Small Groups | Providence Health Plans

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Explore and compare health plans that meet your business and employees’ needs.

Total Enhanced

Offering best-in-class benefits with full access to the Providence Signature Network

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Balance

Excellent benefits, lower premiums & full access to the Providence Signature Network

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HSA Qualified

Affordable plans with lower-premiums, high-deductibles and provider choice in the national Providence Signature Network

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Standard

These plans take advantage of the national Providence Signature Network

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Choice

Patient-centered medical home model of care with a network that includes more than 410 primary care clinics

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Connect

Substantial premium savings with Portland metro area Connect network medical home model

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Plan Overview
- In- and out-of-network common deductibles and out-of-pocket maximums
- Deductible waived on all six pharmacy tiers
- Chiropractic manipulation and acupuncture visits (up to 15 visits per calendar year combined; deductible waived)
- Offering the most robust level of coverage
- Separate deductibles and out-of-pocket maximums, in and out of the network
- Deductible waived on select benefits, including primary care and specialist office visits, urgent care and in-network physical therapy
- Chiropractic manipulation and acupuncture visits (up to 10 visits per calendar year combined; deductible waived)
- Cost-saving features tailored to your employees’ needs.
- NEW! Balance plans are certified for SHOP
- Separate deductibles and out-of-pocket maximums, in and out of the network
- A formulary that includes ACA preventive and safe harbor medications that are exempt from the deductible
- Chiropractic manipulation and acupuncture visits (up to 10 visits per calendar year combined; deductible applies)
- Free health savings accounts with HealthEquity included for all HSA Qualified plan members
- NEW! HSA Qualified plans are certified for SHOP
- Separate deductibles and out-of-pocket maximums, in and out of the network
- Copays starting as low as $20 and deductibles as low as $1,500
- Chiropractic manipulation and acupuncture are not covered
- Defined by the State of Oregon. Available from Providence
- Standard plans are certified for SHOP
- Separate deductibles and out-of-pocket maximums, in and out of the network
- Access to Choice network specialists via referral from the medical home for in-network coverage
- Up to 10 combined chiropractic manipulation and acupuncture visits per calendar year (Does not apply to OOPM)
- NEW! Three EAP visits covered in full before the deductible
- NEW! Three visits covered in full before the deductible on Gold and Silver plans for each of the following: PCP and Mental / Behavioral health
- Separate deductibles and out-of-pocket maximums, in and out of the network
- Access to Choice network specialists via referral from the medical home for in-network coverage
- Up to 10 combined chiropractic manipulation and acupuncture visits per calendar year (Does not apply to OOPM)
- NEW! Three EAP visits covered in full before the deductible
- NEW! Three visits covered in full before the deductible on Gold and Silver plans for each of the following: PCP and Mental / Behavioral health
Provider Network
Signature Network

Broad PPO-style network

No in-network referrals required
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Signature Network

Broad PPO-style network

No in-network referrals required
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Signature Network

Broad PPO-style network

No in-network referrals required
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Signature Network

Broad PPO-style network

No in-network referrals required
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Choice Network

Local medical home model

In-network referrals required
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Connect Network

Local medical home model

In-network referrals required
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Benefits

Combined in-network and out-of- network deductibles and out-of-pocket maximums

Deductible applies to out-of-pocket maximum

ACA preventive care covered in full

Deductible waived for Primary Care Provider and specialist visits

Deductible waived for lab and X-ray

Deductible waived for generic drugs

Deductible waived for preferred brand name drugs

Coverage for chiropractic manipulation and acupuncture

Deductible waived for chiropractic manipulations, physical therapy and acupuncture

Pediatric dental coverage included

Adult vision exam coverage included

Adult vision hardware coverage included

Separate in-network and out-of- network deductibles and out-of-pocket maximums

Deductible applies to out-of-pocket maximum

ACA preventive care covered in full

Deductible waived for Primary Care Provider and specialist visits

Deductible waived for lab and X-ray (Gold and Silver plans only)

Deductible waived for generic drugs

Deductible waived for preferred brand name drugs (Gold and Silver plans only)

Coverage for chiropractic manipulation and acupuncture

Deductible waived for chiropractic manipulations, physical therapy and acupuncture

Pediatric dental coverage included

Adult vision exam coverage included

Adult vision hardware coverage included

Separate in-network and out-of-network deductibles and out-of-pocket maximums

Deductible applies to out-of-pocket maximum

ACA preventive care covered in full

Deductible applies for Primary Care Provider and specialist visits

Deductible applies for lab and X-ray

Deductible applies for generic drugs

Deductible applies for preferred brand name drugs

Coverage for chiropractic manipulation and acupuncture

Deductible applies for chiropractic manipulations, physical therapy and acupuncture

Pediatric dental coverage included

Adult vision exam coverage included

Adult vision hardware coverage not included

Separate in-network and out-of-network deductibles and out-of-pocket maximums

Deductible applies to out-of-pocket maximum

ACA preventive care covered in full

Deductible waived for Primary Care Provider and specialist visits

Deductible applies for lab and X-ray

Deductible waived for generic drugs

Deductible waived for preferred brand name drugs (Gold and Silver plans only)

Coverage for chiropractic manipulation and acupuncture not included

Chiropractic manipulations and acupuncture are not covered

Pediatric dental coverage not included

Adult vision exam coverage not included

Adult vision hardware coverage not included

Separate in-network and out-of-network deductibles and out-of-pocket maximums

Deductible applies to out-of-pocket maximum

ACA preventive care covered in full

Deductible waived for Primary Care Provider and specialist visits

Deductible waived for lab and X-ray (Gold and Silver plans only)

Deductible waived for generic drugs

Deductible waived for preferred brand name drugs (Gold and Silver plans only)

Coverage for chiropractic manipulation and acupuncture

Deductible waived for chiropractic manipulations, physical therapy and acupuncture

Pediatric dental coverage included

Adult vision exam coverage included

Adult vision hardware coverage not included

Separate in-network and out-of-network deductibles and out-of-pocket maximums

Deductible applies to out-of-pocket maximum

ACA preventive care covered in full

Deductible waived for Primary Care Provider and specialist visits

Deductible waived for lab and X-ray (Gold and Silver plans only)

Deductible waived for generic drugs

Deductible waived for preferred brand name drugs (Gold and Silver plans only)

Coverage for chiropractic manipulation and acupuncture

Deductible waived for chiropractic manipulations, physical therapy and acupuncture

Pediatric dental coverage included

Adult vision exam coverage included

Adult vision hardware coverage not included
Health and Wellness Program

ProvRN free 24/7 nurse line

Disease management for chronic conditions

LifeBalance recreational discount program

Health coaching

ProvRN free 24/7 nurse line

Disease management for chronic conditions

LifeBalance recreational discount program

Health coaching

ProvRN free 24/7 nurse line

Disease management for chronic conditions

LifeBalance recreational discount program

Health coaching

ProvRN free 24/7 nurse line

Disease management for chronic conditions

LifeBalance recreational discount program

Health coaching

ProvRN free 24/7 nurse line

Disease management for chronic conditions

LifeBalance recreational discount program

Health coaching

ProvRN free 24/7 nurse line

Disease management for chronic conditions

LifeBalance recreational discount program

Health coaching
Integrated HSA, HRA, and FSA

Can be paired with an integrated HealthEquity account

HRA,FSA

Can be paired with an integrated HealthEquity account

HRA,FSA

Can be paired with an integrated HealthEquity account

HSA

Can be paired with an integrated HealthEquity account

HRA, FSA

Can be paired with an integrated HealthEquity account

HRA, FSA

Can be paired with an integrated HealthEquity account

HRA, FSA

2021 plan overview PDF Summary of Benefits & Coverage

NOTE:

The plan information listed in this compare table is intended to provide an overview only. Please refer to a benefit summary for specific details. Some benefit limitations and exclusions apply to our plans. For a complete listing of benefits and exclusions, please see the plan contract documents.