New for 2017

Benefit changes for 2017 plans

  • Providence Express Care Virtual (previously named Health eXpress) will be covered in full on most plans (deductible applies for HSA plans).
  • Providence Progressive Dental Plan rates reduced from $32 to $30 pmpm.  Preventive services don’t go towards annual maximum benefit. Reminder: Dental can’t be purchased via the FFM. Dental enrollment must match medical enrollment.
  • Out of network services:  UCR now 70th percentile on all plans. Deductible and out-of-pocket maximum are now 4X out-of-network for all plans.
  • The 12-month exclusionary period for elective procedures has been removed.
  • Standard plans are available statewide but rates for Standard plans vary by region; the benefits for Standard are the same statewide. The Providence Health Plan Standard plan market names vary slightly by region in 2017.
  • Choice, Balance, HSA Qualified and Connect are available in select counties.
  • For Balance Bronze and Connect Bronze plans, the deductible applies to X-ray/lab and specialist visits.
  • Providence Essential plan and Healthy Rewards (the $100 gift card incentive for completing the PHI and online health workshops) have been discontinued.

New application effective dates

  • The 15th of the month effective date is discontinued. Effective dates will be the 1st of the month.
  • Applications received after the 15th will be assigned the effective date of the 1st of the second following month. If the premium is paid prior to the 22nd of the current month, the member can have the 1st of the next month’s effective date. Example: Application received on December 16 will be assigned February 1 effective date. Premium must be paid by December 22 to receive a January 1 effective date.
  • In order for coverage to begin on (date assigned) we must receive payment prior to (date assigned), or within 14 days of the date of the request for payment letter, whichever is later.
  • Note that due to increased sensitivity to handling credit card numbers over the phone, we are strongly encouraging applicants and members to primarily use online credit card and check payment options.
  • If the effective date falls on a non-business day, binder payments will be accepted on the next business day (same as FFM).

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