Individual & Family Plan Documents

Understand your plan and view the Benefit Summary or the Summary of Benefits & Coverage (SBC):

 

Benefit Summaries and SBCs

New applicants - get a quote and enroll today

We've made it easy to get a rate quote for our health plans and enroll online.

Get a quote and enroll

The Providence Health Plan Individual & Family Open Enrollment period is closed. 

New applicants who experience a qualifying event may enroll in a 2026 Individual & Family plan during a Special Enrollment Period, Jan. 1, 2026 - Dec. 31, 2026, using the enrollment forms below. 

2026 Oregon Residents 

 

• 2026 fillable enrollment application for Oregon Individual & Family insurance (PDF)

2026 Washington Residents  

 

• 2026 fillable enrollment application for Washington Individual & Family insurance (PDF)

 

Need assistance?

For help with choosing an Individual & Family plan, please contact our sales team at 503-574-5000 or 800-988-0088 (TTY: 711), 8 a.m. to 5 p.m. (Pacific Time), Monday through Friday.

View member forms and documents, including:

 

• Medical claim form
• Medical travel reimbursement form
• Vision claim form
• Privacy forms
• Prescription drug reimbursement request form:

 

Member Forms and Documents

Providence Health Plan Individual & Family plan Open Enrollment Period is closed.

Current members that experience a qualifying event during the Special Enrollment Period, Jan. 1, 2026 - Dec. 31, 2026, can make changes to their plan using the forms below. 

 

2026 Oregon Plan Change Forms

With this form, you can change your plan, add or remove dependents, or terminate your coverage.

  

If you have a Marketplace^® policy, please visit HealthCare.gov to make changes. 

• 2026 online change form for Individual & Family insurance
• 2026 fillable change form for Individual & Family insurance (PDF)
  (Use if you need to list more than six dependents)

2026 Washington Plan Change Forms

With this form, you can change your plan, add or remove dependents, or terminate your coverage.

   

• 2026 online change form for Individual & Family insurance 
• 2026 fillable change form for Individual & Family insurance (PDF)
  (Use if you need to list more than six dependents)

2026 Oregon Plan Contracts

• Providence Connect plans (PDF)
• Providence HSA Qualified Choice Network plan (PDF)
• Providence HSA Qualified Signature Network plan (PDF)
• Providence Oregon Direct Choice Network plan (PDF) 
• Providence Oregon Direct Signature Network plan (PDF) 
• Providence Oregon Standard Choice Network plans (PDF)
• Providence Oregon Standard Signature Network plans (PDF)
• Individual & Family Dental Plan (PDF) 

2026 Washington Plan Contract

• Columbia Plans (PDF)

Use the Transition of Care form if your benefits change and need help transitioning care for current or previous services received from a prior health plan.

Transition of care request