Member authorization and privacy forms
Individual and family insurance plan forms
2020 Oregon plans
Providence Individual & Family Plan Open Enrollment is November 1, 2019 through December 15, 2019.
To make changes to your current coverage effective January 1, 2020, use the links below. With this form, you can change your plan, add or remove dependents, or terminate your coverage. If you have a Marketplace policy, go to HealthCare.gov to make changes.
2019
To make changes to your current Providence Individual & Family Plan coverage for the 2019 plan year, use the links below. With this form, you can change your plan, add or remove dependents, or terminate your coverage. If you have a Marketplace policy, go to HealthCare.gov to make changes.
Transition of care
Claims
Most providers bill Providence Health Plan directly; however, if you must submit a medical claim to Providence, please use these forms:
Pharmacy
Medical home selection
Health education reimbursement