Providence Health Plans

Providence Health Plans began in 1875, founded as the Sisters of Providence in Canada. Providence Health Plans was officially established in 1984 as an HMO to deliver integrated medical care through Providence Health and Services. Providence is available to residents of Oregon and southwest Washington State. The company currently provides its services to businesses, Medicare and Medicaid recipients, individuals, and families.

Though originally offering HMO products, Providence Health Plans has now shifted into a PPO-based line of services. In creating a more flexible choice for members to keep up with its competitors, the new Preferred Provider Organization model gives many more options and the same great in-network benefits.

Providence Health Plans serves over 326,000 members, including more than 50,000 Medicare beneficiaries and 35,000 Medicaid recipients.


Providence Health Plans Recognition

Rated the best customer service of any health insurance provider in Oregon by members, Providence received this honor from a National Committee for Quality Assurance (NCQA) survey in 2009.

Providence has also been recognized nationally for providing their members with exceptional medical coverage, with a broad range of services from disease management to environment stewardship.


Providence Health Plans for Individuals & Families

Optimum Plans

  • With deductible options between $1000 and $10,000, these plans offer the most comprehensive coverage of any Providence plan.
  • Without a waiting period, these plans offer doctor and specialist visits for a $20 copay.
  • Generic prescriptions are a $10 copay, and brand names are covered at 50 percent.
  • Preventive care covered in full
  • Routine vision care.
  • Deductible waived on doctor’s office visits, urgent care, prescription drugs, and certain preventive care services.
  • Deductible waived forĀ  all covered services within 90 days of an accidental injury
  • Out-of-pocket maximum of $4000 for individuals and $12,000 for families.
  • A national network of participating providers.

Value Plans

  • Lower premiums and higher out-of-pocket costs
  • $30 copay for most doctor’s office visits as soon as your plan starts.
  • Some preventive care covered at 100 percent.
  • Routine vision care.
  • Deductible waived on most physician services, urgent care, and select types of preventive care.
  • Deductible waived on all covered services within 90 days of accidental injuries.
  • Hospital, surgery, laboratory and X-ray services covered.
  • A national network of participating providers.

Prime Plans

  • Basic coverage for a low premium.
  • 50 percent coinsurance on all covered care.
  • In-network care only will be covered by your plan.
  • Select types of preventive care covered in full.
  • Deductible waived on most doctor’s office visions and certain preventive services.
  • Surgery, hospital, X-ray and laboratory services for 50 percent coinsurance.

HSA-Qualified Plans

  • Certain preventive care services covered at 100 percent.
  • A national network of participating providers.
  • Hospital, surgery, X-ray and laboratory services.
  • Prescriptions covered at 50 percent.
  • Routine vision care.
  • Emergency and urgent care.
  • Financial flexibility in using your health savings account for qualified medical expenses.

Providence Health Plans Individual Plans Brochure