Lane County Retirees

2018 Medicare Proof of Enrollment
DUE February 23, 2018

QVI Risk Solutions, on behalf of Lane County, requests annual Medicare Proof of Enrollment needed to reimburse amounts due for eligible retirees in 2018.

The form/proofs needed for 2018 are:

1)   Medicare Proof of Enrollment Form for 2018 Quarterly Reimbursements

Please complete, sign and date the "2018 Proof of Enrollmentform under the Quick Links on the right side of this page. 
Please return to QVI Risk Solutions no later than February 23, 2018 to ensure your reimbursements continue without interruption.  

2)   2018 Proof of Part B Premium

Please provide a copy of your “Benefit Verification Letter.” You can request this letter from Social Security by:

If you are not yet receiving monthly Social Security benefits, please contact Medicare for your “Notice of Premium Payment Due.You can request this letter from Medicare by:

3)   2018 Proof of Medicare Advantage or Supplemental Plan (if applicable)

Please provide proof of what plan and monthly premium rate you pay in 2018.

Please call you plan provider directly for your Medicare Advantage or Supplement plan to receive proof of your monthly plan cost for 2018.

If you are on a Lane County Regence BCBS Group plan or PERS plan, please write in the name of the plan only on the Proof of Enrollment Form - NO PROOF is necessary.

Once you have the form/proofs required, please mail to:

QVI Risk Solutions, Inc.
PO Box 7199
Bend, OR 97708

For further assistance, contact QVI at (800) 408-9717

County Paid Retirees

Eligibility for County paid retiree health insurance is based on three main criteria: 1) date of hire, 2) years of service, and 3) proof of retirement under PERS.

Self-Pay Retirees
State and federal laws regulate a retiree’s right to continue health insurance coverage by paying monthly premiums to Lane County, even if they are not eligible for County Paid retiree health insurance.

1095-C Form

Forms 1095-C will be furnished to individuals by March 02, 2018. If you have questions regarding your 1095-C, please contact us at 541-682-3660. You may also email us at

Premium Rate Changes
The next premium rate change will be July 1, 2018 and will run from July 1, 2018 - June 30th, 2019.

Health Savings Accounts - Optum Bank
Eligible County paid retirees receive a $1,500 lump sum contribution on or around 1/5/2018. In 2018, your annual HSA contribution may not exceed IRS limits of $3,450 for individual coverage or $6,900 for family coverage. The "catch-up" contribution for those who are age 55 or older will remain $1,000 for 2018. This amount is in addition to the IRS limits of $3,450 for individual coverage and $6,900 for family coverage. For specific tax information, please consult a tax advisor.
Note: The IRS maximum contributions are inclusive of the amount that Lane County will contribute to the HSA account for eligible County paid retirees.

HSA 1099-SA Forms
1099-SA forms will be available through Optum's consumer online portal under the Notifications Tab towards the end of January. If you have an email on file with Optum, they will send an email letting you know when it is ready to view and you can print it off. If you don't have an email on file, a letter will be sent to your mailing address advising the tax form will be online. 

Please contact Optum Consumer Services if you have questions.

Contact Information

QVI Risk Solutions, Inc.
(Billing for: Retirees, COBRA, Medicare)
(800) 408-9717

Social Security Administration
(800) 772-1213

PERS Health Insurance Program
(800) 768-7377

Regence Medicare Advantage
(888) 319-8904

Benefit Resource Center for PacificSource
(866) 468-7272

Optum Bank - Health Savings Accounts
(877) 470-1771

PacificSource Health Plans
(541) 684-5582  

Delta Dental (formerly MODA)
(877) 277-7280  

Willamette Dental Group
(800) 460-7644

Lane County Benefits & Wellness
(541) 682-3660