Frequently asked questions

  • Who can apply for coverage?
    Oregon residents

    To purchase one of our plans, you must life in the Oregon service area. Service area means the geographic area within Oregon which the policyholder, the spouse, or the child-only member(s) must physically reside to be eligible for coverage. The Oregon service area includes all ZIP codes in Oregon.


    Providence individual and family plans may also be purchased through the Federal Health Insurance Marketplace. Federal assistance may be available to help pay your premiums. To determine if you qualify, visit HealthCare.gov or contact the Federal Health Insurance Marketplace at 1-800-318-2596.


    To be eligible to enroll in the Providence Progressive Dental plan, you must enroll in a Providence individual and family medical plan. The Providence Progressive Dental plan is not available to applicants enrolling through the Federal Health Insurance Marketplace.


    Providence is non-duplication with Medicare on individual and family plans. Someone who is entitled to Medicare Part A or enrolled in Part B is not eligible to enroll in a Providence Health Plan individual and family plan.



    Washington residents

    To purchase one of your plans, you must live in the Washington service area. Service area means the geographic area within Washington which the policyholder, the spouse, or the child-only member(s) must physically reside to be eligible for coverage. The Washington service area include Benton, Clark, Franklin, Spokane, Thurston and Walla Walla counties.


    Providence is non-duplication with Medicare on individual and family plans. Someone who is entitled to Medicare Part A or enrolled in Part B is not eligible to enroll in a Providence Health Plan individual and family plan.

  • Can my employer or another third party pay my premium?

    Providence Health Plan does not accept premium payments from employers or any third parties for individual health coverage, except as permitted by state or federal regulation.

  • Do I have coverage while I'm at work?

    Our plans provide coverage 24 hours a day, 7 days a week. You will be covered while you are working, unless you are required to have coverage through the Workers' Compensation Act or similar law.

  • What about preexisting conditions?

    All plans are guaranteed issue under the Affordable Care Act, meaning that insurance companies no longer can deny coverage for people with preexisting conditions for plans with effective dates starting January 1, 2014 and afterward.

  • Will my premium change?
    Oregon residents

    Premiums are subject to an annual rate change. Your premium may change as you move to a new age category or county within Oregon.



    Washington residents

    Premiums are subject to an annual rate change. Your premium may be adjusted to reflect changes in your family composition, a relocation to a new service area county within Washington, or other plan changes that are requested during a Special Enrollment Period.

  • Will I be charged more if I use a producer (aka insurance agent)?

    No, your monthly premium is the same, whether or not you use a producer. The producers we appoint to represent Providence Health Plan have thorough knowledge of the coverage we offer.

  • How do I pay for my coverage?

    With Providence Health Plan’s online application, you can quickly and conveniently pay your initial premium payment at the time you apply for coverage. In cases where a paper application must be submitted, such as for families with more than three children or child-only plans, an offer of coverage letter will be mailed with payment details once the application has been approved.


    After you have paid your initial premium payment, Providence Health Plan encourages you to visit our Electronic Payment System to set up an automatic recurring payment through the Providence Health Plan Electronic Payment System. Monthly premium payments can also be paid online via our Electronic Payment System, in your myProvidence member portal, or by mail.


    Your monthly premium payment is due on the first of each month.

  • Do I need to purchase pediatric dental coverage?
    Oregon residents

    Under the health care reform law (the Affordable Care Act or ACA), pediatric dental coverage is required as an essential health benefit. The Connect plans include pediatric dental coverage. You will be required to purchase pediatric dental coverage separately if you purchase a Providence Oregon Standard or a Providence HSA Qualified plan directly from Providence or from a producer. This requirement applies whether you obtain coverage for children and/or adults. An exception is made for plans purchased through the Federal Health Insurance Marketplace as these plans do not require pediatric dental coverage.



    Washington residents

    Washington state law requires children under the age of 19 who are enrolled in a health plan to also be enrolled in a pediatric dental plan. You must purchase a separate pediatric dental policy if you choose a Providence Columbia plan. If you buy a Providence health plan outside of the Washington Healthplanfinder, you must provide written proof to Providence that you also bought a pediatric stand-alone dental insurance plan.

  • How will the government know I've signed up for pediatric dental coverage?

    The requirement to purchase pediatric dental coverage was enacted as part of federal health care reform. To date, there is no historical auditing information to rely upon in answering this question. Both the state and federal government have the authority to conduct audits on this subject and could do so at any time.

  • When does my coverage begin?

    If you are applying for coverage during open enrollment between Nov. 1, 2021 – Dec. 15, 2021, your coverage will begin on January 1, 2022. If you are applying during open enrollment between Dec. 16, 2021 – Jan. 15, 2022, your coverage will begin on February 1, 2022, conditioned on Providence Health Plan’s timely receipt of your complete application and initial premium payment.


    Outside of Open Enrollment, visit ProvidenceHealthPlan.com/qe to see if you or a family dependent may be eligible to apply for coverage during a Special Enrollment Period.

  • How does Providence Health Plan protect my privacy?

    We respect the privacy of our members and applicants, and have policies regarding your protected health information.


    Once enrolled for coverage, your agreement enables us to share your health information to administer your plan benefits and pay medical claims.


    We also may share information with your doctors or hospitals to provide medical care to you.
    Please refer to our Privacy Notices and Policies page for uses and disclosures of protected health information, including those required by law.

  • How do I make changes to an existing policy?

    Please refer to our Individual and Family forms page to make changes to your plan, add or remove dependents, or terminate your coverage. Please note that outside of open enrollment some plan changes require a qualifying event. Once submitted, your online form will automatically be sent for processing.


    Additionally, you can submit your change requests through your myProvidence account.

    Send your completed change form securely to Premium Billing, Eligibility & Enrollment by following these steps:


    1. Navigate to 'Contact Us'
    2. Expand the 'Change my name or address' accordion
    3. Select 'Send us a secure message'
    4. Attach your complete plan change form
    5. Press 'Send'

    If you have an active policy through the Federal Health Insurance Marketplace, please visit HealthCare.gov to update your application or contact the Marketplace at 1-800-318-2596.

  • How do I request a Certificate of Creditable Coverage?

    The federal Health Insurance Portability and Accountability Act (HIPAA) requires health insurers to send a Certificate of Creditable Coverage (CCC) when members terminate their coverage.


    To request proof of creditable coverage, please log in to your myProvidence account and contact us by sending a secure message or contact our Membership Accounting department at 503-574-5791 or 1-888-816-1300 (TTY: 711).

  • How do I request a copy of my 1095?

    If you have coverage through the Federal Health Insurance Marketplace in Oregon, you will receive a 1095-A. You can also log in to your account at HealthCare.gov to find your 1090-A under Tax Forms.


    If you have coverage directly through Providence Health Plan, you will receive a 1095-B in the mail. If you need to request another copy, please log in to your myProvidence account and contact us by sending a secure message, or contact our Membership Accounting Department by calling 503-574-5791 or 1-888-816-1300 (TTY: 711).

  • How can I get proof of my premium payments for tax reimbursement purposes?

    Payment receipts can be accessed through your online billpay account, and can also be requested from your bank. If neither of those options work for you, please log in to your myProvidence account and contact us by sending a secure message, or contact our Membership Accounting department at 503-574-5791 or 1-888-816-1300 (TTY: 711).

  • I have paid my monthly premium, why did I receive a Notice of Delinquency?

    Premiums are always due on the first of the month, but Providence Health Plan allows a grace period to ease our member's way. If your payment is not received by the 10th of any given month, you will receive a Notice of Delinquency. Please refer to our Claims and Billing Processes page for more information about premium payment due date and grace periods.

  • How can I sign up for paperless billing?

    Although we hope to offer it in the future, Providence Health Plan does not offer paperless billing at this time.

  • Are Oregon Connect plans offered in Yamhill county?

    Oregon Connect plans are available to members who reside in the city of Newberg (zip code 97132).

  • How do I update my home address and county?

    If you have an active policy directly through Providence, please complete the online form found on our Individual and Family forms page. Once submitted, your online form will automatically be sent for processing. You may also submit a change of address request through your myProvidence account. Please be sure to include your new address, your previous address, and date of move within the request.


    If you have an active policy through the Federal Health Insurance Marketplace , please visit HealthCare.gov to update your application or contact the Marketplace at 1-800-318-2596.

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