Make the most of your health plan benefits
Tip 1: Use your preventive care benefits
Your plan covers certain preventive services (PDF) in full when received from an in-network provider.
Tip 2: Access care from select specialists and receive a higher level of benefit
As a Swedish medical plan member, you receive higher coverage if you receive care from a Swedish, Providence, PacMed, Minor & James Medical, Polyclinic, CHI Franciscan or other Providence-Swedish Health Alliance ACO network specialist.
To find a Providence St. Joseph Health or affiliated specialist:
- Visit the online provider directory.
- Search by member ID number for best results or enter as a visitor (click on browse by provider networks). If you enter as a visitor/browse by provider networks:
- Under the Choose plan type drop down menu, select Specific employer groups.
- Under Choose provider network, select your employer and region then Search.
- Choose Find a care provider then Specialists.
- Choose the type of specialist you need to see.
- On the right side of the Specialist Search Results page, check the Preferred Network (Tier 1) box and Update Filters.
Tip 3: Receive care from 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.
Tip 4: Choose generic medications, use participating pharmacies and mail-order services, and have certain medications prior authorized.
Use participating pharmacies to make the most of your pharmacy benefits. To find a participating pharmacy near you, search the online provider directory. If you prefer, call Providence Health Plan customer service at 800-878-4445, Monday through Friday, 8 a.m. to 5 p.m. to help locate a participating pharmacy or in-network provider. Plus, take advantage of additional pharmacy resources to help you save.
Purchase up to a 90-day supply of maintenance drugs from a preferred retail or mail-order 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 before you receive care, meaning that before you receive care, the service must be pre-approved by Providence Health Plan. Learn about prior authorization.