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Calendar year
Marks the time beginning January 1 and ending December 31.
Coinsurance
The percentage of cost that you must pay for a covered service.
Contract year
Refers to the time period of our specific Providence Individual and Family Plan contract; Nov. 1 to Oct. 31.
Copayment
A dollar amount you must pay to a health care provider at the time you receive service.
Deductible
The amount you pay for certain covered services before the plan begins to pay for these services. A new deductible must be met each calendar year.
Dependent
A person who is supported by the policyholder or policyholder's spouse.
Domestic Partner
A domestic partner, as defined by Providence Health Plan, is at least 18 years of age; 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.
Effective date of coverage
The date when coverage starts for a newly enrolled health plan member.
Lifetime maximum benefit
The total dollar amount of benefits payable under the Plan Contract during the lifetime of a member.
Member
A policyholder, eligible spouse or dependent who is enrolled in the plan.
Non-participating provider
A provider or facility with no agreement to participate with Providence Health Plan. When using nonparticipating providers you receive "Out-of-Plan" benefits.
Participating provider
A provider or facility with an agreement to participate with Providence Health Plan. When you use participating providers you receive "In-Plan" benefits and have less costs.
Plan Contract
The legal agreement between the policyholder and Providence Health Plan, detailing plan benefits, enrollment requirements and information about your coverage.
Policyholder
The person to whom the Plan Contract has been issued. A policyholder must be age 18 or older. If enrolling for dependent-only coverage, the parent/guardian applying will be the policyholder.
Premium
The monthly rate you pay for health plan coverage.
Pre-existing condition
Any medical condition for which medical advice, diagnosis, care or treatment was recommended or received within six months prior to effective date of coverage.
Service area
The geographic area in Oregon, where the policyholder, spouse of policyholder or child-only member must physically reside to qualify for coverage.
Summary of Benefits
A description of your plan benefits, copayments/coinsurance, deductibles and out-of-pocket maximums and is part of your Plan Contract.
Usual, Customary And Reasonable (UCR) Charges
Charges for services provided by nonparticipating providers, UCR means charges billed by providers with similar training and experience.

LifeBalance

Recreational discounts on cultural activities and events.