Frequently asked questions

Who can apply for coverage?

To purchase one of our plans, you must live in the Oregon service area. Service area means the geographic area in Oregon within which the policyholder, the spouse, or the dependent-only member must physically reside in order to be eligible for coverage. Oregon service area is all ZIP codes in Oregon.

In order to be eligible to enroll in the Providence Progressive Dental plan, you must enroll in a Providence Health Plan individual and family medical plan.

Providence is non-duplication with Medicare on individual and family plans. Someone who is entitled to Medicare Part A or enrolled in Part B is not eligible to enroll in a Providence Health Plan individual and family plan.

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Can my employer pay my premium?

In compliance with Oregon state law, Providence Health Plan does not accept premiums from employers for individual health coverage.

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Do I have coverage while I am at work?

Our plans provide coverage 24 hours a day, seven days a week. You will be covered while you are working, unless you are required to have coverage through the Workers' Compensation Act or similar law.

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What about preexisting conditions?

All plans are guaranteed issue under the Affordable Care Act, meaning that insurance companies no longer can deny coverage for people with preexisting conditions for plans with effective dates starting January 1, 2014 and afterward.

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Will my premium change?

Premiums are subject to an annual rate change. Your premium may change as you move to a new age category or county within Oregon.

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Will I be charged more if I use a producer (aka insurance agent)?

No, your monthly premium is the same, whether or not you use a producer. The producers we appoint to represent Providence Health Plan have thorough knowledge of the coverage we offer.

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How do I pay for my coverage?

We will invoice you for your first month's premium once your application is approved and you accept our offer of coverage. Your premium is billed monthly and can be paid online at or by mail.

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Do I need to purchase pediatric dental coverage?

Under the health care reform law (the Affordable Care Act or ACA), pediatric dental coverage is required as an essential health benefit. The Connect plans include pediatric dental coverage. You will be required to purchase pediatric dental coverage separately if you purchase a Providence Oregon Standard plan directly from Providence or from a producer. This applies whether you obtain coverage for children or adults. An exception is made for plans purchased through the Federal Health Insurance Marketplace as these plans do not require pediatric dental coverage.

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How will the government know who has and has not signed up for pediatric dental coverage?

The requirement to purchase pediatric dental coverage was enacted as part of federal health care reform. To date, there is no historical auditing information to rely upon in answering this question. Both the state and federal government have the authority to conduct audits on this subject and could do so at any time.

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When does my coverage begin?

Coverage will begin the first of the month following application approval. You can request a later date to begin coverage, up to 60 days from the date you submit your application. The coverage effective date needs to be within the 60 days.

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How does Providence Health Plan protect my privacy?

We respect the privacy of our members and applicants, and have policies regarding your protected health information:

  • Once enrolled for coverage, your agreement enables us to share your health information to administer your plan benefits and pay medical claims.
  • We also may share information with your doctors or hospitals to provide medical care to you.

Please refer to our Privacy Notices and Policies page for uses and disclosures of protected health information, including those required by law.

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