Health plan details

Get the details you need to feel informed and confident when selecting a Providence health plan. See an overview of general health plan terms, read plan limitations and view commonly asked questions.

Health plan basics

View definitions and explanations of health plan terminology so you can understand your health coverage and care.

Formulary (list of approved drugs)

The formulary is a list of brand-name, generic and specialty medications developed by physicians and pharmacists for the purpose of promoting safe, effective and affordable drug therapy. All medications on the Providence formulary have Food and Drug Administration (FDA) approval. The formulary can help you and your physician choose effective medications that minimize your out-of-pocket expense.

Limitations and exclusions

Review the most common exclusions and limits that apply to our plans, or view the complete list of exclusions.

Frequently asked questions

See answers to the most frequently asked questions about Providence individual and family health plans.

Summary of benefits and coverage

These are federally-required documents that provide basic benefit information for comparison purposes only.

Creditable coverage

Prescription drug benefits under Providence individual and family plan offerings meet or exceed the average benefits one would receive under standard Medicare Part D. (PDF)

Preventive care benefits

Review the list of covered preventive care benefits available to members of all ages. (PDF)

Understanding claims and billing processes

Get information to help you access care under your health insurance plan. Understand coordination of benefits, claim submissions, what's considered a medical necessity, prescription drug benefits, and more.