Providence Individual and Family Plans Frequently Asked Questions

• Who can apply for coverage?
• Can I apply for coverage for my entire family?
• Can my employer pay my premium?
• Do I have coverage while I am at work?
• Will my premium change?
• Will I be charged more if I use an insurance agent?
• How do I pay for my coverage?
• When does my coverage begin?
• How long does it take to process my application?
• Are all applications for coverage approved?
• What if you do not approve my application?
• Can I add a dependent after I'm enrolled?
• How does Providence Health Plan protect my privacy?

Oregon residents who live in our service area (PDF 540kb), are under age 65 and not eligible for Medicare.

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Yes. Eligible dependents include your spouse and unmarried dependent children under age 23. If a family member does not qualify as an eligible family dependent, he or she can apply on a separate individual plan.

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In compliance with Oregon state law, Providence Health Plan does not accept premiums from employers for individual health coverage.

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Our plans provide coverage 24 hours a day, seven days a week. You will be covered while you are working, unless you are required to have coverage through Workers' Compensation Act or similar law.

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Premiums are subject to an annual rate change, usually in November. Your premium may change as you move to a new age category.

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No, your monthly premium is the same, whether or not you use an insurance agent. The agents we appoint to represent Providence Health Plan have thorough knowledge of the coverage we offer.

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We will invoice you for your first month's premium once your application is approved and you accept our offer of coverage. Your premium is billed monthly, either by an automatic credit card payment or by mail.

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

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If you apply online, you will be notified of your application status 1-5 business days from the date you submit online. If you apply by mail, you will be notified of your application status 7-10 business days from the date we receive it. If we request additional information to process your application, we notify you of the additional delay.

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Not all applications are approved for coverage. Sometimes coverage is not offered, based on our review of your 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) at 1-800-848-7280 or http://www.omip.state.or.us

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Yes. You can add your spouse or dependent children by completing a new application. If you add a newborn or adopted child within 60 days, you do not need to complete a new health statement.

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We respect the privacy of our members and applicants, and have policies regarding your protected health information:

• When you complete and sign your application, you agree that your health information may be released to determine eligibility for enrollment.
• Once enrolled for coverage, your agreement enables us to share your health information to administer your plan benefits and pay medical claims.
• We also may share information with your doctors or hospitals to provide medical care to you.

Please refer to our Notice of Privacy Practices for uses and disclosures of protected health information, including those required by law.

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