Frequently asked questions

Who can apply for coverage?

To purchase one of our plans, you must live in the Washington service area. Service area means the geographic area in Washington within which the policyholder, the spouse, or the dependent-only member(s) must physically reside in order to be eligible for coverage. The Washington service area includes Benton, Clark, Franklin, Spokane, Thurston and Walla Walla counties.

Providence Health Plan individual and family plans may be purchased through the Washington Health Benefit Exchange or directly from Providence Health 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 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 Washington, 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. At the time you apply for coverage through the Washington Health Benefit Exchange you can pay your initial premium payment. In cases where a paper application must be submitted to enroll directly through Providence Health Plan, 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?

Washington state law requires children under the age of 19 who are enrolled in a health plan to also be enrolled in a pediatric dental plan. You must purchase a separate pediatric dental policy if you choose a Providence Columbia or Cascade plan. If you buy a Providence health plan outside of the Washington Healthplanfinder, you must provide written proof to Providence that you also bought a pediatric stand-alone dental insurance plan.

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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, 11/1/20 – 12/15/20, your coverage will begin on January 1, 2021, conditioned on Providence Health Plan’s timely receipt of your complete application and initial premium payment.

Outside of Open Enrollment, contact the Washington Health Benefit Exchange or 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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I am enrolled through the Exchange, how do I make changes to my policy?

Because you are enrolled through the Washington Health Benefit Exchange, you must contact them to make any changes to your policy at wahealthplanfinder.org, 855-923-4633.

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Where can I get proof of credible coverage?

Providence Health Plan will provide, upon request, written certification of the Member’s period of Creditable 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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When does a dependent child age-off a policy?

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

The subscriber or dependent (depending on the type of policy) will be sent a letter 60 days 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.

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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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