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Domestic Partner Application Instructions
Providence Health Plan is accepting applications for health care coverage with effective date of April 1, 2008 and beyond.
If you are an Oregon Registered Domestic Partner applying for health care coverage, please download our Individual & Family Plan application (PDF 214kb) and follow these additional instructions:
- Page 2, Step 1: indicate that you are applying for coverage for "myself and my family"
- Page 3, Step 4: fill out lines 1 and 2 for yourself and your domestic partner
- Page 3, Step 4: write "domestic partner" in space provided to indicate your relationship
- Page 10, Acceptance of Enrollment Procedure: sign and date the application for you and your domestic partner in the same manor as indicated for applicant and spouse.
Providence Health Plan's Definition of Domestic Partner
A Domestic Partner is:
- At least eighteen (18) years of age; and
- Has entered into a domestic partnership with a member of the same sex; and
- Has legally registered a Declaration of Domestic Partnership and obtained a Certificate of Registered Domestic Partnership in accordance with Oregon state law.
Note: All provisions of the Individual Contract that apply to a spouse shall apply to a Domestic Partner.
Questions?
For specific information about plan benefits, enrollment requirements, limitations and exclusions, call Providence Individual & Family Plan Sales Team at 503-574-5000 or 1-800-988-0088, Monday – Friday, 8 a.m. to 6 p.m
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