Member forms

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