Providence Health Plans - Electronic Application

Providence knows that health care coverage is important to you and that you have unique coverage needs. That’s why they offer you a variety of plan options. You’ll find that each plan offers comprehensive coverage for a range of medical services.

Optimum Plans

The Optimum Plans provide the most comprehensive coverage and feature:

• $20 copay for doctor and specialists visits.
• $10 generic drugs and brand name drugs covered at 50 percent.
• Routine vision services.
• Deductible waived on all doctor office visits, urgent care, prescription drugs, and most preventive care services.
• Low out-of-pocket maximum: $2,500 individual or $7,500 family.
• Deductible waived for all covered services within 90 days of an accidental injury.
• Hospital, surgery, X-ray and laboratory services.
• A national network of participating providers.

Value Plans

The Value Plans offer similar coverage as Optimum Plans, but with slightly higher out-of-pocket costs. Value Plans feature:

• $20 copay for most doctor office visits.
• Prescription drugs covered at 50 percent.
• Routine vision services.
• Deductible waived on most doctor office visits, urgent care, prescription drugs and most preventive care services.
• Deductible waived on all covered services within 90 days of an accidental injury.
• Hospital, surgery, X-ray and laboratory services.
• A national network of participating providers.

Prime Plan

Our Prime Plan offers basic coverage for a lower premium. The Prime Plan includes:

• 50 percent coinsurance for all covered services.
• Receive covered services from an in-plan participating provider only. (Out-of-plan providers not covered.)
• Prescription drugs covered at $15 for generics, 50 percent coinsurance for brand name drugs.
• Deductible waived on most doctor office visits, urgent care, prescription drugs and most preventive care services.
• Hospital, surgery, X-ray and laboratory services for 50 percent coinsurance.

HSA Plan features

Providence HSA-Qualified Plans offer comprehensive medical benefits that feature:

• $20 copay for most doctor office visits.
• Prescription drugs covered at 50 percent.
• Deductible waived on most preventive care services
• Hospital, surgery, X-ray and laboratory services.
• Emergency and Urgent care.
• Vision services.
• A national network of participating providers.

Preventive Care

We believe that getting the right preventive care is essential for maintaining good health. All our plans cover many preventive care services prior to meeting your deductible, including:

• Men’s and women’s preventive care
• Well baby care
• Mammograms
• Periodic health examinations
• Immunizations/shots
• Annual women’s gynecological exams
• Prostate screening exams