Frequently Asked Questions

Oregon residents

To purchase one of our plans, you must live or reside 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 & Family plans may also be purchased through the Health Insurance Marketplace™. Financial assistance may be available to help pay your premiums. To determine if you qualify, visit HealthCare.gov or contact the Health Insurance Marketplace™ at 800-318-2596.

To be eligible to enroll in the Individual & Family Dental plan, you must enroll in a Providence Individual & Family medical plan. The Individual & Family Dental plan is not available to applicants enrolling through the Health Insurance Marketplace™.

Providence is non-duplication with Medicare on Individual & Family plans. Someone who is entitled to Medicare Part A and/or enrolled in Part B is not eligible to enroll in a Providence Individual & Family plan.

Washington residents

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

Providence is non-duplication with Medicare on Individual & Family plans. Someone who is entitled to Medicare Part A and/or enrolled in Part B is not eligible to enroll in a Providence Individual & Family plan.

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.

Providence Connect plans are available to members who reside in Yamhill county ZIP codes 97123 and 97132.

Oregon residents

Under the health care reform law (the Affordable Care Act or ACA), pediatric dental coverage is required as an essential health benefit. Providence Connect Network plans include pediatric dental coverage. You will be required to purchase pediatric dental coverage separately if you purchase a Providence Oregon Standard, Providence Oregon Direct or Providence HSA Qualified plan directly from Providence Health Plan 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 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 Columbia plan, you must provide written proof to Providence that you also bought a pediatric stand-alone dental insurance plan. If you do not obtain pediatric dental coverage, Providence Health Plan may discontinue your or any of your enrolled dependents health benefits until reasonable assurance is obtained.

The requirement to purchase pediatric dental coverage was enacted as part of the health care reform law. 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.

Apply for coverage during the Open Enrollment Period between November 1, 2024  - January 15, 2025. 

Oregon residents applying for coverage directly through Providence Health Plan

Apply for coverage between November 1, 2024 - December 31, 2024 for coverage beginning January 1, 2025. If you apply for coverage between January 1, 2025 - January 15, 2025, your coverage will begin on February 1, 2025. Coverage is conditioned on Providence Health Plan's timely receipt of your initial premium payment.

Oregon residents applying for coverage through the Health Insurance Marketplace 

Apply for coverage between November 1, 2024 - December 15, 2024 for coverage beginning January 1, 2025. If you apply for coverage between December 16, 2024 - January 15, 2025, your coverage will begin on February 1, 2025. Coverage is conditioned on Providence Health Plan's timely receipt of your initial premium payment.

Washington residents applying for coverage directly through the Providence Health Plan 

Apply for coverage between November 1, 2024 - December 15, 2024 for coverage beginning January 1, 2025. If you apply for coverage between December 16, 2024 - January 15, 2025, your coverage will begin on February 1, 2025. Coverage is conditioned on Providence Health Plan's timely receipt of your initial premium payment.

Outside of the Open Enrollment Period, see a list of qualifying events to determine if you or a family dependent may be eligible to apply for coverage during a Special Enrollment Period.

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, an offer of coverage letter will be mailed with payment details once your 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. Monthly premium payments can also be paid online using your myProvidence account or by mail.

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

Although we hope to offer it in the future, Providence Health Plan does not offer paperless billing at this time. However, if you set up an automatic recurring payment by visiting our electronic payment system, you can choose to opt-out of receiving monthly paper invoices. To opt-out of receiving monthly paper invoices, 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 888-816-1300 (TTY: 711).

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

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, or other plan changes that are requested during a Special Enrollment Period.

Premiums are always due on the first of the month; however, Providence Health Plan allows a grace period. 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.

If you have an active policy directly through Providence Health Plan, please complete an online change form which can be found on our member forms and documents page.

If you have an active policy through the Health Insurance Marketplace™, please contact the Marketplace at 800-318-2596 and file a Life Change event.

Please refer to our member forms and documents page to make changes to your plan, add or remove dependents, or terminate your coverage. Please note that outside of the Open Enrollment Period, some plan changes require a qualifying event.  

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

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.

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 that 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.

If you have coverage through the Health Insurance Marketplace™, you will receive a 1095-A. You can also log in to your account at HealthCare.gov to find your 1095-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 888-816-1300 (TTY: 711).

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 888-816-1300 (TTY: 711).

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

To request proof of prior coverage, please contact Customer Service at 503-574-7500 or 800-878-4445 (TTY: 711) 8 a.m. to 5 p.m. (Pacific Time), Monday through Friday.

The federal Health Insurance Portability and Accountability Act (HIPAA) requires health issuers to send Proof of Prior Coverage when requested by a member that terminates their plan coverage.

In some cases, your coverage may not coordinate benefits with Medicare Part A, Part B, or Part A and B. If you wish to cancel your other coverage and recurring payments as well as ensure your dependents still have the coverage they need, please refer to the document below. 

Transitioning to Medicare Advantage (PDF)

For assistance, please contact 888-816-1300 (TTY: 711) Monday through Friday 8 a.m. to 5 p.m. (Pacific Time).