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.


For help regarding form and submission options, please contact our Membership Accounting team at 503-574-5791 or 888-816-1300 (TTY: 711), Monday through Friday 8 a.m. to 5 p.m. (Pacific Time)

To reach our Sales department, call 503-574-5000 or 800-988-0088 (TTY: 711), Monday through Friday 8 a.m. to 5 p.m. or Saturday 9 a.m. to 2 p.m. (Pacific Time)

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