New applicants - get a quote

Beginning November 1, 2024, new applicants can apply online for Individual & Family coverage during the Open Enrollment Period.  

New applicants can also apply for Individual & Family coverage during the Open Enrollment Period, beginning November 1, 2024, using the enrollment forms below.

2025 Oregon Residents

Enrollment forms received between Nov. 1, 2024 – Dec. 31, 2024 will become effective January 1, 2025.

Enrollment forms received between Jan. 1, 2025 – Jan. 15, 2025 will become effective February 1, 2025.

• 2025 fillable application for Oregon Individual & Family insurance (PDF - Coming Soon)

2025 Washington Residents

Enrollment forms received between Nov. 1, 2024 – Dec. 15, 2024 will become effective January 1, 2025.

Enrollment forms received between Dec. 16, 2024 – Jan. 15, 2025 will become effective February 1, 2025.

• 2025 fillable application for Washington Individual & Family insurance (PDF - Coming Soon)

Need assistance?

For help with choosing an Individual & Family plan, please contact our sales team at 503-574-5000 or 800-988-0088 (TTY: 711), 8 a.m. to 5 p.m. (Pacific Time), Monday through Friday.

New applicants - Get a quote

We’ve made it easy to view plan options and get a quote for our health plans. New applicants can get a quote and enroll online by clicking the button below.  

Providence Health Plan Individual & Family plan Open Enrollment Period is closed.

New applicants that experience a qualifying event between Jan. 1, 2024 - Dec. 31, 2024 may enroll in a 2024 Individual & Family plan during a Special Enrollment Period, using the enrollment forms below.

2024 Oregon Residents

• 2024 fillable application for Oregon Individual & Family insurance (PDF)

2024 Washington Residents

• 2024 fillable application for Washington Individual & Family insurance (PDF)

Need assistance?

For help with choosing an Individual & Family plan, please contact our sales team at 503-574-5000 or 800-988-0088 (TTY: 711), 8 a.m. to 5 p.m. (Pacific Time), Monday through Friday.

Use the Transition of Care form when you experience a change of benefits and need assistance transitioning care for current or previous services received from a prior health plan.

• Transition of care request (PDF)

Most providers bill Providence Health Plan directly; however, if you must submit a medical claim to Providence, please use these forms: 

• Medical claim form (PDF) 
• Alternative care claim form (PDF)
  (Please have your provider complete the Alternative Care Claim Form)
• Medical travel reimbursement form (PDF)
• Oregon transplant travel reimbursement form (PDF)
• Washington transplant travel reimbursement form (PDF)
• Gene therapy and adoptive cellular travel reimbursement form (PDF)

Vision claim form

• VSP reimbursement form (PDF)
  (Use when services are rendered by a non-VSP provider)

For more information

Visit our claims and billing page to learn more about how we handle our processes.

• Prescription drug reimbursement request form (PDF)
• Prescription drug prior authorization form (PDF)
• Uniform prior authorization prescription request form (PDF)

Medical home selections only apply to Choice and Connect plan designs. If you're unsure if this applies to your Providence Health Plan coverage, please contact customer service at 503-574-7500 or 800-878-4445 (TTY: 711). 

• Medical home selection form (PDF)
• Formulario de Providence para la selección de hogar médico (PDF)