Online enrollment is no longer available for 2021 plans
If you have experienced a qualifying event and would like to enroll in a 2021 plan for coverage during the 2021 Special Enrollment Period, please download and complete the enrollment form below. Once complete, please return the form to Providence Health Plan. You may mail it to P.O. Box 4649 Portland, Oregon 97028-4649 or fax it to 503-574-8131.
- 2021 Fillable application for Oregon individual and family insurance (PDF)
- 2021 Fillable application for Washington individual and family insurance (PDF)