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Benefits 101

Your benefits are designed to support your well-being. As a Providence Health Plan member you can count on comprehensive benefits and provider choice.

Explore the following topics to learn about your plan’s benefits:

  • Plan highlights
    • Care available from in-network and out-of-network providers. Your out-of-pocket costs are typically lower when you receive care from in-network providers.
    • Access to nearly 1 million in-network providers nationwide.
    • Care from in-network providers without referrals, including specialists.
    • No requirement to designate a primary care provider; however, Providence encourages and promotes the provider and member relationship to enhance your care experience.
    • In-network providers work with Providence Health Plan to prior authorize treatment for certain services, such as hospitalization, high-tech diagnostic imaging and surgery. If care requires prior authorization and you want to receive services from out-of-network providers, you will need to ask your provider to initiate prior authorization.
    • Prescription drug benefits with access to more than 34,500 pharmacies. 
    • Alternative care benefits for chiropractic manipulation and acupuncture services when care is received from a licensed qualified practitioner and determined as medically necessary.

    Refer to your member materials (available in myProvidence) for complete information about your plan's benefits. 

  • You’re covered in the great northwest and beyond

    One million providers – that’s a lot. We take great care to contract with the highest quality providers that offer compassion as they practice evidence-based medicine.



    Find a provider near you

    Because Providence Health Plan contracts with nearly 1 million providers, chances are that you’ll find exactly the provider you’re looking for. Search in the online provider directory. To optimize your search:


    • Access the online provider directory.
    • Enter your member ID number or select “Coverage through my employer,” then the Providence Signature Network in the drop down menus to search for providers.
    • If you select a ZIP code outside of Oregon and southwest Washington, you will receive search results near that ZIP code.
    • If you need help locating a provider, please contact customer service at 800-878-4445.



    Tips for receiving care outside the northwest
    • Bring your member ID card with you to each appointment.
    • Tell your provider you are a Providence Health Plan member receiving care through the First Health network. The First Health logo appears on the back of your member identification card.



    Seeing an out-of-network provider?

    Your out-of-pocket costs for care received from out-of-network providers will be higher, except for emergency care. You may need to submit a claim form for reimbursement. When the cost of out-of-network services exceeds usual, customary and reasonable charges, you are responsible for paying the provider any difference.



    Health education reimbursement

    Providence Health Plan members have access to a health education reimbursement. To qualify the following must apply:


    • Take a class offered through Providence-contracted facilities. If you are looking for a facility outside of Oregon and southwest Washington, find contact information for a Providence-contracted hospital by visiting the online provider directory. You can also call the Providence Resource Line at 800-562-8964 with any questions.
    • Pay for the class in full. Then, complete the Providence Health Plan Health Education Reimbursement form (PDF) and follow instructions on the form to receive reimbursement.
    • Enjoy your class!


    Contact us

    If you have any questions regarding classes and reimbursements, please contact the Providence Resource Line at 503-574-6595 or 800-562-8964, Monday through Friday, 8 a.m. to 6:30 p.m.

  • Health and wellness resources
    myProvidence

    myProvidence is your secure total health management website. Register for your account and log in any time to access plan information including:


    • Plan materials, including your benefit summary and member handbook
    • Claims history
    • Explanations of benefits
    • Amounts met toward your deductible and out-of-pocket maximum
    • Treatment cost estimator
    • Prescription drug cost estimator
    • Member ID card replacement request


    Additionally, myProvidence includes access to Wellness Central, a health and well-being hub that offers:


    • A personal and customized dashboard that's based on the your unique health needs, risks and activity
    • Nutrition and activity resources
    • Health trackers
    • Online wellness workshops built around a variety of health and wellness topics
    • Searchable library of health topics


    Health Coaching

    Whether you’d like to shed a few pounds, quit tobacco or just feel better every day – a Providence health coach can help. A health coach can help remove barriers, support your efforts, motivate you when you need a nudge and be a resource on your journey to a healthier, happier you. And, there’s no cost to you. The health coaching program offers:



    • One-on-one sessions with a Providence health coach
    • Personalized action plans
    • Programs designed to empower you to lose weight, improve your diet, manage stress, exercise or stop using tobacco
    • Guidance to help you identify and take action towards healthier lifestyle and behavior choices


    For more information or to get started, complete a health coach inquiry form, or call 888-819-8999 or 503-574-6000.




    Free or discounted health resources
    • 24/7 nursing support – A Providence registered nurse is just a phone call away through the free ProvRN medical advice line. Call 800-700-0481 and have your member ID number handy.
    • Health incentives and savings – discounts for health clubs, retail stores, tours and museums, performing arts, massage, spa services and other healthy activities.
    • Fitness, health and nutrition classes – discounts on small-group classes that focus on everything from weight loss to yoga to childbirth. If you live outside of the Portland metropolitan area, you can take classes and receive reimbursement up to a specified amount.


    More member perks

    Explore all the perks your Providence Health Plan has to offer to maximize your membership on your journey to True Health.


    Learn more
  • Tobacco-cessation resources
    If you're tired of being captive to nicotine, we can help you break free.

    Quitting tobacco of any sort takes a commitment. And keeping your commitment can be challenging if you're trying to do it on your own. We suggest you get support. Research shows that counseling or support in combination with medication (nicotine replacement therapy/prescription medication) offers the best shot at breaking free from tobacco.

    Whether you've smoked for six months or 16 years, we've got someone you can partner with to help you be successful. It's up to you to find what works for you – telephone counseling or coaching, nicotine replacement therapy, a class. Take stock of your temperament – and then take the next step. All of these resources are available at no cost to you as a Providence Health Plan member:


    • Quit For Life. A free telephone-based tobacco cessation program that provides extensive support to help you succeed at quitting – with a 91 percent satisfaction rate among participants. Counselors are on hand 24/7 to support you. To get started, call 866-QUIT-4LIFE (866-784-8454).
    • Tobacco cessation classes. To find a class or provider near you, view our most recent list of tobacco cessation providers. If you live outside of the area, you are eligible for a class reimbursement.
    • Prescription drugs (Nicotine replacement therapy). Do all you can do to break the habit. Combine telephone and class support with nicotine replacement therapy offering you a greater shot at breaking free from tobacco. Counseling, classes and medication are covered in full from an approved in-network provider. Limitations may apply. 
    • Health coaching. Our health coaches are here to support your journey to a healthier, happier life. For more information or to get started, complete a health coach inquiry form, or call 888-819-8999 or 503-574-6000.

    Congratulations on taking this important – and difficult – step. Get ready to feel good.

  • Pharmacy resources
    Formularies

    Providence Health Plan is pleased to provide plan members with a comprehensive prescription drug formulary designed to promote safe, effective and affordable drug therapy.

    There are a number of ways to see if your prescription is included in the formulary. You can search alphabetically or by entering a portion of the drug name.


    Search your plan’s formulary:


    Find an in-network pharmacy


    Tips to help you save when you need a prescription
    • Choose generics when possible.
    • Use an in-network retail pharmacy. Search the online provider directory to find an in-network pharmacy near you.
    • Fill maintenance medications (medications taken on a regular, recurring basis for a chronic or long-term health condition) at preferred retail or mail-order pharmacy. You can purchase up to a 90-day supply.
    • Have certain medications pre-authorized before they are filled.


    Retail pharmacy

    A retail pharmacy can provide up to a one-month supply of prescription medications. Search the provider directory for a pharmacy near you.



    Preferred retail pharmacy

    A retail pharmacy can provide up to a three-month supply of prescription medications. Search the provider directory for a pharmacy near you.



    Mail-order pharmacies

    A mail-order pharmacy can provide up to a 90-day supply of maintenance medications and will deliver your prescription directly to your home.


    Postal Prescription Services

    Phone: 

    503-797-2100 or 800-552-6694
    Monday – Friday, 6 a.m. to 6 p.m. PT; Saturday, 9 a.m. to 2 p.m. PT


    Mailing address:

    P.O. Box 2718, Portland, OR 97208

    Automated refill line available 24/7, 365 days a year: 800-552-6694


    Costco Home Delivery

    Phone: 

    800-607-6861

    Monday – Friday, 5 a.m. to 7 p.m. PT; Saturday, 9:30 a.m. to 2 p.m. PT


    Fax:

    800-633-0334

    (Pharmacy is available 24/7 to refill prescriptions, order new prescriptions and check prescription status.)


    Mailing address:

    802 134th St. SW, Ste 140, Everett, WA 98204-7314


    Email:
    webpharmacy@costco.com

    All covered members and their qualified dependents have access to these mail order pharmacies. Your network provisions may require the use of just one of these mail order pharmacies for coverage. Please call the Providence Health Plan Pharmacy Department at 877-216-3644 if you have questions.



    Specialty pharmacy

    Specialty drugs are prescriptions that require special delivery, handling, administration and monitoring by a pharmacist. These drugs are listed on the Providence Health Plan formulary with a status of "specialty."


    • Specialty drugs are available through Credena Health.
    • Some specialty drugs are denoted as Limited Access (LA) on the formulary. Credena Health may not be able to provide some of these medications since they are limited to only a few specialty pharmacies. For more information, consult your provider and pharmacy directory or call Customer Service at 877-216-3644 (TTY: 711), Monday – Friday, 8 a.m. - 6 p.m. (Pacific time).
Contact customer service

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