Hey!

Here's a preview of the new benefits and programs we’ve added:

• Smart RxAssist  

  Co-pay will be eliminated on all eligible specialty medications
  With this program cost is reduced to zero for certain specialty medications. Those are drugs that may require special handling or administration

• Omada  

  Take steps to prevent diabetes
  The Omada prevention program helps members achieve and maintain a healthy weight.
  You’ll get proactive support and interventions with proven success.

• Breast reductions

  Expanded coverage to include medically necessary situations
  Previously breast reduction surgery was only covered to remove malignant tumors. Now coverage is being added to include symptoms of pain and disability. To find other benefit coverage details, check out the section titled 2023 plan benefit summaries below.

• Providence Pathfinder

  Simplifying your healthcare journey with a personal Pathfinder
  With one click or call, you will be connected to a personal Pathfinder who is dedicated to help you. They will guide you to the answers, virtual tools, or resources you need. For more complex needs, your Pathfinder will connect you to a True Health Guide, to help you every step of the way.

• myProvidence

  Member portal updates
  myProvidence provides on-demand access to your personalized health plan information and it has a whole new look and feel. Updated navigation and new features make it easier to find what you need.

Choose from your two plan options below.

With either plan, you get:

• Preventive services, in-network at no cost ($0 deductible)
• Virtual visits, in-network at no cost ($0 deductible)
• Access to the nationwide Cigna PPO network
• Wellness resources to help with chronic disease, stress, diet and exercise, sleep, and much more
• Chiropractic manipulation and acupuncture (Statewide plan: 15% coinsurance; Choice: $10 copay)

These are the main differences between your plan options:

PEBB Statewide PPO Plan

Get more access with the Providence Statewide plan. You’ll be able to select more primary care providers, specialists, and pharmacies of your choice.

• $250 individual deductible; $750 family deductible
• Out of pocket maximum: $1,900 individual; $5,700 family
• Primary care: 15% or 10% coinsurance for the first four visits ($0 deductible)
• Specialty care: 15% coinsurance
• Access to the Providence Signature network, OHSU, and Providence Hospitals
  
  

Benefit Summary 

Learn more

Providence Choice Plan (Medical Home)

The Providence Choice plan is led by a primary care provider at a medical home who knows you and your needs. They also can help coordinate your care with other providers.

• $250 individual deductible; $750 family deductible
• Out of pocket maximum: $1,500 individual; $4,500 family
• Primary care: $10 copay, first four visits ($0 deductible)
• Massage therapy: $10 copay, $1,000 maximum benefit
• Specialty care: $10 copay (with referral)
• Access to the Providence Choice network, with over 400 medical homes

Benefit Summary 

Learn more

Providence members have options when it comes to getting behavioral health care. Our expansive network of providers offers care close to home or while you’re away. Then there’s Behavioral Health Concierge, a unique program that provides quick access to virtual appointments. You also have access to a self-help tool called Learn to Live - proven to help manage conditions like anxiety and depression.

Behavioral Health Network

We value whole self-care for all members. That’s why we’ve enhanced our focus on behavioral health and substance use treatment services. To simplify whole self-care, we’ve established a direct access line to a 24/7 dedicated support team that includes a crisis-trained staff.

Behavioral Health Concierge

Members in six states including Oregon and Washington can access virtual and confidential appointments at no cost. Appointments with licensed providers can be made on the same day or next day.

Learn to Live

For comprehensive whole-health support, we also provide a virtual self-directed program called Learn to Live. Take advantage of interactive resources that are confidential and accessible from anywhere.

Learn more at the behavioral health resource page

Our pharmacy network gives you access to thousands of participating pharmacies. With in-person and mail order options, you can conveniently access the prescriptions you need. Save yourself both time and money with our resources.

List of covered drugs

We provide members with an in-depth list of covered drugs, called a formulary. It promotes affordable and effective medications.

Participating pharmacies

You have nationwide access to thousands of participating pharmacies. 30-day and 90-day supplies are available.

Mail-order pharmacy

Use mail-order to get a 90-day drug supply, at a reduced cost, delivered directly to your home.

Specialty pharmacy

Specialty drugs include those that require careful handling or administration (like refrigeration or complex injection instructions). Your specialty care team will help coordinate everything for you. We also offer support to help reduce costs.

Smart RxAssist – reduces copay to $0

Our Smart RxAssist program lowers some specialty drug costs. Eligible members are enrolled automatically. A specialized patient navigator will assist you every step of the way.

Prescription drugs summary of benefits

Providence Statewide PPO Plan & Providence Choice Plan (Medical Home)

• $50 deductible per person or $150 for families
• Out-of-pocket maximum $1,000 per person, family maximum of $3,000
• $0 copay on value drugs
• $10 copay on generic drugs
• $30 copay on brand name drugs
• Statewide plan: $100 copay on specialty drugs
• Choice plan: $20 copay on generic specialty drugs, $100 copay on brand specialty drugs
• Copay x2.5 for 90-day supplies

Learn more at the pharmacy resource page

See or talk to a provider in minutes, from your phone or computer. Virtual care is covered in full, with no cost to you.

Telehealth

Telehealth is a convenient option for getting care wherever you are. It includes all virtual visits using a teleconferencing application, such as Zoom.

ExpressCare Virtual

We have created ExpressCare Virtual for members who don’t have the time or ability to travel to a clinic for treatment. It can address non-urgent medical issues. Available nationwide. Access 7 days a week from a tablet, smartphone, or computer.

ProvRN

Providence Health Plan members can call ProvRN 24/7 to ask questions about their health. They’ll speak with a registered nurse in minutes. Nurses are available to listen and provide answers as best as possible.

Behavioral Health Concierge

Access virtual and confidential same-day or next-day appointments. Services are available with Providence licensed behavioral health professionals. This unique service is a convenient way to seek help from a mental health provider.

More tools and resources to help you on your journey to True Health

Learn to Live (L2L) – a wealth of mental health resources at your fingertips

L2L offers online self-help programs. Get help for things like anxiety, stress, or depression. You’ll be using self-help tools that include interactive content and dynamic resources. Along the way, encouragement is available from a personal coach via text or email.

Kaia Health - join over 500,000 people who have turned to Kaia for pain relief

Kaia is an evidence-based digital therapy app. It helps you learn ways to manage joint and muscle pain throughout the entire body. Receive a customized therapy plan that can include exercise, relaxation, and expert advice.

Omada – take steps to prevent diabetes

The Omada program helps reduce the risk of prediabetes and chronic disease. It offers nutritional guidance and weight loss resources. Your care path includes certified health coaches, condition-specific peer groups, and virtual physician visits.

Virta Health - type 2 diabetes reversal is here

Virta is a provider-led and research-backed treatment. It can help reverse type 2 diabetes. You can work to lower your blood sugar and A1c, all while reducing diabetes medications and losing weight. With a personalized treatment plan from Virta, you get professional support and useful resources.

WW (Weight Watchers) - assistance in tracking what you eat and working towards your goals

Eat well, move more, and lose the weight you want with a personalized action plan. Get progress reports, easy-to-use-tracking tools, and thousands of recipes. Also take advantage of 24/7 coaching. All from an app on your phone.

myProvidence.com provides access to your health plan information. It’s also where you can access tools and resources.

Things like:

• Find in-network providers
• Get a replacement ID card
• Estimate costs for medical, pharmacy, and dental
• View claims and explanations of benefits
• View progress towards your deductible and out-of-pocket maximum
• Communicate with Customer Service via secure email and chat
• Access exclusive member discounts on fitness memberships, travel and more

Your member perks are the additional programs and benefits we make available to you.

• Active&Fit Direct™: Access more than 16,000 participating fitness centers, and over 4,000 workout videos on demand for only $25 a month
• Our Providence health coaches are here to support your journey to a healthier, happier life
• Get emergency medical help while traveling away from home, or even internationally, with Assist America Travel Assistance
• Get peace of mind with Assist America Identity Theft Protection’s fraud monitoring, warning, and resolution
• LifeBalance provides savings on more than 20,000 travel, cultural, recreational, and other fun activities
• Save big on fitness and wellness products, services, and memberships with ChooseHealthy

Use the documents and links below for at-your-fingertips access to resources designed to help you achieve True Health.

• Navigate your health plan with assistance from your Member Resource Guide (PDF)
• Visit our online provider directory to locate a doctor, clinic, pharmacy or other care provider near you
• Enjoy more than just great coverage. Access wellness resources designed to support your True Health.
• Learn more about how Providence helps members achieve their True Health.