The 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 for PHP members. 

View or download

Member materials for contract years starting 1/1/24 through 12/31/24. Not sure? Ask your employer or call Customer Service.

Member ID card

Carry your member ID card with you as you’ll need it when you receive services. It includes important information, including your name, member ID number, medical plan, network information and important phone numbers.

2024 Benefit Summaries

Option Advantage Base (Custom) Plans

• Option Advantage Base 1000 (PDF)
• Option Advantage Base 1000 - Spanish (PDF)
• Option Advantage Base 2500 (PDF)
• Option Advantage Base 2500 - Spanish (PDF)
• Option Advantage Base 3500 (PDF)
• Option Advantage Base 3500 - Spanish (PDF)
• Option Advantage Base 4500 (PDF)
• Option Advantage Base 4500 - Spanish (PDF)
• Option Advantage Base 5000 (PDF)
• Option Advantage Base 5000 - Spanish (PDF)

Option Advantage Premium Plans

• Option Advantage Premium 500 (PDF)
• Option Advantage Premium 500 - Spanish (PDF)
• Option Advantage Premium 1000 (PDF)
• Option Advantage Premium 1000 - Spanish (PDF)
• Option Advantage Premium 1500 (PDF)
• Option Advantage Premium 1500 - Spanish (PDF)
• Option Advantage Premium 2500 (PDF)
• Option Advantage Premium 2500 - Spanish (PDF)
• Option Advantage Premium 3500 (PDF)
• Option Advantage Premium 3500 - Spanish (PDF)

Choice Plans

• Choice 1500 (PDF)
• Choice 1500 - Spanish (PDF)
• Choice 2000 (PDF)
• Choice 2000 - Spanish (PDF)
• Choice 3000 (PDF)
• Choice 3000 - Spanish (PDF)
• Choice 5000 (PDF)
• Choice 5000 - Spanish (PDF)
• Choice 6500 (PDF)
• Choice 6500 - Spanish (PDF)

Connect Plans

• Connect 500 (PDF)
• Connect 500 - Spanish (PDF)
• Connect 2000 (PDF)
• Connect 2000 - Spanish (PDF)
• Connect 3500 (PDF)
• Connect 3500 - Spanish (PDF)
• Connect 4000 (PDF)
• Connect 4000 - Spanish (PDF)

HSA Plans

• HSA 2000 (PDF)
• HSA 2000 - Spanish (PDF)
• HSA 3500 (PDF)
• HSA 3500 - Spanish (PDF)
• HSA 4150 (PDF)
• HSA 4150 - Spanish (PDF)
• HSA 6750 (PDF)
• HSA 6750 - Spanish (PDF)

Vision Plus Benefit

• Vision Plus (PDF)
• Vision Plus - Spanish (PDF)

Vision Premium Benefit

• Vision Premium (PDF)
• Vision Premium - Spanish (PDF)

Rx Benefit

• RX 10-15-45-75-200 (PDF)
• Rx 10-15-45-75-200 - Spanish (PDF)

EAP Benefits

• 3-visit Employee Assistance Program (PDF)
• 6-visit Employee Assistance Program (PDF)

Domestic Partner Benefit

• Domestic Partner Plus (PDF)
• Domestic Partner Plus - Spanish (PDF)

2024 Summaries of Benefits and Coverage

• Summaries of Benefits and Coverage (PDF) - Coming Soon

Vision Exam

• Option Advantage Base Vision Exam 1000 (PDF)
• Option Advantage Base Vision Exam 1000 - Spanish (PDF)
• Option Advantage Base Vision Exam 2500 (PDF)
• Option Advantage Base Vision Exam 2500 - Spanish (PDF)
• Option Advantage Base Vision Exam 3500 (PDF)
• Option Advantage Base Vision Exam 3500 - Spanish (PDF)
• Option Advantage Base Vision Exam 4500 (PDF)
• Option Advantage Base Vision Exam 4500 - Spanish (PDF)
• Option Advantage Base Vision Exam 5000 (PDF)
• Option Advantage Base Vision Exam 5000 - Spanish (PDF)

Vision Plus

• Option Advantage Base Vision Plus 1000 (PDF)
• Option Advantage Base Vision Plus 1000 - Spanish (PDF)
• Option Advantage Base Vision Plus 2500 (PDF)
• Option Advantage Base Vision Plus 2500 - Spanish (PDF)
• Option Advantage Base Vision Plus 3500 (PDF)
• Option Advantage Base Vision Plus 3500 - Spanish (PDF)
• Option Advantage Base Vision Plus 4500 (PDF)
• Option Advantage Base Vision Plus 4500 - Spanish (PDF)
• Option Advantage Base Vision Plus 5000 (PDF)
• Option Advantage Base Vision Plus 5000 - Spanish (PDF)

Vision Premium

• Option Advantage Base Vision Premium 1000 (PDF)
• Option Advantage Base Vision Premium 1000 - Spanish (PDF)
• Option Advantage Base Vision Premium 2500 (PDF)
• Option Advantage Base Vision Premium 2500 - Spanish (PDF)
• Option Advantage Base Vision Premium 3500 (PDF)
• Option Advantage Base Vision Premium 3500 - Spanish (PDF)
• Option Advantage Base Vision Premium 4500 (PDF)
• Option Advantage Base Vision Premium 4500 - Spanish (PDF)
• Option Advantage Base Vision Premium 5000 (PDF)
• Option Advantage Base Vision Premium 5000 - Spanish (PDF)

Vision Exam

• Option Advantage Premium Vision Exam 500 (PDF)
• Option Advantage Premium Vision Exam 500 - Spanish (PDF)
• Option Advantage Premium Vision Exam 1000 (PDF)
• Option Advantage Premium Vision Exam 1000 - Spanish (PDF)
• Option Advantage Premium Vision Exam 1500 (PDF)
• Option Advantage Premium Vision Exam 1500 - Spanish (PDF)
• Option Advantage Premium Vision Exam 2500 (PDF)
• Option Advantage Premium Vision Exam 2500 - Spanish (PDF)
• Option Advantage Premium Vision Exam 3500 (PDF)
• Option Advantage Premium Vision Exam 3500 - Spanish (PDF)

Vision Plus

• Option Advantage Premium Vision Plus 500 (PDF)
• Option Advantage Premium Vision Plus 500 - Spanish (PDF)
• Option Advantage Premium Vision Plus 1000 (PDF)
• Option Advantage Premium Vision Plus 1000 - Spanish (PDF)
• Option Advantage Premium Vision Plus 1500 (PDF)
• Option Advantage Premium Vision Plus 1500 - Spanish (PDF)
• Option Advantage Premium Vision Plus 2500 (PDF)
• Option Advantage Premium Vision Plus 2500 - Spanish (PDF)
• Option Advantage Premium Vision Plus 3500 (PDF)
• Option Advantage Premium Vision Plus 3500 - Spanish (PDF)

Vision Premium

• Option Advantage Premium Vision Premium 500 (PDF)
• Option Advantage Premium Vision Premium 500 - Spanish (PDF)
• Option Advantage Premium Vision Premium 1000 (PDF)
• Option Advantage Premium Vision Premium 1000 - Spanish (PDF)
• Option Advantage Premium Vision Premium 1500 (PDF)
• Option Advantage Premium Vision Premium 1500 - Spanish (PDF)
• Option Advantage Premium Vision Premium 2500 (PDF)
• Option Advantage Premium Vision Premium 2500 - Spanish (PDF)
• Option Advantage Premium Vision Premium 3500 (PDF)
• Option Advantage Premium Vision Premium 3500 - Spanish (PDF)

Vision Exam

• Choice Vision Exam 1500 (PDF)
• Choice Vision Exam 1500 - Spanish (PDF)
• Choice Vision Exam 2000 (PDF)
• Choice Vision Exam 2000 - Spanish (PDF)
• Choice Vision Exam 3000 (PDF)
• Choice Vision Exam 3000 - Spanish (PDF)
• Choice Vision Exam 5000 (PDF)
• Choice Vision Exam 5000 - Spanish (PDF)
• Choice Vision Exam 6500 (PDF)
• Choice Vision Exam 6500 - Spanish (PDF)

Vision Plus

• Choice Vision Plus 1500 (PDF)
• Choice Vision Plus 1500 - Spanish (PDF)
• Choice Vision Plus 2000 (PDF)
• Choice Vision Plus 2000 - Spanish (PDF)
• Choice Vision Plus 3000 (PDF)
• Choice Vision Plus 3000 - Spanish (PDF)
• Choice Vision Plus 5000 (PDF)
• Choice Vision Plus 5000 - Spanish (PDF)
• Choice Vision Plus 6500 (PDF)
• Choice Vision Plus 6500 - Spanish (PDF)

Vision Premium

• Choice Vision Premium 1500 (PDF)
• Choice Vision Premium 1500 - Spanish (PDF)
• Choice Vision Premium 2000 (PDF)
• Choice Vision Premium 2000 - Spanish (PDF)
• Choice Vision Premium 3000 (PDF)
• Choice Vision Premium 3000 - Spanish (PDF)
• Choice Vision Premium 5000 (PDF)
• Choice Vision Premium 5000 - Spanish (PDF)
• Choice Vision Premium 6500 (PDF)
• Choice Vision Premium 6500 - Spanish (PDF)

Vision Exam

• Connect Vision Exam 500 (PDF)
• Connect Vision Exam 500 - Spanish (PDF)
• Connect Vision Exam 2000 (PDF)
• Connect Vision Exam 2000 - Spanish (PDF)
• Connect Vision Exam 3500 (PDF)
• Connect Vision Exam 3500 - Spanish (PDF)
• Connect Vision Exam 4000 (PDF)
• Connect Vision Exam 4000 - Spanish (PDF)

Vision Plus

• Connect Vision Plus 500 (PDF)
• Connect Vision Plus 500 - Spanish (PDF)
• Connect Vision Plus 2000 (PDF)
• Connect Vision Plus 2000 - Spanish (PDF)
• Connect Vision Plus 3500 (PDF)
• Connect Vision Plus 3500 - Spanish (PDF)
• Connect Vision Plus 4000 (PDF)
• Connect Vision Plus 4000 - Spanish (PDF)

Vision Premium

• Connect Vision Premium 500 (PDF)
• Connect Vision Premium 500 - Spanish (PDF)
• Connect Vision Premium 2000 (PDF)
• Connect Vision Premium 2000 - Spanish (PDF)
• Connect Vision Premium 3500 (PDF)
• Connect Vision Premium 3500 - Spanish (PDF)
• Connect Vision Premium 4000 (PDF)
• Connect Vision Premium 4000 - Spanish (PDF)

Vision Exam

• HSA Vision Exam 2000 (PDF)
• HSA Vision Exam 2000 - Spanish (PDF)
• HSA Vision Exam 3500 (PDF)
• HSA Vision Exam 3500 - Spanish (PDF)
• HSA Vision Exam 4150 (PDF)
• HSA Vision Exam 4150 - Spanish (PDF)
• HSA Vision Exam 6750 (PDF)
• HSA Vision Exam 6750 - Spanish (PDF)

Vision Plus

• HSA Vision Plus 2000 (PDF)
• HSA Vision Plus 2000 - Spanish (PDF)
• HSA Vision Plus 3500 (PDF)
• HSA Vision Plus 3500 - Spanish (PDF)
• HSA Vision Plus 4150 (PDF)
• HSA Vision Plus 4150 - Spanish (PDF)
• HSA Vision Plus 6750 (PDF)
• HSA Vision Plus 6750 - Spanish (PDF)

Vision Premium

• HSA Vision Premium 2000 (PDF)
• HSA Vision Premium 2000 - Spanish (PDF)
• HSA Vision Premium 3500 (PDF)
• HSA Vision Premium 3500 - Spanish (PDF)
• HSA Vision Premium 4150 (PDF)
• HSA Vision Premium 4150 - Spanish (PDF)
• HSA Vision Premium 6750 (PDF)
• HSA Vision Premium 6750 - Spanish (PDF)

Member materials for contract years starting 1/1/23 through 12/31/23. Not sure? Ask your employer or call Customer Service.

Member ID card

Carry your member ID card with you as you’ll need it when you receive services. It includes important information, including your name, member ID number, medical plan, network information and important phone numbers.

2023 Benefit Summaries  

Option Advantage Premium Plans

• Option Advantage Premium 500 (PDF)
• Option Advantage Premium 500 - Spanish (PDF)
• Option Advantage Premium 1000 (PDF)
• Option Advantage Premium 1000 - Spanish (PDF)
• Option Advantage Premium 2000 (PDF)
• Option Advantage Premium 2000 - Spanish (PDF)
• Option Advantage Premium 3000 (PDF)
• Option Advantage Premium 3000 - Spanish (PDF)
• Option Advantage Premium 5000 (PDF)
• Option Advantage Premium 5000 - Spanish (PDF)
• Option Advantage Premium 6500 (PDF)
• Option Advantage Premium 6500 - Spanish (PDF)

Choice Plans

• Choice 1500 (PDF)
• Choice 1500 - Spanish (PDF)
• Choice 2000 (PDF)
• Choice 2000 - Spanish (PDF)
• Choice 3000 (PDF)
• Choice 3000 - Spanish (PDF)
• Choice 6500 (PDF)
• Choice 6500 - Spanish (PDF)

Connect Plans

• Connect 500 (PDF)
• Connect 500 - Spanish (PDF)
• Connect 2000 (PDF)
• Connect 2000 - Spanish (PDF)
• Connect 3000 (PDF)
• Connect 3000 - Spanish (PDF)
• Connect 4000 (PDF)
• Connect 4000 - Spanish (PDF)
• Connect 6500 (PDF)
• Connect 6500 - Spanish (PDF)

HSA Plans

• HSA 2000 (PDF)
• HSA 2000 - Spanish (PDF)
• HSA 3500 (PDF)
• HSA 3500 - Spanish (PDF)
• HSA 4000 (PDF)
• HSA 4000 - Spanish (PDF)
• HSA 6750 (PDF)
• HSA 6750 - Spanish (PDF)

HSA Connect Pan

• HSA Connect 4000 (PDF)
• HSA Connect 4000 - Spanish (PDF)

Vision Plus Benefit

• Vision Plus (PDF)
• Vision Plus - Spanish (PDF)

Vision Premium Benefit

• Vision Premium (PDF)
• Vision Premium - Spanish (PDF)

RX Benefit

• RX 10-15-45-75-200 (PDF)
• RX 10-15-45-75-200 - Spanish (PDF)

EAP Benefits

• 3-visit Employee Assistance Program (PDF)
• 6-visit Employee Assistance Program (PDF)

Domestic Partner Benefit

• Domestic Partner Plus (PDF)
• Domestic Partner Plus - Spanish (PDF)

We know behavioral health care isn’t a one-size-fits-all solution. We’re all unique, and our journey and needs vary depending on our personal situation. At Providence, we want that lens to drive us when looking at the mix of services and solutions we offer for your well-being. Whether you’re looking for some support to relax, ready to try self-directed therapy that helps you to engage when you feel like it, or looking for immediate connection to a provider – via text, voice, video or face to face – we have many options to fit your needs.

Formulary

Providence Health Plan provides a comprehensive prescription drug formulary designed to promote safe, effective and affordable drug therapy.

Tips to help you save when you need a prescription

• Choose generics when possible.
• Use a participating retail pharmacy; refer to the online provider directory
• Fill medication taken on a regular, recurring basis for a chronic or long-term health condition (i.e., “maintenance medication”) at a preferred retail or mail-order pharmacy. You can purchase up to a 90-day supply.
• Have certain medications prior-authorized (see prior authorization below for more information).
• If you take an eligible specialty medication, the Smart RxAssist program (available on 1/1/24) helps lower your out-of-pocket costs to $0.
• The list of medications eligible for this program is available here.
• There is no cost to you for participating in the Smart RxAssist program.
• You are automatically enrolled in the program if you take an eligible specialty medication in the Smart RxAssist program.
• If you are filling an eligible medication in the Smart RxAssist program, a Patient Advocate may reach out to you to complete program enrollment.
• Medications eligible for the program are subject to change.
• Because this program provides a $0 cost not subject to the deductible, the tax laws regarding a health savings account make this program unavailable to those enrolled in the Health Savings Account (HSA) medical plan.

Participating pharmacies

As a member, you have access to more than 36,000 participating pharmacies, including retail, preferred retail, mail-order and specialty. Find one in our online provider directory.

Mail-order pharmacy:

Postal Prescription Services
Website: www.ppsrx.com
503-797-2100 or 800-552-6694
Monday to Friday, 6 a.m. to 6 p.m.; Saturday, 9 a.m. to 2 p.m. (Pacific Time)
Mailing address: P.O. Box 2718, Portland, OR 97208
Automated refill line available 24/7, 365 days a year: 800-552-6694

Pharmacy FAQ

Get answers to frequently asked questions about prescription drug coverage, prior authorization, using the formulary, and specialty medication.

Costco Home Delivery

As a Providence Health Plan member, you have access to full-service mail-order prescription services through Costco Home Delivery. Costco Home Delivery offers affordable prescriptions, outstanding customer service and free standard shipping on all orders. You may also call a pharmacist for consultation any time during business hours.

Who is eligible?

Costco Home Delivery will verify your eligibility when you register. All covered members and their qualified dependents have access to this mail order pharmacy. For non-Medicare and non-Medicaid plans, your network provisions may require the use of just one mail order pharmacy for coverage. Please call the Providence Health Plan Pharmacy Department at 877-216-3644 if you have questions.

Order prescriptions by mail

• Register with Costco Home Delivery online at www.costco.com/Pharmacy/home-delivery
• Costco pharmacy agents are available at 800-607-6861, 5 a.m. to 7 p.m. (Pacific Time), Monday - Friday, 9:30 a.m. to 2 p.m. (Pacific Time), Saturday
• Your doctor may also fax in new or refill orders at 800-633-0334
• Refer to your prescription drug benefit summary for plan details

Costco contacts, FAQ, and how-to guide

• www.costco.com/Pharmacy/home-delivery
• Costco FAQ

Contact information

Mon – Fri 5 a.m. to 7 p.m. PT, Sat 9:30 a.m. to 2 p.m. PT,
Pharmacy is available 24/7 to refill prescriptions, order new prescriptions and check prescription status.

Phone:
800-607-6861

Fax:
800-633-0334

Mailing address:
802 134th St. SW Ste 140, Everett, WA 98204-7314

Contact Costco Home Delivery Pharmacy email:

mail to: webpharmacy@costco.com

Costco Home Delivery contracts with Providence Health Plan as a participating pharmacy for members. You are responsible for arrangement of services and/or payment of services directly to Costco Home Delivery.

Certain services require a prior authorization before you receive care, meaning that before you receive care, the service must be pre-approved by Providence Health Plan. Here’s what you should know about prior authorization:

Certain services need to be approved before you receive them from a health care provider.
Sometimes you need to get the prior authorization; sometimes your provider will get the approval. 

Make sure to discuss prior authorization with your provider when you are considering one of the following procedures:

• Inpatient hospital admissions, including maternity
• High tech diagnostic imaging, such as MRI, MRA, SPECT, CT, CTA, PET, Nuclear Cardiology (Carelon Medical Benefits Management (formerly American Imaging Management) authorizes these services; contact Carelon at 800-920-1250)
  
  
  • Effective March 1, 2023, American Imaging Management/AIM Specialty Health and Beacon Health Options changed their names to Carelon. AIM transitioned to Carelon Medical Benefits Management, and Beacon Health Options transitioned to Carelon Behavioral Health. If you have questions about this change, please call 800-878-4445 or click here to learn more.
• Mental Health and/or Chemical Dependency services (PBH, a team of experts in mental health – sometimes called "behavioral health," is the authorizing agent: 800-711-4577)
• Outpatient Rehab for Physical and Occupational Therapy: 866-803-8052 www.evicore.com/pages/ProviderLogin.aspx
• Select outpatient procedures, included but not limited to these categories:
  
  
  • Miscellaneous cosmetic, reconstructive, nasal, oral/dental/orthognathic procedures
  • Cervical, thoracic and lumbar spinal surgeries
  • All bariatric services
  • Organ/tissue and bone marrow transplants (including pre-transplant evaluations and HLA typing)
  • Uvulectomy, uvulopalatophyaryngoplasty (UPPP), laser-assisted uvulopalatoplasty (LAUP)
  • Select hip, knee and shoulder procedures
  • Sleep studies and/or treatment of sleep disorders
• Skilled nursing facility admissions
• Inpatient rehabilitation facility admissions
• Inpatient hospice
• Pulmonary rehabilitation
• Cardiac rehabilitation
• General anesthesia for dental services
• Procedures/surgeries/treatment that may be considered experimental or investigational
• Genetic testing (Cytogenetic Studies) and counseling
• Neuropsychological testing
• Prosthetics
• Select Durable Medical Equipment including but not limited to the following categories:
  
  
  • Power-wheel chairs & supplies
  • Seat Lift Mechanisms
  • Select nerve stimulators
  • Skin substitutes
  • Oral appliances
  • Flexion/Extension devices
  • Wound Therapy pumps
  • Speech Generating devices
  • Purchase of CPAP post trial rental period
• Select injectable medications also require prior authorization. See your pharmacy medical services prior-authorization list (PDF) for details.
  
  

The list of services needing prior authorization is not exhaustive. For a complete list of services that require prior authorization, please contact PHP customer service at 800-878-4445.

Important information about how prior authorization works

Talk with your provider about getting prior authorization. Many times a provider will obtain the prior authorization on your behalf. You can call Providence Health Plan customer service at 800-878-4445 to verify if prior authorization has been obtained. If you do not obtain prior authorization for services received from an out-of-network provider, a financial penalty may apply.

The following tips can help you stay well and save on health care costs.

Tip 1: Use your preventive care benefits
Your plan covers certain preventive services in full when received from an in-network provider.

Tip 2: Choose in-network providers and pharmacies
Refer to the online provider directory to locate in-network providers and participating pharmacies.

Tip 3: Use preferred retail or mail order pharmacies to fill 90-day supplies of maintenance medication
Purchase up to a 90-day supply of maintenance medications using a participating mail-order pharmacy or a preferred retail pharmacy. Not all drugs are considered maintenance prescriptions, including compounded drugs, drugs from specialty pharmacies and oncology drugs. Learn more about this in the pharmacy resources section of this page.

Tip 4: Access the most appropriate care
Knowing when and where to get care is essential to your health and your wallet.

Learn about your care options here.

Tip 5: Compare costs
Before receiving care, log in to myProvidence and use the treatment cost calculator to learn about a facility or doctor, and the estimated costs of your treatment. You can also compare medical facilities to make sure you’re getting the best care at the best price. The costs are customized to you based on your plan benefits, the providers in your plan’s network and how much you’ve accumulated toward your deductible and out-of-pocket maximum.

Extra values and discounts

You can enjoy many perks when you’re enrolled in a Providence Health Plan. Here are just a few extras values and discounted services just for members.

ProvRN offers 24/7 medical advice from registered nurses who can evaluate your symptoms to help determine your next steps for care. Exclusive to Providence Health Plan members, it's free and available when you need it. Contact ProvRN by phone at 503-574-6520 or 800-700-0481 (TTY: 711).

LifeBalance offers savings on health club memberships, fitness classes, massage therapy, weight loss programs, recreational, cultural and wellness events, family activities, movies, travel and more. Log in or register for a free myProvidence account to access discounts through LifeBalance. 

Wellness resources

Smoking cessation
Smoking is a powerful addiction. Quitting takes practice, patience and support. You can get the help you need with one of our award-winning support groups and telephone counseling programs:

• Tobacco quit line - A free telephone service to help you develop a personalized quit plan and find counseling and resources in your area. Call 1-800-QUIT-NOW or 877-2NO-FUME (Spanish).
• Free & Clear - A telephone-based program designed for smokers who want a structured program, but cannot attend regular classes. Call 800-292-2336.