Benefits are provided for gender affirming services for the treatment of the primary diagnosis of gender dysphoria. Covered services include, but are not limited to, mental health, prescription drug, and medically necessary surgical procedures. Coverage is provided at the applicable benefit level for the type of covered services received, as shown in your benefit summary. Treatment of gender dysphoria must be received from licensed providers and facilities and is subject to your provider, inpatient or outpatient network facility benefit.

Please see your benefit summary for more information about coverage. You can also call us 503-574-7500 or 800-878-4445 (TTY: 711), Monday through Friday, 8 a.m. to 5 p.m. (Pacific Time)

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

Your formulary includes many preventive care medications, as well as those that help you get better if you’re already sick.

Providence Health Plan encourages you to get the COVID-19 vaccine wherever there is availability. All COVID-19 vaccines approved or authorized for use by the U.S. Food and Drug Administration (FDA) are highly effective at preventing hospitalizations and death from COVID-19.

Read our COVID-19 notice for answers to frequently asked questions about the COVID-19 vaccine.

For more information, visit the Providence COVID-19 info hub.

Providence Behavioral Health Network

We're here for you when you need us.

At Providence, we value whole self-care for all members. That’s why we’ve enhanced our focus on behavioral health and substance abuse services. To help simplify the way you get whole self-care, we’ve established a direct access line to a dedicated behavioral health and substance abuse service support team that includes a crisis-trained staff. This team is available 24/7 for members.

Find an in-network behavioral health provider in a few steps:

• Log in to your myProvidence account
• Click the provider directory to find a provider in your area
• Contact the provider and make an appointment – no referral required

Talkspace

As a Providence Health Plan member, you also have access to virtual therapy through Talkspace. Get personal behavioral health and emotional wellness support through online counseling and therapy from one of the thousands of licensed and verified counselors in the Talkspace clinical network.

Program features:

• Connect with a counselor on a private, secure, and HIPAA-compliant digital platform
• Choose how and when you communicate with a counselor through text, voice, or video messages that can be sent anytime, anywhere
• Access self-guided exercises, such as journaling and meditation
• Speak to a Talkspace counselor in your preferred language with a network that supports 32 different languages

Providence Behavioral Health Concierge

Behavioral health support is only a call or click away

Providence Health Plan members and dependents in Oregon, Washington, Idaho, Montana, California, and Texas can access virtual and confidential same-day or next-day appointments at no cost, with Providence licensed behavioral health professionals. This evidence-based and solution-focused service is a convenient way to seek help from a mental health provider.

The Behavioral Health Concierge offers:

• Help with life stressors, mental health and addiction issues
• Support for you and your family
• Counseling, care guidance and self-help tools
• All appointments are virtual
• Translation services available upon request
• HSA plans are subject to deductible first and then covered in full (for more information, call customer service*)

Learn to Live

It’s important to treat emotional, psychological, and social well-being with the same care as physical health concerns. Mental health conditions can significantly impact day-to-day life, including overall happiness and productivity at work. To provide comprehensive whole-health support, we offer a virtual self-directed program called Learn to Live based on the principles of Cognitive Behavioral Therapy (CBT). It’s confidential, available in English and Spanish, and can be accessible from anywhere.

Learn more about your Behavioral Health Resources.

Benefits for fertility services are provided through Unified Life and covered as described as below.

Covered services include the following:

• Diagnostic testing and associated office visits to determine the cause of infertility. This includes the physical examination, related laboratory testing, instruction, and medical/surgical procedures when performed for the sole purpose of diagnosing and treating an infertile state. Diagnostic services for the treatment of infertility include, but are not limited to, hysterosalpingogram, laparoscopy and pelvic ultrasound.
• Artificial insemination, limited to a lifetime maximum of six (6) cycles and sperm wash;
• Cost of acquiring semen only if the donor is the legal spouse of the recipient;
• Infertility-related prescription drugs or injectables administered by an in-network provider;
• Covered infertility-related supplies;
• In vitro fertilization services, egg freezing and storage, and including Gamete Intrafallopian Transfer (GIFT) and Zygote Intrafallopian Transplant (ZIFT);
• Charges for donor semen from donor banks or other providers; and
• Charges for harvesting and storage of semen other than for immediate use.

For more information, call us at 503-574-7500 or 800-878-4445 (TTY: 711), Monday through Friday, 8 a.m. to 5 p.m. (Pacific Time)

The Provider Directory has recently been updated to include more search options such as personal and professional attributes to help you select a provider. This includes whether the provider is a member of the LGBTQ+ community.

Check out the updated Provider Directory today. For the best experience and most accurate options, have your member ID card with you.