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Individuals and Families Providence Health Plan

Details: Call 911 or get a ride to the nearest hospital for emergency care 24/7 when you think you may be in danger. Learn more. We're a community of care dedicated to your well-being. myProvidence.com. Your secure, total health management website. Access your plan, claims and wellness tools to keep track of your health at home or on the go.

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Providence Medical Home Providence Health Plan

Details: Option 2: Complete and return a medical home selection form (PDF). Option 3: Call customer service at 503-574-7500 or 800-878-4445 (TTY: 711). For many Providence Health Plan members, if you do not communicate your medical home, one will be chosen for you. If you are a PEBB member enrolled in a Providence Choice plan, you must communicate your

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Providence Approved Site of Care List

Details: medications provided in an unapproved outpatient hospital infusion setting. This site of care prior authorization is in addition to the prior authorization for the medication, if required. Refer to individual drug specific policies for clinical criteria. Please be aware that approval for Site of Care is

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Medicare Providence Health Assurance

Details: Medicare Advantage covers hospital bills and doctor visits and oftentimes prescription drugs. Plus, insurers can add coverage for items not included in standard Medicare — like paying for wheelchair ramps, hold bars, in-home respite care, and …

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Member Benefit Basics Providence Health Plans

Details: Health insurance offsets the cost of doctor bills, surgery, hospital, laboratory and X-ray fees, and pharmacy costs. Take a look at the following two examples that compare costs without insurance to costs with insurance in a plan that has a preferred provider network: Example 1: Sample healthcare cost for a sports injury (costs are approximate

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Your Benefit Summary

Details: Hospital Services Acute care 10% 25% 50% Rehabilitative care 10% 25% 50% Skilled nursing facility 20% 20% 50% Maternity Prenatal services Covered in full Covered in full 50% Delivery and postnatal services 10% 20% 50% Routine newborn nursery care 10% 25% 50% Hospital services 10% 25% 50% Infertility services 10% 20% 50%

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Summary of Benefits and Coverage: What this Plan Covers

Details: admitted to hospital, all services subject to inpatient benefits. Emergency medical transportation No charge No charge None Urgent care $100 copay/per visit; deductible does not apply in-network No charge Some services will include additional member costs. If you have a hospital stay Facility fee (e.g., hospital room) No charge Not covered

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Pharmacy Resources Providence Health Plan

Details: Providence Health Plan (PHP) requires site of care prior authorization for the drugs listed below when given in an unapproved hospital setting. A separate prior authorization may be required for the drug. Approved Site of Care List (PDF) Additional member resources. Formulary updates (PDF) A summary of upcoming changes to your formulary

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2022 Summary of Benefits

Details: If you are admitted to the hospital within 24 hours, you do not have to pay your share of the cost for urgent care. 1. Services may require prior authorization. 2. Services may require a referral from your doctor. H9047_2022AMSB13_M MDC-910A 3 . …

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Member Reimbursement Form for Medical Claims

Details: Hospital, Clinic, Pharmacy) and explain nature of injury or illness: 12. Signature (required): I attest that the information above is true and accurate, and the services were received and paid for in the amount requested as indicated above.

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Providence Health and Services Caregivers Providence

Details: Providence Health Plan offers commercial group, individual health coverage and ASO services. Providence Medicare Advantage Plans is an HMO, HMO‐POS and HMO D-SNP with Medicare and Oregon Health Plan contracts under contract ID H9047.

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Your Benefit Summary

Details: admitted to hospital, all services subject to inpatient benefits.) $250 $250 $250 Urgent care services (for non-life threatening illness/minor injury) 10% 20% 50% Emergency medical transportation 20% 20% 20% Other Covered Services Outpatient rehabilitative services (75 visits per calendar year) 10% 20% 50%

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Claims and Billing Processes Providence Health Plan

Details: Understanding our claims and billing processes. The following information is provided to help you access care under your health insurance plan. If you have questions about any of the information listed below, please call customer service at 503-574-7500 or 800-878-4445.If any information listed below conflicts with your Contract, your Contract is the governing document.

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2022 Summary of Benefits

Details: 2022 Summary of Benefits Providence Medicare Bridge 1 + Rx (HMO-POS) January 1, 2022 – December 31, 2022 This plan is available in Clackamas, Multnomah, Washington and Yamhill counties in Oregon.

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Health Share Providence Providence Health Assurance

Details: Providence Health Plan offers commercial group, individual health coverage and ASO services. Providence Medicare Advantage Plans is an HMO, HMO‐POS and HMO D-SNP with Medicare and Oregon Health Plan contracts under contract ID H9047.

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Formulary List of Approved Drugs Providence Medicare

Details: Formulary and prescription drug information. A formulary is your list of approved drugs. Use this page to access our searchable database and PDFs to learn whether your prescription drug is covered by your Providence Medicare Advantage Plan, as well as information about prior authorization and step therapy.. In addition to formulary information, use this page to access …

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ExpressCare Virtual Providence Health Plan

Details: ExpressCare Virtual visits are free with most Providence health plans. HSA members must first meet the plan deductible, but the cost of an ExpressCare visit is significantly less than an office visit. Ancillary services, such as laboratory tests, may …

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Urgent Care Providence Health Plan

Details: You can call the urgent care or immediate care facility you wish to visit to verify hours of operation and when they stop accepting patients for the day. Next up on care options. Emergency Care. Use emergency care for suspected heart attack, stroke, severe abdominal pain, poisoning, choking, loss of consciousness, and uncontrolled bleeding.

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Providers Networks Providence Health Plan

Details: Alternative health. Providence Health Plan delegates administration of alternative care to American Specialty Health (ASH). Providers must be contracted with ASH to be considered participating with Providence Health Plan. For more information, call 888-511-2743 or visit ASH online. Learn more.

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St Joseph Health Caregivers Benefits 101 Providence

Details: Inpatient hospital admissions, including maternity High tech diagnostic imaging, such as MRI, MRA, SPECT, CT, CTA, PET, Nuclear Cardiology (American Imaging Management authorizes these services; contact AIM at 800-920-1250 )

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PERS 2022 Plans Providence Medicare Advantage Plans

Details: Our 2022 plans. Our plans are accepted by thousands of doctors. We offer two Medicare Advantage Plan types, Providence Medicare Align Group Plan + Rx (HMO) and Providence Medicare Flex Group Plan + Rx (HMO-POS). To enroll in a PHIP Medicare Plan, contact PERS directly at 503-224-7377 or 1-800-768-7377. PHIP Enrollment.

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Your Benefit Summary

Details: admitted to hospital, all services subject to inpatient benefits.) $250 $250 $250 Urgent care services (for non-life threatening illness/minor injury) 10% 20% 50% Emergency medical transportation 20% 20% 20% Other Covered Services Outpatient rehabilitative services (75 visits per calendar year) 10% 20% 50%

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Continuation of coverage

Details: Continuation of coverage COBRA administration (groups with 20 or more employees) Employers with 20 or more employees are required under the Consolidated Omnibus Budget

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About Us Providence Health Plan

Details: Through bravery, ingenuity, and faith, the Sisters of Providence built a network of hospitals, schools, orphanages, and shelters across the Pacific Northwest. For over 160 years, our community of caregivers has championed True Health as a human right. As we look forward to the future we hope to open the door of access to care more fully to our

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2022 Evidence of Coverage

Details: asking us to keep covering hospital care and certain types of medical services if you think your coverage is ending too soon. Explains how to make complaints about quality of care, waiting times, customer service, and other concerns. Chapter 10.

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Complaints and Appeals Providence Health Assurance

Details: If your complaint needs more follow up, you will receive a call or letter within five (5) business days. We will provide a final answer to you within 30 calendar days. If you need assistance, you can call Providence Health Assurance Customer Service at 503-574-8200 or 800-898-8174 (TTY/TDD 711).

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Your Rights and Protections Against Surprise Medical Bills

Details: Certain services at an in-network hospital or ambulatory surgical center . When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount.

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Health Plans Basics Providence Health Plan

Details: Periodic health examinations (from any provider licensed to provide this service) Routine immunizations and shots. Annual women’s gynecological exams. Mammograms. Colorectal cancer screening exams (preventive age 45 and over) Pediatric routine eye exams (one per calendar year) *Based on Affordable Care Act regulations.

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Providence Health Plan We help you find your True Health

Details: Providence Health Plan offers commercial group, individual health coverage and ASO services. Providence Medicare Advantage Plans is an HMO, HMO‐POS and HMO D-SNP with Medicare and Oregon Health Plan contracts under contract ID H9047.

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Your Benefit Summary

Details: (For Emergency Medical Conditions only. If admitted to the Hospital, all Services subject to inpatient benefits.) In-Network 30% Out-of-Network 30% Emergency medical transportation (air and/or ground) (Emergency transportation is covered regardless of whether or not the provider is an In-Network Provider.) 30%

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Dental Plans Providence Health Plan

Details: Our optional dental plans are a great way to contribute to your employees’ total health. With Providence dental plans, you get: Four dental plan choices to meet your employees’ needs and your budget. Robust coverage for services received both in and outside the network. In-network diagnostic and preventive care services, such as exams

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Members Providence Medicare Advantage Plans

Details: Providence Health Plan offers commercial group, individual health coverage and ASO services. Providence Medicare Advantage Plans is an HMO, HMO‐POS and HMO D-SNP with Medicare and Oregon Health Plan contracts under contract ID H9047.

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2021 Plan Overview

Details: Hospital Services Inpatient hospital services and well-baby care. These services are covered at the and maternity care 20% 35% Covered in full Emergency and Urgent Care Emergency services (all services treated as in-network) $250 then 20% $250 then 35% Covered in full Urgent care services (deductible applies out-of-network) $50 $60 $75

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Notice of Privacy Practices Providence Health Plan

Details: This is the role of a healthcare provider, such as your doctor or a hospital. We may use and disclose your PHI with your doctors or hospitals to help them provide medical care to you. Plan Sponsor/Administrator: If you are enrolled with Providence Health Plan through an employer-sponsored group health plan, Providence Health Plan may share PHI

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Medicare Supplement Plans Providence Health Assurance

Details: As a healthcare provider, Providence has been working to improve the standard of care for the local community for more than 160 years. Providence Medicare Supplement members have access to any hospital or doctor that accepts Medicare patients — locally or nationwide — with no referrals needed.

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Annual Notice of Changes for 2022

Details: Hospital stays in-network: $300 copayment each day for days 1-6 per admission and there is no coinsurance, copayment, or deductible each day for day 7 and beyond for Medicare-covered inpatient hospital care . Hospital stays when using your POS benefit: 30% of the total cost per admission for Medicare-covered inpatient hospital care . Hospital

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Medical Policy, Pharmacy Policy & Provider Information

Details: The timing of annual review is posted in the section below. Medical Policy Inquiries. All inquiries concerning PHP medical policies or new medical devices and technologies may be sent to: [email protected] Please do not contact PHP medical directors or medical policy analysts directly.

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SCOPE: APPLIES TO: BENEFIT APPLICATION …

Details: Planned out-of-hospital birth is considered not medically appropriate and not covered when any of the following high-risk conditions (II.A-D) are present at the time of initial prenatal care or develop anytime during the current pregnancy or delivery: A. Member has a maternal medical history of any of the following:

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Explanation of Benefits Providence Health Plan

Details: Pre-register for services such as a surgical or hospital visit, or the delivery of your baby. Search for providers who participate with your specific plan. How to contact us. Call Customer Service at 503-574-7500 or 800-878-4445 with any questions about your EOB. Please have your claim number (indicated on your Explanation of Benefits

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PROVIDENCE HEALTH PLANS PAYMENT POLICY SUBJECT: …

Details: Subsequent hospital care services (limited to one every three days) (CPT codes 99231-99233) Subsequent nursing facility care services (limited to one every 30 days) (CPT codes 99307-99310) For dates of service on or after March 6, 2020, through June 30, 2020, or until further

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Forms Providence Health Plan

Details: Most providers bill Providence Health Plan directly; however, if you must submit a medical claim to Providence, please use these forms: Medical claim form (PDF) Mental health/chemical dependency claim form (PDF) For Providence St. Joseph Caregivers ONLY, use this form for mental health/chemical dependency reimbursements (all dates of service).

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2021 Summary of Benefits

Details: If you are admitted to the hospital within 24 hours, you do not have to pay your share of the cost for urgent care. 1 . Services may require prior authorization. 2 . Services may require a referral from your doctor. H9047_2021GRSB01_M MDC-920 3 . …

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Summary of Benefits and Coverage (SBC)

Details: Hospital-based facility: 50% . coinsurance 50% : coinsurance Prior authorization. required. Physician/surgeon fees 50% coinsurance 50% coinsurance All copayment and coinsurance costs shown in this chart are after your deductible has been met, if a deductible applies.

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Resumen de beneficios y cobertura Período de cobertura: A

Details: Resumen de beneficios y cobertura: Lo que este plan cubre y lo que paga por los servicios cubiertos Período de cobertura: A partir del 1/ene./2022 Providence Health Plan: Balance 2500 Gold Cobertura para: Todos los niveles de cobertura | Tipo de plan: PPO El documento del resumen de beneficios y cobertura (SBC) lo ayudará a elegir un plan de salud.

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Annual Notice of Changes for 2022

Details: inpatient hospital services. Inpatient hospital care starts the day you are formally admitted to the hospital with a doctor’s order. The day before you are discharged is your last inpatient day. The amounts for each

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Resumen de beneficios y cobertura: . Periodo de cobertura

Details: admitido al hospital, todo servicio queda sujeto a beneficios de paciente interno. Transporte médico, emergencia 25% coseguro. 25% coseguro. Ninguna Atención de urgencia $50 copago / visita; no aplica el deducible. 50% coseguro. Algunos servicios incluirán costos por miembros adicionales. Si le hospitalizan . Cargo de instalaciones (p. ej.,

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