Providence Individual and Family Plans Frequently Asked Questions

• Who can apply for coverage?
• Can I apply for coverage for my entire family?
• What determines the amount of my monthly premium?
• Can my employer pay the premium for my policy?
• Do I have coverage while I am at work?
• Will my premium change?
• How can I reduce my premium?
• Will I be charged more if I use an insurance agent?
• Do I include any payment with my application?
• How long does it take to process my application?
• Are all applications for coverage approved?
• What are my choices for coverage if you do not approve my application?
• When does my coverage begin?
• How do I pay for my coverage?
• How do I apply for a Health Savings Account (HSA)?
• What if I decide to add a dependent later after I'm enrolled on the plan?
• Can I change to a different plan type after I'm enrolled?

Oregon residents living in our service area who are under age 65 and not eligible for Medicare. Our Oregon service area includes: the Portland Metro, Willamette Valley, Hood River and Central Oregon areas. See our Service Area Map (PDF 540kb).

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Yes. Eligible dependents include your spouse and unmarried dependent children under age 23. If your dependent is no longer eligible to enroll for coverage as a family dependent, he or she can apply for coverage as the policyholder on a separate individual plan.

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Your monthly premium is determined by the health plan option that you choose and your age.

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To be in compliance with Oregon state law, it is the policy of Providence Health Plan to not accept premiums from employers for individual health coverage.

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If you are not required to have coverage through the Workers' Compensation Act or similar law, your health plan benefits will apply 24 hours a day, seven days a week.

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Premiums for individual plans are subject to an annual rate change. This usually is in November for our Oregon plans. You also may experience a rate change as you get older and move from one age category to another.

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Usually your premium can be reduced by switching to a plan with a higher deductible or from an Open Option Optimum Plan to an Open Option Value Plan.

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Your monthly premium is the same, whether or not you use an insurance agent. The agents we appoint to represent Providence Health Plan have a thorough knowledge of the coverage we offer. They can help you make the right choice for your coverage needs.

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Please do not include any payment with your application. We will invoice you for your first month's premium once your application is approved and you decide to accept our offer of coverage.

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If you apply online, we will notify you about the status of your application within 1-5 business days from the date your application is submitted. If you apply by mail, you will be notified about the status of your application within 7-10 business days from when we receive it. Sometimes we need to request additional information to process your application. If this happens, we will let you know about the additional delay.

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Not all applications are approved for coverage. Sometimes coverage is not offered, based on our review of the health statement.

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If your application is not approved, you may be eligible for insurance through the Oregon Medical Insurance Pool (OMIP). For more information call them at 1-800-848-7280 or visit their Web site at: http://www.omip.state.or.us

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If your application is approved, your coverage will begin either the first or 15th of the month following approval. You also can request a later date to begin your coverage, up to 70 days from the date you submit your application.

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Your premium is billed monthly. For your initial premium payment, you can pay by credit card, eCheck or personal check. For subsequent monthly payments, automatic credit card payment is available or we can send you a monthly billing statement. When we approve your application for coverage, we'll send you additional details about your billing choices.

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Before you can apply for an HSA you must be approved for coverage and enrolled in our Providence Open Option HSA Plan. HSAs are managed by HSA trustees, usually a bank or other financial institution. You choose the bank that will administer your HSA. For HSA information, you should consult the bank administering your HSA. For your convenience, we have partnered with U.S. Bank, an FDIC-insured financial institution.

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You can add your spouse or dependent children to your plan at any time by completing another application form. If you add a newborn or recently adopted child to your plan within 60 days of the event, there is no need for you to complete the health statement section on the application form.

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Yes. But some limits may apply for how many times you can make a change and when you may change. Depending on the type of change, you also may need to complete a new health history statement.

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