Member authorization and privacy forms
2019 change forms for individual and family insurance plans
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
Most providers bill Providence Health Plan directly; however, if you must submit a medical claim to Providence, please use these forms:
Medical home selection
Health education reimbursement