The Member Resource Guide is a single resource you can use to take an active role in your health and engage with your health plan. It provides useful information about myProvidence, care options, and other programs available to Providence Health Plan members. 

• 2024 Member Resource Guide (PDF)
• 2025 Member Resource Guide (PDF)
• 2025 Member Resource Guide (Spanish) (PDF)

The Welcome Guide provides you with information about your plan and how to use your benefits.

New members, a guide will be mailed to you with your member ID card.

• 2024 Welcome Guide (PDF)
• 2025 Welcome Guide (PDF coming soon)

Health insurance is a contract between the person who buys health insurance (for example, an individual, employer, or association) and a health insurance company. You and/or your employer pay a premium — a specific amount of money — for your insurance coverage. In exchange, the health insurance plan pays all or a portion of the health care service cost. While no one plans on getting sick, it happens. Having health insurance helps pay for these costs and provides protection from very expensive medical services in the event care is needed.

There are a lot of plans, providers, and coverage options to choose from.

When you receive care from a provider, you may have to pay a copayment (a flat dollar amount) or a coinsurance (a percentage of the amount) for health care services such as an office visit, lab work or an X-ray.

You may have to meet a deductible each year before your health plan begins paying benefits.

In-network providers have an agreement with the health plan to participate as a health care provider for a given plan. Plan benefits are typically better when services are rendered by an in-network provider.

Plans typically have a calendar or plan year out-of-pocket maximum, which is the most you’ll pay for covered health services during the plan year.

After you receive care, the provider will submit a claim for services. Your health plan will send payment to the provider and will send you an Explanation of Benefits, which shows how the claim was paid. Read more about this via the EOBs explained link below. Your provider sends you a bill that shows what your health insurance company paid and what you still owe for the care received. It’s your responsibility to pay the provider the remaining balance.

Explanation of benefits (EOB) explained

There are a number of different types of medical plans. They are similar in that they cover many of the same services. Yet, they can differ greatly in:

• How much you pay for coverage (i.e., the health insurance premium)
• The amount you pay each year before the plan pays for covered services (i.e., the deductible)
• Provider choice

Here are 3 common types of medical plans:

• Health Maintenance Organization (HMO)
  Under an HMO, your health insurer gives you a list of primary care providers you can choose from. If the doctor you want to see is not part of the plan's network, you could see that doctor, but you may pay for the complete cost of care. Generally, your primary care provider also needs to refer you to a specialist if you want to see one. 
• Preferred Provider Organization (PPO) / Exclusive Provider Organization (EPO)
  A PPO plan provides more provider choice. You may go to any doctor you want, but visits are more affordable if you choose in-network providers. You do not need a referral to see a specialist. 
• High deductible plan + health savings account (HSA)
  Another health care option is a high-deductible health plan along with a health savings account (HSA). In exchange for having a higher deductible, you pay a lower monthly premium. After you sign up for a high-deductible plan, you may be eligible to open an HSA. You'll get a debit card when you open your HSA. Any time you need to pay for qualified medical expenses (for instance copays, prescription drugs), you can use your debit card to pay for the cost of care. Any money left over in your account at the end of the year rolls over to the following year. Plus, HSAs have some tax advantages and investment options for long term savings.

Learn more about HSA plans

Learn more about qualified medical expenses

Like any industry, health insurance has its own terminology.

Before you receive care, get to know what an insurance term or phrase means. The more you know, the more you can make the most of your benefits and your health.

Glossary of healthcare terms

There are several different types of integrated accounts including health savings accounts (HSAs), health reimbursement arrangements (HRAs), and flexible spending accounts (FSAs).

Your employer may have selected a healthcare account plan.

Whichever type is available to you, you can be assured that Providence Health Plan, along with our partner HealthEquity, is committed to ensuring that your enrollment, billing and claims are seamless. Explore the links below to see if one of these health accounts is right for you.

• Health Savings Account (HSA)
• Health Reimbursement Arrangement (HRA)
• Flexible Spending Account (FSA)
• Examples of qualified medical expenses
• Examples of non-qualified medical expenses

Your member materials indicate plan coverage and benefits, including any related to alternative care coverage. Log in to myProvidence to access plan materials.

1. Navigate to “My Health Plan”
2. Select “Benefits Documents” from the drop down menu

You also have access to discounts on acupuncture, chiropractic care, massage therapy, and dietitian services.

1. Navigate to “My Health”
2. Select “Member Perks” from the drop down menu 

Plan benefits and in-network providers

An alternative care provider can be a naturopath, chiropractor, acupuncturist, or massage therapist who is professionally licensed by the appropriate governmental agency to diagnose or treat an injury or illness, and who provides services within the scope of that license.

Plan benefits for alternative care services and provider networks vary. Please talk with your benefit administrator or refer to your member materials for information about your specific plan benefits. To find an in-network provider near you, please refer to the provider directory.

For assistance related to alternative care eligibility and benefits, call Providence Health Plan Customer Service at 503-574-7500 or 800-878-4445 (TTY: 711).

A healthy smile can help maintain overall health

Tooth decay is the leading childhood disease in America; yet, it’s completely preventable. A quality dental plan can mean better health, fewer sick days, and a better smile. Make the most of your child’s health with Providence pediatric dental plan benefits.

Pediatric dental benefits are included in many Providence health plans. To see if your medical plan includes pediatric dental benefits, view your member materials by logging into myProvidence.

1. Navigate to “My Health Tools”
2. Select “Benefits Documents” from the drop down menu

Dental benefits at a glance

If your health plan includes pediatric dental coverage, your enrolled dependents up to age 19 have access to:

• Preventive services (e.g., routine exams, bitewing X-rays, and cleanings) that are covered in full when services are received from an in-network dentist
• More than 210,000 in-network dentists across the nation
• No waiting periods

Need help getting started?

1. Review your member material, including your benefit summary, to confirm dental coverage and specific dental benefits. You’ll find your summary in our secure member website, myProvidence.
2. Visit the Delta Dental provider directory to locate an in-network dentist. Use filters such as specialty, plan network, and location to find a dentist.
3. Schedule an appointment with an in-network dentist.

Your health plan coverage may include vision benefits

If you have vision coverage, your member materials will indicate plan coverage and benefits. To view your health plan benefits, log in to myProvidence.

Providence Health Plan partners with VSP Vision Care, the only national not-for-profit vision company. VSP offers:

• The best care
• Low out-of-pocket costs
• Hundreds of frame options from classics to designer brands

How to use your VSP benefits

• Review your member material, including your benefit summary through myProvidence.
• Use the provider directory to locate an in-network provider. When searching for a provider, choose "routine vision services" from the Provider Type drop-down to the right of your search results.
• Schedule an appointment with your VSP provider. Tell the scheduler that you have VSP.

Tip: When you access care from a VSP provider, you’ll need your 17-digit VSP member ID number. Your VSP member ID is your Providence Health Plan member ID number* plus your Providence Health Plan Group number. Both numbers are located on the front of your member ID card. Be sure to provide all 17 digits when contacting VSP regarding eligibility, services, benefits or claims.

* Each plan participant has a unique member ID number. Be sure to reference or provide the card of the individual who is receiving services.

Other vision perks

As a Providence Health Plan member, you have access to discounts through Northwest Vision Associates and Visionworks. These discounts are available to you regardless of your medical plan selection. To learn more, visit Visionworks.com or call Visionworks at 800-669-1183.

Tips to take care of your eyes

There are things you can do to keep your eyes healthy. In addition to regular vision checkups, see what you can do.

Plan benefits and in-network providers

Vision benefits and provider networks vary by plan. Please talk with your benefit administrator or refer to your member materials for information about your specific plan benefits. Your benefit summary includes details regarding covered benefits, in-network providers and copays, coinsurance and deductibles.

Your health plan coverage may include a hearing aid benefit.

Hearing aids are considered medical equipment and are subject to plan requirements such as medical necessity, deductible(s), and network requirements.

Information about medical necessity, network requirements, and your plan coverage for medical equipment is included in your member materials. Log in to your myProvidence account to access member materials.

1. Navigate to “My Health Tools” 
2. Select “Benefits Documents” from the drop down menu

Providence Health Plan has partnered with TruHearing to provide members with affordable options for hearing aids.

To learn more about coverage for hearing aids and to locate a TruHearing provider, contact Providence Health Plan Customer Service at 503-574-7500 or 800-878-4445 (TTY: 711).

Why is preventive care so important?

• Preventive care allows you to detect potential health concerns early before a more serious health issue shows up.
• It’s much easier — and far less expensive — to address health problems now rather than to try to cure them once they occur.
• Learn more about how to make the most out or your preventive care options in our guide to preventive health care (PDF).