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| About Providence |
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Providence Health Plans (PHP) is pleased to be selected to provide health insurance to Oregon school district employees, ESDs and Community Colleges. We celebrate your service to students in the communities we serve and look forward to providing outstanding service to you.
Our medical plans offer comprehensive in-plan medical benefits providing members with low copays for preventive care, predictable out-of-pocket expenses and access to more than 10,000 doctors in Oregon and southwest Washington.
When you choose Providence Health Plan, you receive more than just health insurance; we provide peace of mind. At Providence, we don’t just talk about wellness, we are recognized as best in the nation at keeping our members well (tied with Harvard Pilgrim Health). We want you to receive the care you deserve, so in-plan copays to visit your doctor are $5, $10 or $25 depending on the plan selected. Preventive care services that people use most such as flu shots, mammograms or routine immunizations are covered in full in-plan.
You will also have access to online wellness tools to assess your current health status, understand any risks and put together an actionable plan for maintaining or improving your health.
We know accidents happen, so emergency room visits are a flat copay of $100; urgent care is $25 a visit. Just need some guidance or wondering if a medical issue requires a trip to the ER? Our ProvRN line is available 24 hours a day providing free advice to members.
Providence has a 150-year history of providing care in the northwest. We are a not-for-profit serving our members with Oregon-based, friendly four-star customer service. Give us a call to ask any questions before you make your OEBB choice at 1-800-633-1878. We’re here Monday through Friday, 8 a.m. to 5 p.m.
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| Types of Medical Plans |
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For the plan year beginning Oct. 1, 2009, Providence offers three medical plan options that feature in-plan low copays for physician visits, predictable hospital and ER copays and many covered-in-full benefits such as prevention services, lab and X-ray.
Alternative care such as chiropractic or naturopathic healers is available in-plan only.
Our mental health and chemical dependency benefits are covered like any other medically necessary services. The copay is the same as other medical services and no prior authorization is required for outpatient visits.
All of our plans offer low out-of-pocket maximums.
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| Receiving Care From Providers |
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Providence Health Plan members may receive medical care from any licensed physician, including out-of-plan providers. Providence Health Plan, however, pays higher benefits when care is received from an in-plan provider who contracts with Providence Health Plan. Alternative care must be provided in-plan to receive benefits.
You are free to see a specialist without a referral and many are in-plan. You can search by specialty on our online provider directory or call our customer service for help in finding a doctor.
Providence contracts with multiple physician networks to ensure that you have in-plan access in all 50 states. This means retirees or dependents living out-of-area have access to thousands of providers and benefits are paid in-plan when received from one of our national network of providers as well as when you are traveling.
While Providence Health & Services owns many hospitals and clinics in the Pacific Northwest, we also contract with many other providers. So you can choose a provider and facility that meets your needs. The Providence Health Plan network is much larger than just Providence-owned facilities.
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| Finding A Doctor |
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With most doctors in Oregon accepting Providence Health Plan, it’s likely the physician you know and trust is already on our plan. Search the Providence OEBB Provider Network or call us to check the physicians in your area.
Providence Health Plan provides in-plan access to more than 10,000 participating providers in Oregon and southwest Washington and access to an extensive national network of providers across 50 states.
- You have access to 57 of the top hospitals in Oregon and Southwest Washington.
- You can choose a doctor and see a specialist without a referral.
- Chiropractic and naturopathic healer benefits are in-plan only.
- For those in Eastern Oregon, you have in-plan access to St. Luke’s hospital and their employed physicians in Idaho.
- Out-of-network benefits apply when you see any non-participating provider.
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| Covered Benefits |
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Medical benefits
- Your in-plan benefits are available to you with no deductible. This means that your benefits start right away with Providence Health Plan, so you can get the care that you need.
- You have a choice to see in-plan and out-of-plan physicians (except alternative care); benefits are paid at higher levels when care is received from in-plan providers
- Many preventive care and diagnostic services, such as well baby exams, immunizations, lab services, X-rays and outpatient surgery, are covered in full in-plan.
- We want you to see your doctor, so office visit copays are $5, $10 or $25 when you see in-plan providers.
- You have access to in-plan specialists with no referral required.
Prescription drug benefits
- Prescription drug benefits have low retail copays of $5 for generic and $15 for formulary brand drugs with thousands of participating retail pharmacies across the state.
- A 90-day supply is available from our mail order or preferred retails such as Costco, Walgreens, Safeway, Fred Meyer, QFC or Yoke’s for $10 for generics and $30 for formulary brand drugs.
- Nonformulary drugs have a 50% copay.
- The plan year out-of-pocket maximum is $1,000 per person for our prescription drug plan.
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| Extra Values and Discounts |
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- Health Balance, Providence Health Plan’s health and wellness program, provides you with resources to learn more about your current health condition, put together a personalized health report and a motivational action plan and take health and fitness classes at reduced rates.
- Online tools via MyProvidence enable members to get online access to diagnoses, a medical cost estimator and claims information.
- You will receive a newsletter with articles and information about health, wellness and other topics that help you take best advantage of your health insurance. You can also sign up for Wellness Watch, our monthly email newsletter with current wellness topics.
- Free health advice is available when you need it, from local registered nurses 24 hours a day.
- You can receive exclusive discounts on recreational, and fitness activities, such as saving on monthly dues or initiation fees on gym memberships including 24 Hour Fitness and Ballys Total Fitness, through LifeBalance
- You can receive discounts on vision services through Binyons and TruVision.
- Digital hearing aids at a reduced price for you, parents and grandparents.
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| Dedicated OEBB Customer Service Resources |
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www.providence.org/oebb
(800) 633-1878
8 a.m. to 5 p.m., Monday through Friday PST
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| Frequently Asked Questions |
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To view some of Providence's most Frequently Asked Questions, click here: FAQ
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| Transition of Care |
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If you will be new to Providence Health Plan and are currently undergoing treatment for a serious health condition with an out-of-plan physician, we encourage you to complete the Transition of Care Form, sign and date it and fax the form to Providence Health Plan Medical Management.
To download the Transition of Care form, click here: Transition of Care
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| Healthcare Cost Calculator |
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Providence Health Plan’s Treatment Cost Estimator is available to its members on its secure member portal, "myProvidence" at www.providence.org/healthplans.
Members also can access the information over the phone by calling Providence Health Plan customer service at 503-574-7500 or 1-800-878-4445.
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