|
Date we receive your application |
Effective date of coverage |
Due date for your initial premium payment |
|---|---|---|
| 1st – 15th of the month Example: We receive your application on March 12th. |
1st day of the following month Example: Your coverage will start on April 1st. |
Within 15 days after the effective date of coverage or within 30 days after the date of our offer of coverage and initial payment request, whichever is later. |
| 16th – last day of the month Example: We receive your application on March 28th. |
1st day of the 2nd following month Example: Your coverage will start on May 1st. |
Within 15 days after the effective date of coverage or within 30 days after the date of our offer of coverage and initial payment request, whichever is later. |
Special enrollment and qualifying events
COVID-19 special enrollment period (2/15/21 – 8/15/21)
Open enrollment for 2021 individual and family plan coverage ended December 15, 2020 in Oregon (January 15, 2021 in Washington); however, you can still apply for and get health insurance coverage during the COVID-19 special enrollment period from February 15, 2021 – August 15, 2021 without experiencing a qualifying life event.
Oregon and Washington policyholders may obtain coverage due to the COVID-19 special enrollment period by submitting an application for coverage to Providence Health Plan, the Oregon Marketplace (HealthCare.gov), or the Washington Health Benefit Exchange (WAHBE).
If your application is not submitted by August 15, 2021, a qualifying event will be required to apply for coverage as the COVID-19 special enrollment period will be closed.
Coverage will be effective the first day of the month per the application and effective dates table indicated below provided that Providence Health Plan receives timely payment of the initial premium.
Policyholders submitting an application directly to Providence Health Plan may request an accelerated effective date of coverage which would start on the 1st of the month following our receipt of your completed application. To request an accelerated effective date, please contact our Membership Accounting team at 503-574-5791 or 888-816-1300 (TTY: 711), 8 a.m. to 5 p.m. (Pacific Time), Monday through Friday.
Examples of accelerated effective dates
| If we receive your application March 1st – 31st | April 1st effective date |
| If we receive your application April 1st – 30th | May 1st effective date |
| If we receive your application May 1st – 31st | June 1st effective date |
Birth, adoption, placement or court order
Policyholders enrolling for coverage after experiencing one of the following qualifying life events can submit an application for coverage to Providence Health Plan, the Oregon Marketplace (HealthCare.gov), or the Washington Health Benefit Exchange (WAHBE).
- Birth, adoption, placement for adoption or foster care of a child
- Acquisition of legal guardianship
- Qualified Medical Child Support Order (QMCSO)
When the qualifying event is birth, adoption, placement or court order; coverage will be effective from date of birth, adoption, placement or court order, provided the completed application and initial premium payment are received within 60 days of the special enrollment qualifying event. If the application is not completed within 60 days, the policyholder may choose to enroll during the COVID-19 special enrollment period noted above.
Policyholders submitting an application directly to Providence Health Plan will need to complete the fillable pdf copy of the application form to receive a retroactive effective date of coverage from the date of birth, adoption, placement or court order.
Please note: Our acceptance of premium is not a guarantee of coverage. If the policyholder is applying directly, Providence Health Plan can request proof of the qualifying event. If applying through the Oregon Marketplace (HealthCare.gov) or Washington Health Benefit Exchange (WAHBE), they may also request documentation. If the policyholder enrolls under special enrollment and later it is discovered they cannot prove the qualifying event, the coverage may be cancelled.
Questions?
For Providence Health Plan questions, contact one of our Sales representatives at 1-800-988-0088. For Oregon Marketplace questions, contact the HealthCare.gov call center at 1-800-318-2596. For Washington Health Benefit Exchange (WAHBE) questions, call 1-855-923-4633.