Open Enrollment season is here!
Providence Health Plan is here to make sure you get the most from your healthcare coverage. The virtual benefits fair helps you learn about your benefit options from the comfort of your home. Below you will find everything you need to make the most of your chosen plan this year.
Watch this presentation to help you pick the best plan to meet your needs
This presentation will guide you through the benefits you can receive through the plan of your choice.
Health Engagement Model (HEM)
Participating in the HEM means you agree to take a Health Assessment (HA). For participating you may be eligible for a monthly incentive and a lower deductible on your medical plan.
With the assessment you can take an active role in your health. You’ll identify any potential health risks and then you can take action to reduce them. It’s recommended to share the results of the assessment with your primary care provider (PCP), so that they can better serve your needs.
What's new in 2024
Here's a preview of the new benefits and programs we’ve added:
Eliminate referral requirements on all plans
For the Choice plan, referrals are no longer required from a PCP in order for a member to receive in-network Specialty care.
Massage therapy is available with the Statewide plan to help reduce pain and tension found in your joints and muscles.
Increasing Behavioral Health virtual solutionsFocused on broad access and additional specialty support.
- Talkspace: telehealth provider of virtual psychotherapy for adults and teens 13+, and available through text, voice, or video options.
- Equip: virtual, eating disorder treatment for kids and young adults ages 6-24 using Family Based Treatment (FBT).
- Charlie Health: Intensive Outpatient Program (IOP) delivered virtually and available 24/7 for teens and young adults ages 11-30.
Find the plan that fits your lifestyle
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 (PCP), 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)
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
- Access to the Providence Choice network, with over 400 medical homes
Behavioral health resources
We know behavioral health care isn’t a one-size-fits-all solution. We’re all unique, and our journey and needs vary depending on our personal situation. At Providence, we want that lens to drive us when looking at the mix of services and solutions we offer for your well-being. Whether you’re looking for some support to relax, ready to try self-directed therapy that helps you to engage when you feel like it, or looking for immediate connection to a provider – via text, voice, video or face to face – we have many options to fit your needs.
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. This unique solution-focused service is a convenient way to seek help from a mental health provider.
As a Providence Health Plan member, you also have access to virtual therapy through Talkspace. Get personal behavioral health and emotional wellness support through online counseling and therapy from one of the thousands of licensed counselors in the Talkspace clinical network.
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.
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.
You have nationwide access to thousands of participating pharmacies. 30-day and 90-day supplies are available.
Use mail-order to get a 90-day drug supply, at a reduced cost, delivered directly to your home.
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
- No Rx fertility annual benefit maximum
Virtual access to care, whenever you need it
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 is a convenient option for getting care wherever you are. It includes all virtual visits using a teleconferencing application, such as Zoom.
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.
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.
More tools and resources to help you on your healthcare journey
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.
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 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.
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 (your secure member portal)
myProvidence.com provides access to your health plan information. It’s also where you can access tools and resources.
- 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.
- One Pass Select™. Access thousands of participating fitness centers and workout videos on demand along with grocery delivery.
- 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
Use the documents and links below for at-your-fingertips access to resources designed to help you achieve True Health.
We’re here for you
We're here for you if you need any assistance or have questions about enrollment or your benefits. Don't hesitate to reach out. We're happy to answer your questions or to assist you in finding the resources you need. Contact Customer Service at 503-574-7500 or 800-878-4445 (TTY: 711), Monday through Friday, 8 a.m. to 5 p.m. (Pacific Time).