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 child-only member(s) must physically reside in order to be eligible for coverage. The Oregon service area includes all ZIP codes in Oregon.

Providence Health Plan individual and family plans may also be purchased through the Federal Health Insurance Marketplace. Federal financial assistance may be available to help pay your premiums. To determine if you qualify, you must apply for coverage at HealthCare.gov.

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. The Providence Progressive Dental plan is not available to applicants enrolling through the Federal Health Insurance Marketplace.

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 or another third party pay my premium?

Providence Health Plan does not accept premium payments from employers or any third parties for individual health coverage, except as permitted by state or federal regulation.

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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?

With Providence Health Plan’s online application, you can quickly and conveniently pay your initial premium payment at the time you apply for coverage. In cases where a paper application must be submitted, such as for families with more than three children or child-only plans, an offer of coverage letter will be mailed with payment details once the application has been approved.

After you have paid your initial premium payment, Providence Health Plan encourages you to visit Providence.org/premiumpay to set up an automatic recurring payment through the Providence Health Plan Electronic Payment System. Monthly premium payments can also be paid online at Providence.org/premiumpay or by mail.

Your monthly premium payment is due on the first of each month.

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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 or a Providence HSA Qualified plan directly from Providence or from a producer. This requirement applies whether you obtain coverage for children and/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?

If you are applying for coverage during Open Enrollment, 11/1/18 – 12/15/18, your coverage will begin on January 1, 2019, conditioned on Providence Health Plan’s timely receipt of your complete application and initial premium payment.

Outside of Open Enrollment, visit ProvidenceHealthPlan.com/qe to see if you or a family dependent may be eligible to apply for coverage during a Special Enrollment Period.

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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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