INDIVIDUAL PLANS FOR 2018

       

     Many of my clients are with Providence now, so I'd like to start by outlining some significant changes to the 2018 plans which may affect access to your providers of choice. 

THE SIGNATURE NETWORK AND OUT-OF-NETWORK IS ELIMINATED FOR 2018 
   The larger Signature Network will not be available in the Portland area for 2018.   There is also no longer any coverage if you go to  non-contracted provider.  However, emergency room visits are always considered In-Network so you don't need to worry when you travel.  To say it another way, if your plan uses the Providence Choice network, your plan will only pay claims if you see providers in the Providence Choice network.

MEDICAL HOME SELECTION REQUIRED:  CHECK TO SEE IF YOUR DOCTOR IS STILL CONTRACTED
   
Another change is the requirement on all plans that you choose a Medical Home clinic in your network, then get referrals to see other contracted providers outside of that clinic.  Your plan will use either the Choice or smaller Connect network.  Take a minute to check to see if your doctors will be working in the network for 2018.

Providence Directory

http://phppd.providence.org/?_ga=1.104490944.1163329782.1446576415

 

Providence Plans Compared

    In the spreadsheet below I compare the top 5 plans side-by-side.  Once you see a plan you like, read the full plan summary as I include that after the quote sheets. Read the find print carefully.  Notice that many of the plans include Pediatric Vision and/or Preventative Dental for kids under age 19.  

    2018 Providence Plans Compared & Full Benefit Summaries.pdf   
 

Providence Company Brochure

    You can view the Providence company brochure at the link below:
 

2018_Providence_Brochure.pdf

 

HOW TO APPLY FOR COVERAGE

1. Enroll through the Federal Marketplace

    My recommendation is to apply through the Federal Marketplace at http://www.healthcare.gov  instead of purchasing coverage direct with Providence.

Here are a few reasons to purchase through the Marketplace: 

1.  EASE OF APPLICATION:  Each year you can easily select a new plan, or even put different family members on different company plans without any paperwork.  As your broker this helps me greatly!  Even if you don't qualify for a tax credit you can enroll through the Marketplace.

2.  TAX CREDIT:  The Marketplace is the only way to claim the tax credits. Even if you don't qualify when you apply, you may later on.  You never know how life can change.  

 3. FLEXIBILITY:  If your life changes mid-year you can do a 'Life Change' (Like a change of income situation)  This can sometimes allow you to select a new plan mid-year.

4.  IF YOU DO IT YOURSELF... :   Should you chose to enroll yourself in the Marketplace without my help, I would appreciate in the agent section of the application adding my agent name, Dan Neils, and NPN number, 757811.  This allows me to be compensated at no cost to you, and be appointed as your broker should you need help during the year.  I have a guide with a few key ideas to keep you from making critical errors when you apply on your own in my tab "Federal Marketplace".

5.  I'M HERE TO HELP:  Should you like my help enrolling or completing the annual enrollment I am at your service.  I can help you enroll in 1/2 the time you could do it yourself and help you avoid consequential errors.  Just call me at 503-650-4325 or email me at danneils@gmail.com to setup a phone time or in person.

 

2. Apply Direct to Providence with a paper application

     Please only apply direct with Providence if you are certain you will not qualify for a tax credit in 2018.   
 
    You can submit the completed application (without payment) direct to Providence, but if you prefer,  you can email, fax, or mail it to me first so that I can review it and scan for errors that may delay processing.   Providence will bill you for the initial premium.

Learn about the prescription drug coverage

   If you take expensive prescription drugs, it is important to understand the list of covered prescription drugs, also called the "Drug Formulary". Different drugs are covered under different 'tier's, and the plans differ in what tier's are paid for before the deductible, and which are paid after your deductible.  You can explore this topic at the link below.
 

https://healthplans.providence.org/members/pharmacy-resources/
 

 HOW TO MAKE YOUR INITIAL PAYMENT

    After you submit your paper application, you must make payment before the policy is finalized.  After enrollment Providence will either email you or mail you information on making this first payment and they give you an application number for reference.  If you lose this information you can pay online at http://www.providence.org/billpay

Option 2 is to pay by phone by calling the Enrollment dept at 888-816-1300 and make a phone payment.   

HANDY CONTACT INFO

Providence customer service:   503-574-7500

Providence Free Nurse Hotline: 800-700-0481 or 503-574-652

Dan Neils 503-650-4325  danneils@gmail.com

 

$0 copay Express Care Virtual Video-visits

     This service allows you to conveniently meet as needed with a Providence provider through a laptop, tablet with camera, or smart phone you can set up the video visit with Providence.  From a computer use the link below to set up an account:

https://virtual.providence.org

From a smart phone, download the Express Care Virtual app to install and set up an account.   If you have the Bronze HSA plan, the cost is $39.00 per visit.

 

 

VSP Vision Providers:  If your plan includes vision:  

     If you buy a plan with vision coverage, the in-network provider network is called VSP.  You can search for local providers at:          https://vsp.com

 

WHERE YOU CAN READ DETAILED EXCLUSIONS IN THE MEDICAL PLAN

On the Providence Broker page below you can read detailed summaries of what is excluded in the 2017 Providence Medical Plans.

https://healthplans.providence.org/producers/2017-products-services/individuals-families/health-plan-details/list-of-exclusions/#general

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2018 Individual Application

Click filename below to access file

2018_Providence_Application.pdf

2018 Providence Brochure

Click filename below to access file

2018_Providence_Brochure.pdf

2018 Providence Rates & Benefit Summaries

Click filename below to access file

2018_Providence_Rates_&_Benefit_Summaries.pdf