What is covered?
Most medical, dental, optical, mental health, chemical dependence, prescriptions and durable medical equipment services. Some services have limited funding, some require pre-authorization and some have patient cost sharing. Please contact Shasta Administrative Services for full benefits.
Who is Eligible?
A. The eligibility requirements for the Confederated Tribes of Grand Ronde membership are as follows. 1. You must be an enrolled member of the Confederated Tribes of Grand Ronde
B. Spouses of enrolled Tribal members are eligible if:
- Both member and spouse are age 55 or older
- Member and spouse have been married for at least 1 year
- Member and spouse reside in the same household
- Members that are incarcerated are not eligible for health coverage
Questions regarding eligibility should be directed to the Tribal Member Health Care Specialist at (503) 879-2487 or (800) 775-0095.
Program Registration and Effective Date
The Skookum Health Assistance Program (SHAP) is a voluntary program and you may enroll at any time by filling out a registration form. The SHAP staff provides you with information about your coverage and a registration form prior to the date you become eligible for coverage. Carefully review the material, complete the registration form, sign (by the member or the parent/guardian), date it, and return it to the SHAP office. Coverage will be decided after receiving the original registration form, signed and dated. The effective date for newborns may vary. Please contact the SHAP staff for more information
If you are currently enrolled or become eligible for Medicare or any other coverage, please notify the SHAP office immediately. Please send a copy of your card or provide your new coverage information to the SHAP office or Shasta Administrative Services.
If you have a change of address, it is important to contact the SHAP office, so your services are not interrupted.
Termination of Coverage
You are no longer eligible for coverage effective the date of the event in which any one of the following events occurs:
1. Your status as an eligible Tribal member changes.
2. You are incarcerated; once released eligibility may be reinstated with the completion of a new registration form.
3. For a non-member spouse, the non-member spouse becomes divorced or legally separated from a Tribal member.
4. For a non-member spouse, monthly payments received 14 days after the 25th of the month will result in termination of coverage for the following month.
5. For a non-member spouse, if the Tribal Member walks on, termination of coverage will end if non-member spouse re-marries.
6. You defraud or attempt to defraud the program.
7. If the program terminates, your coverage terminates the date of the event. If you are hospitalized when any of the above events occurs, coverage will continue until you are discharged.
Eligibility for Alternate Resources
This program is a Payor of Last Resort. If you are eligible for medical benefits under a group health plan, private insurance plan, Medicaid, Medicare, Veterans Administration, Vocational Rehabilitations, Crippled Children’s, homeowners, automobile PIP insurance, or other Federal or State program, you must use these alternate resources first. The Skookum Health Assistance Program is a secondary resource; it is not insurance. It will pay only the eligible medical services that are not covered by any other alternate resources. Enrollment in any and all alternate resources which are available at no cost to you is mandatory. Members who have questions about the coordination of coverage with alternate resources should contact the Skookum Health Assistance Program staff (SHAP) at (800) 775-0095.