Welcome Providence Montana Members
We're glad you're here! And, we're here to help you get started, make the most of your health plan benefits and get engaged. Here's an introduction about how to get to know your benefits and make the most of them this year.
Let's get started: benefit basics
Understanding your benefits is a great place to start. To begin, take a look at your benefit summary and summary plan description. Your plan benefit summary provides an overview of covered services and benefit level. Your summary plan description offers additional details about your benefits. See your member materials to get started
. Then, start to make the most of your benefits
Find a provider
Need help selecting a physician? Our online provider directory is a great place to start. It's easy to use, and we can help you determine whether the provider you'd like to see is in or out of our network. With our online directory, you also can pinpoint your nearest urgent care facility, which can save you time when you need immediate care. With nearly one-million health care providers nationwide, we can help you find the right match for your health care needs.
Transition your care
We want to understand any special health needs or medical conditions you or your family members may have. You may be eligible for transition of care benefits. Review the transition of care form (PDF) and complete the form if the criteria apply to you. We can help you:
- Find a specialist
- Transfer your prescription medication
- Connect with our registered nurse care managers for ongoing support
- Get the necessary authorizations for care
- Schedule medical procedures
- Obtain medical equipment necessary to optimize your care
If you prefer to speak with a customer service team member for help, we're here for you. Call 800-878-4445.
Take a look at the following resources to help you make the most of your pharmacy benefits:
- Participating pharmacies. Find a participating pharmacy by searching our online provider directory
- Providence pharmacy formulary. Know what's included in the Providence pharmacy formulary. The formulary is a list of brand-name, generic and specialty medications developed by physicians and pharmacists for the purpose of promoting safe, effective and affordable drug therapy. All medications on the Providence formulary have Food and Drug Administration (FDA) approval. Using a medication that's included on the Providence formulary can help you and your physician choose effective medications that minimize your out-of-pocket expense.
- Preventive drug list. Select medications are covered in full, meaning that certain medications are covered at 100%, and are not subject to the deductible for the Health Reimbursement Medical Plan and the Health Savings Medical Plan. Learn what medications are included on the preventive drug list (PDF)
- Specialty drug prior authorization. Prior authorization is a process to review a prescription drug for coverage before it is dispensed. This process is usually initiated by your doctor or other prescriber of the medication. Many factors - including serious risks, Food and Drug Administration approved indications, and cost-effectiveness - are considered before making the decision to require prior authorization of a prescription medication. If a drug requires a prior authorization, there will be a “PA” in the comment section on the formulary.
- Step therapy. The step therapy program asks members to try “first-line” prescriptions to determine their effectiveness. The purpose of step therapy is to confirm if a member has tried a drug that is considered to be "first-line" therapy based on clinical evidence first, before the drug requiring step therapy is generally considered. Step therapy uses Providence Health Plan pharmacy claims history to confirm if certain drugs have been tried first and if they have, the drug requiring prior authorization will automatically be approved. In the event these drugs are not tried first, cannot be tried first or the drug history is not part of Providence Health Plan claims, prior authorization is required. Drugs that require step therapy are indicated with a "ST" in the online formulary.