Make the most of your medical plan benefits
The following tips can help you save when you receive care:
Tip 1: Use your preventive care benefits; certain services are covered in full
Your plan covers certain preventive services in full when received from an in-network provider.
Tip 2: Seeing a specialist? Access care from select specialists and receive a higher level of benefit
As a Providence Health Reimbursement or Health Savings medical plan member, you will receive higher coverage if you receive care from a Providence Health & Services specialist or a Providence-affiliated specialist. This means that after you meet your calendar year deductible, you'll pay 10 percent and Providence Health Plan will pay 90 percent of the cost of specialty care visits. Specialists include cardiologists, dermatologists, endocrinologists, and a number of other specialties. To find a Providence specialist or Providence-affiliated specialist:
- Visit our online provider directory
- Search by member ID number for best results or enter as a visitor. In the Visitors section, under the Choose plan type drop down menu, select Specific employer groups and then click on the Search button.
- Under Choose provider network, select your employer and region, then click on the Search button. (example: PH&S Washington Employee Plan).
- Choose Find a care provider and under What type of doctor are you looking for?, select Specialists.
- Under What type of Specialist are you looking for?, choose the type of Specialist you need to see.
- On the Specialist Search Results page, check the Providence/Swedish Providers & Locations box (located on the bottom left of the page), then click on the Update Filters button.
Your results will list Providence specialists and affiliated Providence specialists. When you receive care from one of these specialists, you'll pay less out of pocket for specialist services.
Tip 3: Choose in-network providers and receive a higher level of benefit
To find an in-network provider and access a wide range of services, visit the online provider directory. For the highest benefit, follow the instructions listed above to find the type of care you need. Note: Select the Providence/Swedish Providers & Locations box on the bottom left of your screen.
Providence Health Plan members in Eastern Washington can also access in-network care for select services from Group Health (PDF).
Tip 4: Choose generic medications, use in-network pharmacies and mail-order services, and have certain medications prior authorized before they are filled.
Use in-network pharmacies to make the most of your pharmacy benefits. To find an in-network pharmacy near you, search the online provider directory. If you prefer, call Providence Health Plan customer service at 800-878-4445, Monday through Friday, 7 a.m. to 6 p.m. to help locate an in-network pharmacy or provider. Plus, take advantage of additional pharmacy resources to help you save.
Did you know that you can receive a 90-day supply of your maintenance medications at our preferred retail pharmacies and through the mail? Purchase up to a 90-day supply of maintenance drugs using a participating mail-order pharmacy or a preferred retail pharmacy. Not all drugs are considered maintenance prescriptions, including compounded drugs, drugs from specialty pharmacies and oncology drugs.
Tip 5: Know what services need to be authorized before you receive care.
Certain services require a prior authorization, meaning that before you receive care, the service must be authorized by Providence Health Plan. Learn about prior authorization.