Make the most of your medical 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, The Polyclinic, CHI Franciscan or other Providence-Swedish Health Alliance ACO network 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:

  1. Visit the online provider directory.
  2. 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:
    • Under the Choose plan type drop down menu, select Specific employer groups.
    • Under Choose provider network, select your employer and region then click on the Search button (i.e., Swedish Health Services).
  3. Choose Find a care provider then select Specialists.
  4. 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: Receive care from in-network providers and receive a higher level of benefit

To find an in-network provider and access a wide range services, visit the online provider directory. For the highest benefit, select the Providence-Swedish Health Alliance box on the right side of your screen.

Tip 4: Use and save with your pharmacy benefits:

  • Choose generics
  • Use in-network pharmacies and mail-order services
  • Have certain medications prior authorized before they are filled

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, 8 a.m. to 5 p.m. to help locate a participating 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 before you receive care, meaning that before you receive care, the service must be pre-approved by Providence Health Plan. Learn about prior authorization.