Member forms

Member authorization and privacy forms

Individual and family insurance plan forms

2021 Oregon plans

Providence Individual & Family Plan Open Enrollment is closed.

If you have experienced a qualifying event, you may use the links below to make changes to your 2021 plan.

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.

2020 Oregon plans

If you have experienced a recent qualifying event, you may use the links below to make changes to your  2020 plan.

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.

2021 Washington plans

Providence Individual & Family Plan Open Enrollment is closed. 

If you have experienced a qualifying event, you may use the links below to make changes to your 2021 plan.

With this form, you can change your plan, add or remove dependents, or terminate your coverage. If you have a Washington Health Benefit Exchange policy, go to WaHealthPlanFinder.org to make changes.

2020 Washington plans

If you have experienced a qualifying event, you may enroll in a 2020 plan at WaHealthPlanFinder.org.

To make changes to your 2020 coverage, visit WaHealthPlanFinder.org.

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