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 be adjusted to reflect changes in your family composition, a relocation to a new service area county within Oregon or other plan changes that are requested during a Special Enrollment Period.

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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, Nov. 1-Dec. 15, 2019, your coverage will begin on Jan. 1, 2020, 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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How do I make changes to an existing plan?

If you would like to make changes to your current plan, visit ProvidenceHealthPlan.com/forms to complete an online or paper Individual & Family Plan Change Form. Please note that outside of Open Enrollment, some plan changes require a Special Enrollment Qualifying Event.

If you have an active policy through the Exchange, please visit Healthcare.gov to update your application or contact the Marketplace at 1-800-318-2596.

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How do I request a Certificate of Credible Coverage?

The federal Health Insurance Portability and Accountability Act (HIPAA) requires health insurers to send a Certificate of Creditable Coverage (CCC) when members terminate their coverage.

To request proof of credible coverage, please contact the Membership Accounting Department by calling 1-503-574-5791 or 1-888-816-1300.

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Can I purchase stand-alone dental insurance?

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. If you choose to enroll in a dental plan, all covered members on the plan will be enrolled.

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When does a dependent child age-off a policy?

A dependent child enrolled under a family policy is limited to age 25. A dependent becomes ineligible for coverage on the family policy on the last day of the month in which their 26th birthday occurs.

The subscriber will be sent a letter 60 prior to the dependent’s 26th birthday. The dependent may then apply for coverage on their own policy. A completed application must be received within 30 days from losing coverage to avoid a lapse in coverage. A completed application received 31 – 60 days after losing coverage will be given a prospective effective date of coverage.

A dependent child enrolled under a child-only policy is limited to age 20. A dependent becomes ineligible for coverage on a child-only policy on the last day of the month in which their 21st birthday occurs.

The dependent will be sent a letter 60 prior to the dependent’s 21st birthday. The dependent may then apply for coverage on their own policy. A completed application must be received within 30 days from losing coverage to avoid a lapse in coverage. A completed application received 31 – 60 days after losing coverage will be given a prospective effective date of coverage.

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How do I request a copy of my 1095?

If you have coverage through the Federal Exchange in Oregon, you will receive a 1095-A. You can also log on to your HealthCare.gov account and find your 1095-A under "tax forms."

If you have coverage directly with Providence Health Plan, you will receive a 1095-B in the mail. If you need to request another copy, you may call Membership Accounting at 503-574-5791 or email PHPIndiPremium@providence.org.

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When will I receive ID cards?

Once Providence Health Plan receives a timely payment, your policy will become effectuated. You should expect to receive your ID cards and membership materials within 7 – 10 business days.

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How can I get proof of my premium payments for tax reimbursement purposes?

You can access payment receipts from your ePay online billpay account, or request records from your bank. If neither of those options works for you, you can also send a request to Membership Accounting at PHPIndividualPlan@providence.org.

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How can I sign up for paperless billing?

Although we hope to offer it in the future, Providence Health Plan does not offer paperless billing at this time.

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