Member forms

Member authorization and privacy forms

Individual and family insurance plan forms

2020 Oregon plans

Providence Individual & Family Plan Open Enrollment is closed. If you have a qualifying event, you may shop, compare and enroll in a 2020 plan.

To make changes to your current 2020 coverage, 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.

2020 Washington plans

Providence Individual & Family Plan Open Enrollment is closed. If you have a qualifying event, you may enroll in a 2020 plan at WaHealthPlanFinder.org.

To make changes to your current 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