug list. The list is a directory of medications approved for Jackson Care Connect members. It explains if there are special rules about the drug. The list is updated often, so if we remove or change a medication that you take, you’ll be notified in advance. To download and view the drug list, click the link below.


Search for a drug in one of the following ways:

  1. Find the drug listed in the Formulary/PDF index.
  2. In the PDF file, enter the drug name into the search box located in the menu.
  3. Call Customer Service for help finding a drug.

If you want us to send you a printed copy of the formulary, contact Customer Service. There is no charge for this service, and you’ll receive it within five business days.

If you urgently need a drug that’s not on our formulary, call Customer Service. You, your provider or your pharmacist can ask for an emergency 72-hour (maximum) supply. To fill a prescription, go to any pharmacy in our network. You’ll have lots of choices. Our network includes most large pharmacy chains and many independent drug stores.

 

Other Prescription Drug Resources

OptumRx is your one-stop pharmacy benefits resource:

  • Search for network pharmacies.
  • View your prescription history.
  • Look up prior authorization status and more!

Create an account and get the information you need to best manage your health.

Go to OptumRx

 

Language interpreter services

If you need an interpreter for visits or phone calls to your (or your child’s) provider’s office, you are legally entitled to this service free of charge. When you join Jackson Care Connect, you may receive a Preferred Language card. The card informs your provider’s office of your spoken language and will show the language you selected on your Medicaid application. Please show this to your provider to receive interpretation.

For phone interpretation, call Customer Service when you are at the doctor, dentist or pharmacist, or while you are making an appointment.

Please call Customer Service if you have any problems getting an interpreter.

Member rights and responsibilities

As an OHP member, you will be:

  • Treated with dignity, respect and privacy.
  • Free to choose your primary care provider (PCP).
  • Urged to tell your PCP about all your health concerns.
  • Able to have a friend or helper come to your appointments, and an interpreter if you want one.
  • Told about all of your OHP-covered and non-covered treatment options.
  • Allowed to help make decisions about your health care, including refusing treatment, without being kept away from other people or forced to do something you don’t want to do.
  • Given a referral or second opinion, if you need it.
  • Given care when you need it. 24 hours a day, seven days a week.
  • Free to get mental health and family planning services without a referral.
  • Free to get help with addiction to tobacco products, alcohol and drugs without a referral.
  • Given handbooks and letters you can understand.
  • Able to see and get a copy of your health records.
  • Able to limit who can see your health records.
  • Sent a Notice of Action letter if you are denied a service or there is a change in service level.
  • Given information and help to appeal denials and ask for a hearing.
  • Free from any form of restraint or seclusion (isolation) that is not medically necessary or is used by staff to bully or punish you. Staff may not restrain or isolate you for the staff’s convenience or retaliation against you. You have the right to report violations to Jackson Care Connect and/or the Oregon Health Plan.
  • Allowed to make complaints and get a response without a bad reaction from your plan or provider.
  • Free to ask the Oregon Health Authority Ombudsperson for help with problems. You can reach them at 503-947-2346 or toll-free 877-642-0450 (TTY 711).

 

As an OHP member, you agree to:

  • Find a doctor or other provider you can work with and tell them about your health.
  • Treat providers and their staff with the same respect you want.
  • Bring your Member ID card to appointments, tell the receptionist that you have OHP and any other health insurance, and let them know if you were hurt in an accident.
  • Be on time for appointments.
  • Call your provider as soon as possible if you can’t make it to an appointment.
  • Have yearly check-ups, wellness visits and other services to prevent illness and keep you healthy.
  • Follow your providers’ and pharmacists’ directions or ask for another choice.
  • Be honest with your providers to get the best service possible.
  • Call OHP Customer Service when you move, are pregnant or are no longer pregnant.

About the Oregon Health Plan

The Oregon Health Authority (OHA) sends you a coverage letter that shows your:

  • Benefit package
  • Coordinated care plan name

This letter gives information for everyone in your household who has an Oregon Health Plan (OHP) ID card. You do not need to take this letter to your health care appointments or pharmacies. OHA will send you a new coverage letter if you ask for one or if your coverage changes.

OHA sends you one OHP ID card that has your name, Member ID number and the date the card was issued. All eligible members in your household receive their own OHP ID cards.

Keep your OHP ID card in a safe place. OHA only sends a new card if you change your name or ask for a new card. If there are any issues with your OHP ID card, call OHP Customer Service right away at 800-699-9075 (TTY 711).

There are three ways to contact OHP for questions or to make updates to your current information:

1. By telephone (toll-free): 800-699-9075

Members can call OHP to do any of the following:

  • Change your address, phone number, family status, CCO or other information
  • Replace a lost OHP Card
  • Check the status of your application
  • See if you or your children are still covered by OHP
  • Change plans
  • Solve a problem or make a complaint
  • Get an OHP Handbook

2. By email: oregonhealthplan.changes@state.or.us Your email must include your full name, date of birth, Member ID number and phone number.

Existing members can email OHP to change your address, phone number, family status, CCO or other information. Note: The email address is for changes only.  

3. Online: Most OHP members can report changes online at ONE.Oregon.gov. The online site supports the following browsers. (If you don't know your browser version, click your browser's Help menu, then click About.)

  • Windows (PC): Internet Explorer 11, Internet Explorer 10, Internet Explorer 9, Internet Explorer 8, Firefox 39.0 and 43.0 and Chrome 43.0 and 44.0.
  • Macintosh: Firefox 39.0 and 43.0 and Chrome 43.0 and 44.0. Safari is not supported.
  • Smartphone browsers are not supported.

Need help?


Renewing OHP coverage

You must renew every 12 months to keep your Oregon Health Plan (OHP) coverage. OHP sends you a letter about how to keep your membership. It will include a form for you to fill out and return. You can also create an account at one.oregon.gov to renew or update your information.

We also will contact you near your renewal date. We’ll send you a list of places and phone numbers where you can get help to renew.

OHP information for currently enrolled members:

OHP information for potential members:

 

OHP enrollment assisters

You must apply every 12 months to keep your Oregon Health Plan (OHP) coverage. OHP sends you a letter about how to keep your membership. It will include a form for you to fill out and return. You can also create an account at ONE.Oregon.gov to apply or update your information.

We also will contact you near your renewal date. We’ll send you a list of places and phone numbers where you can get help to apply.

OHP assistors are available at these locations. Due to concerns about the spread of COVID-19, assisters are available by phone only. Please call one of the offices below to make a phone appointment.

Rogue Community Health:
English and Spanish
Phone: 541-414-0517 

La Clinica:
English and Spanish
Phone: 541-414-1189
Email: benefitenrollment@laclinicahealth.org

Access:
English and Spanish
Phone: 541-732-7036 

Providence:
English only
Phone: 503-215-4300 

Unete:
English and Spanish
Phone: 541-778-4623 

Asante:
Ashland Community Hospital: 541-201-4121

Complaints and Appeals

How to make a complaint or grievance

If you are unhappy with Jackson Care Connect, your health care services or your provider, you can complain or file a grievance at any time, for anything other than a denial of service. Your provider or authorized representative may also file a grievance on your behalf with your written consent. 

We will try to make things better. Just call Customer Service at 855-722-8208, TTY 711 or send us a letter to the address on page 55 of your member handbook, available on this page. 

Jackson Care Connect will work to resolve your complaint or grievance as quickly as your health condition requires. If we need more than five business days, we will send you a letter to let you know why. You will receive a final answer within 30 calendar days. We will not tell anyone about your complaint unless you ask us to.
 
You can also file a complaint with:
Oregon Health Authority (OHA)
Please call the OHP Client Services unit (CSU) toll free at 800-273-0557 or OHA’s Ombudsman at 503-947-2346 or toll free at 877-642-0450.

Appeals and hearings

If we deny, stop or reduce a medical service your provider has ordered, we will mail you a Notice of Action letter explaining why we made that decision. You have a right to ask to change it through an appeal and a state fair hearing. You must ask for an appeal no more than 60 days from the date on the Notice of Action letter. You can ask for a denial notice that shows a service is not covered if:

  • You did not receive a written notice of denial, or;
  • Your provider tells you that you will need to pay for a service that is not covered.

For full instructions on the appeals process, please see page 54 of your member handbook, available at the top of this page.
 

Provider Appeals

Your provider has a right to appeal for you when their physician’s orders are denied by a plan. You must agree to this in writing. Instructions for this process can be found on page 55 of your member handbook.

 

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