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Providence Health Insurance Company

Dino Christoforakis
Dino Christoforakis

Editor in Chief & Licensed Insurance Agent.

Providence Health Insurance operates under Providence Health Plan and is part of Providence Health & Services. Run by the Sisters of Providence, its history dates back over 160 years to Montreal, Quebec, Canada in 1843. Currently based in Oregon and serving Oregon and southwest Washington, Providence Health Plan is a not for profit health insurance organization. Read this Providence Health Insurance Company Review and then enter your zip code in above to start comparing health insurance quotes online!

The History of Providence Health Insurance

In 1856, a group of Sisters of Providence moved from Montreal to Washington territory under the direction of Mother Joseph of the Sacred Heart. Once they arrived, they began caring for the ill as well as for elderly women and children that were orphaned. This nurturing took place in what was called The Providence Enclosure and then in 1858 they opened Saint Joseph Hospital.

In 1984 a Health Maintenance Organization (HMO) formed between Providence Portland Medical Center and Saint Vincent Medical Center. One year later, Physician InterHospital Plan, known as The Good Health Plan, was approved by the United States Department of Health and Human Services. By 1987 the Sisters of Providence in Oregon established a new care system that included both HMO’s and Preferred Provider Networks (PPO’s).

Later, in 1997, Oregon health plans merged with Washington health plans and The Good Health Plan became Providence Health Plan. Providence Health Plan’s membership reached 326,000 by the year 2000, which included over 50,000 Medicare members and more than 35,000 Medicaid members. With their commitment to care for those most at risk in society, they continued to move away from HMOs toward PPOs and Point of Service (POS) plans. Today they offer a variety of commercial plans, individual and family coverage, Medicaid, and Medicare.

Rated “A” from A.M. Best, Providence Health Plan has received numerous awards and recognitions. In 2009 they received the highest rating of four stars from J.D. Power and Associates in their National Health Insurance Plan Study. The Disease Management Purchasing Consortium International tied them for first place in 2001 through 2007 for “Best in US for Chronic Conditions” and also gave them Recognition of Excellence in Disease Management in 2008 and 2009. They also received two awards for Excellence in Disease Management from Health Industries Research Companies.

American’s Health Insurance Plans honored Providence Health Insurance with a Community Leadership Award. The American Association of Health Plans named them the Winner of Managed Care Achievements in Tobacco Control Awards Program in 2001 and 2002. SDI recognized them as the top nine for the past nine years in the Top 100 Most Integrated Health Networks. They also received a Top 10 Ranking in Corporate Philanthropy Awards from Portland Business Journal in 2008.

Oregon and southwest Washington have benefited from millions of dollars contributed to different health care projects since 1987 by Providence Health Plan. Furthermore, their employees volunteer for numerous charitable organizations such as Camp Erin, Medical Teams International, Mercy Corps, Our House of Portland, Susan G. Komen Race for the Cure, and United Way. Employees also save 36,000 trees by recycling 1849 tons of materials annually. In addition, all materials provided by Providence Health Plan to their members are available electronically and everything that is printed uses paper that is at least 50% recycled and 25% consumer waste.

Providence Health Plan has over 16,000 employees, making them the largest employer in Oregon. They have been named in “100 Best Employers to work for in Oregon” ten times in a row by Oregon Business Magazine and the Portland Business Journal named them one of the “Top 10 Most Admired Health Care Companies” three years in a row.

Insurance Plans Offered by Providence Health Insurance

Individual and family plans have three options with both in-network and out-of-network coverage. The network contains over 540,000 providers and 4,000 hospitals. Nationwide, 78,000 network clinics and hospitals are available for members. Plans vary widely and can range in premiums from $55 per month to $1236 per month. All fees mentioned here are for individual coverage (family coverage will cost more) and are subject to change.

There are five choices within the Optimum Plan with deductibles ranging from $500 to $10,000. There is an annual out of pocket cost of $2,500 with a lifetime maximum of $2 million. The deductible is waived for the Accidental Injury Benefit. There is a $20 co-payment for annual gynecological exams, health exams, mammograms, office visits, well-baby visits, and routine vaccines, and the deductible is waived for these services. After your deductible is applied, you are responsible for a $20 co-payment for office visits to specialists.

Once your deductible is met you are responsible for 20% of the following services: inpatient hospital visits, observation, maternity care, rehabilitation services, surgery and other services. There is a $125 co-payment for emergency services and you pay 20% for urgent care with a waived deductible. You are responsible for 20% of emergency transportation services after your deductible is waived.

Additional coverage after meeting your deductible includes chemotherapy, home and health care (with limitations), lab work, medical and diabetes supplies (with limitations), mental health and alcohol treatment (with limitations), outpatient surgery, radiation therapy, and x-rays. Prescription drugs are available from participating pharmacies and mail-order at a cost of $10 for generic drugs and 50% for brand name drugs. All services that go out-of-network are at a higher rate, typically costing you 40% of the charges.

The Value Plans also have five choices with deductibles ranging from $500 to $7,500 and out of pocket costs ranging from $4,000 to $11,000. Some of the copayments are the same as the Optimum Plans, but most of the services cost more, such as 30 % for inpatient hospital visits, maternity care, specialists, and urgent care. Out-of-network costs are also higher, typically 50% of the benefits covered.

Two Health Savings Accounts (HSA) Plans are available with a choice of a $1,200 deductible or a $2,500 deductible. The annual out of pocket goes from $5,250 to $5,000 but the lifetime maximum is the same for both plans, $2 million per individual. The Accidental Injury Benefit does not apply with the HSA plans, but if you stay in the network, many of the deductibles are waived and you only have a $20 co-payment. Other services will cost you 20 % after your deductible has been met. All drugs, generic or brand, are covered at 50 % the cost. If you choose to go out-of-network, your costs will be approximately 40 % of the benefits received.

No matter which plan you choose, they all include vision benefits that are administered by VSP. Provided you stay in the network, you have a $30 co-payment for annual routine vision exams. Every two years you receive an $80 benefit for frames or contact lenses and there is no charge for basic lenses whether they are single, bifocal, or trifocal. Additionally you receive 15% off of the fitting and evaluation of your contact lenses and 15% off of laser vision correction from contracted facilities. Note, you will only receive 5% off of laser vision correction if you are being offered a promotional price for the service.

Other benefits of membership include a deductible carryover and member discounts for family attractions, health classes, health clubs, hearing services, massage therapy, and sporting events. Individual coverage is available for people aged eighteen to sixty-four who live in the service area and are not eligible for Medicare. A family includes you, a spouse or domestic partner, and/or dependent children aged newborn to twenty-two. The premiums for a family plan are based on the oldest person that will be covered. Child-only plans are also available for children aged newborn to 17 who live in the service area.

Insurance plans are also available for employer group plans. Since Oregon state law prohibits an employer from paying premiums for individual health coverage, employers must consider commercial products. Teachers have three health insurance options through the Oregon Educators Benefit Board (OEBB). Those qualifying for Medicare will find two choices, each one with an optional drug benefit. Providence Medicare Extra™ is for in-network services and Providence Medicare Choice™ is for out-of-network services.

New Oregon Laws Affecting Providence Health Insurance

New Oregon laws go into effect in 2010 that will affect health insurance carriers. One new law is the 1 % premium tax for group plans, which will tax group plans 1 % to help fund health care for 80,000 uninsured children in Oregon and 35,000 low income adults. A telemedicine law provides for the inclusion of medical video conferencing services same as in person services. Carriers must also now provide a minimum $500 for tobacco use cessation. Benefit coverage will also have to include hearing aids for dependents under the age of eighteen.

Insurance carriers are required to update their new contracts with current laws and are typically shown as benefits in a new quote. Quote tools are helpful in comparing benefits and costs so that you are making informed choices with your health care. Look for an online quote tool that lets you compare your options before you commit to any single insurance provider.

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