Individual and family plan members

You want to know how health care reform will affect you and your Individual and Family Plan. Visit this website to stay informed about plan decisions and reform news. Feel secure knowing that we are implementing these reforms with your well-being in mind.

What Has Changed?

In 2012:

  • Certain women’s preventive health care services covered in full
  • Summary of Benefits and Coverage document available to provide basic benefit information in a standardized format, for comparison purposes only

In 2011:

  • New guidelines for termination and re-enrollment. Members under age 19 are not eligible for re-enrollment if they had coverage under another Providence Individual and Family Plan in the 12-months preceding the effective date of their application
  • Annual limits for mental health and alcohol dependency have changed

In 2010:

  • Some lifetime and annual limits removed.
  • Certain preventive services covered in full.
  • The overall lifetime benefit maximum has been removed.
  • You can keep children up to age 26 on your health plan, for existing members and dependents.

Visit the Individual and Family Plan website for the latest information.

Upcoming - Oregon Health Insurance Exchange

Starting in October 2013, Oregonians will be able to find information and compare health insurance plans, determine tax credit and financial assistance eligibility and enroll for health insurance through the Oregon Health Insurance Exchange, also known as Cover Oregon. Health insurance coverage will take effect on or after Jan. 1, 2014.

Health insurance exchanges are intended to:

  • Help consumers better understand their health insurance options
  • Provide a more standardized market of health plans to choose from, and
  • Provide financial assistance for those who qualify

The Oregon Health Insurance Exchange is designed to benefit:

  • Children and adults who do not have access to affordable coverage through an employer
  • Children and adults who earn up to 400 percent of federal poverty level ($92,000 for a family of four in 2012) who will be eligible for federal tax credits

Learn more about the Health Insurance Exchange.

See below for answers to frequently asked questions. You may also call Customer Service at 503-574-7500 or 800-878-4445 or contact us online.

Frequently asked questions

Rule-making on health care reform continues on federal and state levels. We will update our Individual and Family Plan website with the latest information.

I'm healthy. With health care reform, can I now wait to get insurance when I actually get sick?

Health insurance helps protect you financially, especially in the event of an unexpected serious illness, injury or hospitalization. Paying out-of -pocket for these services can be expensive, and if you or a family member is critically ill, it may be difficult to get insurance quickly. Plus, with health insurance, you are also more likely to get routine and preventive care to keep you healthy or diagnose problems early before they become costly chronic conditions.

Health care reform will help improve your access to health insurance. In addition, in 2014 most individuals will be required to obtain minimum health insurance coverage or pay a penalty. Although reform will prohibit insurance companies from denying any individual coverage due to a pre-existing condition in 2014 and beyond, insurance companies can still require a health screen and are able to deny coverage for adults until 2014.

How will health care reform affect me and my individual or family plan?

We're committed to making this transition easy for all our members. We will provide you with the information you need to understand your health insurance benefits. You can expect to see changes to plan benefits and premiums. We will update the Providence Individual and Family Plan website with current information.

Will Providence Health Plan still be our insurance company?

Yes. We will continue to offer health insurance. We value our relationship with you and appreciate your business.

Should I cancel my appointments with my doctors?

Please continue to use your benefits. We will inform you of any benefit changes at least 30 days before the effective date.