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Benefits 101



Your health matters!

SAIF and Providence Health Plan are partnering to bring you quality, comprehensive health care benefits that are designed with your and your family’s health needs in mind. SAIF has designed your health care plans; Providence, as your health plan administrator, will administer these plans and provide you resources to help meet your health goals. We look forward to providing you with excellent customer service and friendly resources that are easy to find and use.



Your health benefits

As a Providence Health Plan member enrolled in a Providence Health Benefits Plan, count on comprehensive in-plan benefits and providers when and where you need them. Highlights of your medical and prescription drug plans include:


  • Provider choice. With over one-million providers in our national network, it's easy to find a doctor wherever you live and where you travel. You can receive care from in-plan providers and/or out-of-plan providers. When you receive care from in-plan providers, you’ll usually pay less for these services.
  • Access to specialist without a referral. You can see a specialist without a referral.
  • Preventive care benefits covered in full as a result of the Patient Protection and Affordable Care Act, meaning you don’t have to pay a copay when you receive these services.

Explore the following topics to learn about your plan’s benefits:

  • Member materials

    This section provides links to your health care benefit summaries and your Summary Plan Description. These resources are designed to help you understand and use your benefits throughout the year.



    2022 Benefit Summaries


    2021 Benefit Summaries


    2020 Benefit Summaries


    Summaries of Benefits and Coverage (SBCs)

    As part of the Patient Protection and Affordable Care Act, health insurers and group health plans are required to provide you with an easy to understand document that lists and describes your plan’s health benefits and insurance coverage. This document is called a Summary of Benefits and Coverage, or an SBC. The purpose of the SBC is to provide you with basic benefit information in a format that uses short, plain language. The SBC does not replace your plan’s benefit summary. All insurance companies are required to use the same form ideally making it easier for you to compare health plans, benefits and plan features.

    Get more information about SBCs


    2021


    2020


    As a Providence Health Plan member with SAIF, access these resources to get the most appropriate and affordable care you need when and where you need it:
  • Pharmacy resources
    Formulary

    Providence Health Plan is pleased to provide plan members with a comprehensive prescription drug formulary designed to promote safe, effective and affordable drug therapy.

    Your formulary has the following enhanced features:


    • It’s easy to search
    • It includes information about the medication
    • It includes special considerations about the prescription, if applicable 

     2022 formulary

     2021 formulary


    You can search:


    • Alphabetically
    • By entering a portion of the drug name 
    • By therapeutic class


    Participating pharmacies

    As a member, you have access to more than 36,000 participating pharmacies, including retail, preferred retail, mail-order and specialty.



    Learn more


    Pharmacy FAQ

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

    Learn more
  • Providence laboratory services

    Your laboratory services are performed and processed at a facility that depends on your location. If you receive laboratory services in the following counties, ask that your lab work be sent to the nearest Providence Health & Services hospital:


    • Clackamas
    • Clatsop
    • Hood River
    • Jackson
    • Multnomah
    • Yamhill

    For a list of Providence laboratory facilities and services in Oregon, visit our website.

    If you are located in Marion County, please see our list of participating lab locations. If you prefer, you can ask your provider to send your lab work to a facility that contracts with Providence Health Plan.

  • Discounts and wellness resources
    myProvidence: one of many resources to help meet your health goals

    A proactive approach to prevention and early detection can ward off many serious medical problems and help you live a longer, healthier life. Online health and wellness tools are accessible through myProvidence, a secure website designed to help you manage all aspects of your health care. Create a myProvidence account, and you’ll gain 24-hour access to personalized tools and resources built exclusively for Providence Health Plan members. You can:


    • Create a Health Record
    • Take a Personal Health Assessment
    • Utilize health trackers to chart key health measurements
    • Research health conditions, treatment options and costs
    • Review your insurance claims history and details
    • Order a replacement Member ID card
    • Manage your health plan account and pay your medical bills
    • Manage your family's health


    Extra discounts and savings

    There’s more. We encourage you to take advantage of these extra discounts and savings designed to help you stay active and healthy:


    • 24/7 nursing support – free medical advice from a Providence Registered nurse, just a phone call away through the ProvRN medical advice line.

      Learn more
    • Health incentives – discounts for health clubs, retail stores, tours and museums, performing arts, massage, spa services and other healthy activities.

      Learn more
    • Fitness, health and nutrition classes – discounts on small-group classes that focus on everything from weight loss to yoga to childbirth. Classes vary by location; please select your location to see what classes are available near where you live or work. You can also request nutrition services to help meet your goals.

      Learn more
    • 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.


    More wellness information

    If you have questions or need more information about our health and wellness options, visit our member website for additional details.

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