2020 Providence Health Plans do not cover all state required benefits

INFORMATION FOR ASSISTERS: NEW 2020 PROVIDENCE HEALTH PLANS

Providence Health Plan is entering the Exchange market in 2020 in Benton, Clark, Franklin, Spokane, Thurston, and Walla Walla counties. Providence health plans will not cover all state required benefits. Providence is the first Exchange carrier to invoke a religious objection. The information below is intended to help customers understand how to access all state required benefits.

 

Frequently Asked Questions (FAQs)

Where is Providence offering health plans in 2020?

Providence health plans will be offered in Benton, Clark, Franklin, Spokane, Thurston, and Walla Walla.  Those counties represent approximately 19% of the total qualified health plan enrollment through Washington Healthplanfinder.

What state required benefits will Providence health plans not cover?

Abortion is not covered unless there is a severe threat to the mother, or the fetus cannot be sustained. Providence has a religious objection to providing this service in all other circumstances.

How will Providence inform customers about state required benefits that are not covered?

Customers who select a Providence plan through Washington Healthplanfinder will receive the following materials from them:

  • Welcome Letter  
  • Benefit Summary
  • Section 1557 Taglines and Non-Discrimination
  • Contract
  • Notice of Privacy Practices
  • Pharmacy Benefits Flyer
  • Member Extra Values
  • Emergency Room and Urgent Care Flyer
  • Cost Calculator Flyer
  • MyProvidence Flyer

The plan exclusions are listed in the 95-page contract in Section 5. Page 53 includes information on the services not being provided due to a religious objection.

How can Providence health plan customers access uncovered state required benefits at no cost to them?

Providence health plan customers who need abortion services can receive them for free through the Washington Department of Health Family Planning Program.

Customers can call the Department of Health customer service line at 1-800-525-0127 for information on how to receive these services. They will not be required to notify or interact with Providence Health Plan in any way concerning these services.

What is the Washington Department of Health Family Planning Program?

The Department of Health (DOH) Family Planning Program works with contracted family planning agencies for abortion services for patients who were unable to pay for them.  Exchange customers who need abortion services but lack coverage in their religiously affiliated healthcare plan are eligible for this program, even if they are not eligible for financial assistance.  More information on this program is available at: https://www.doh.wa.gov/YouandYourFamily/FamilyPlanning.

How can customers use Washington Healthplanfinder to find out which services are excluded?

While shopping and comparing plans on Washington Healthplanfinder, a customer can access information on plan exclusions by selecting “More information on this plan”. The screen with more information will include a link at the bottom of the page to the plan’s Summary of Benefits and Coverage (SBC). This will include a comprehensive list of plan exclusions.

Washington Healthplanfinder includes additional information that directs customers to a Providence website that describes the state required benefits that Providence does not cover. See screenshots below for additional detail.

If a customer does not understand that Providence does not cover all state required benefits, can they switch plans? 

The Exchange is providing a special enrollment opportunity for customers who enroll in Providence through Washington Healthplanfinder expecting coverage of all state required benefits.  Requests to take advantage of the special enrollment are reviewed on a case-by-case basis.

Customers who want to invoke this special enrollment opportunity need to contact the Exchange Customer Support Center at 1-855-923-4633 (TTY: 1-855-627-9604) and indicate they were not aware at time of plan selection that the plan did not cover all state required benefits.

 

Washington Healthplanfinder screens:

 

 

 

How can Providence health plan customers access uncovered state required benefits at no cost to them?

Providence health plan customers who need abortion services can receive them for free through the Washington Department of Health Family Planning Program.

Customers can call the Department of Health customer service line at 1-800-525-0127 for information on how to receive these services. They will not be required to notify or interact with Providence Health Plan in any way concerning these services.

 What is the Washington Department of Health Family Planning Program?

The Department of Health (DOH) Family Planning Program works with contracted family planning agencies for abortion services for patients who were unable to pay for them.  Exchange customers who need abortion services but lack coverage in their religiously affiliated healthcare plan are eligible for this program, even if they are not eligible for financial assistance.  More information on this program is available at: https://www.doh.wa.gov/YouandYourFamily/FamilyPlanning.

 How can customers use Washington Healthplanfinder to find out which services are excluded?

While shopping and comparing plans on Washington Healthplanfinder, a customer can access information on plan exclusions by selecting “More information on this plan”. The screen with more information will include a link at the bottom of the page to the plan’s Summary of Benefits and Coverage (SBC). This will include a comprehensive list of plan exclusions.

Washington Healthplanfinder includes additional information that directs customers to a Providence website that describes the state required benefits that Providence does not cover. See screenshots below for additional detail.

 If a customer does not understand that Providence does not cover all state required benefits, can they switch plans? 

The Exchange is providing a special enrollment opportunity for customers who enroll in Providence through Washington Healthplanfinder expecting coverage of all state required benefits.  Requests to take advantage of the special enrolment are reviewed on a case-by-case basis.

Customers who want to invoke this special enrollment opportunity need to contact the Exchange Customer Support Center at 1-855-923-4633 (TTY: 1-855-627-9604) and indicate they were not aware at time of plan selection that the plan did not cover all state required benefits.

 

Providence website (http://providence.org/tpr):