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Employee Benefit Programs


Documents and Resources April 2025 to March 2026


Providence Health Plan

Standard Bronze Benefit Summary
Standard Bronze Summary of Benefits and Coverage
Advantage Access Dental 1500 Benefit Summary

Enrollment/Change Form
Provider directory
Pharmacy resources
About Providence
Customer Service
MyProvidence
MyChart
LifeBalance
Virtual Care
How to use your benefits
ProvRN
Employee Assistance Program

Notices
ACA Exchange Model Notice
Medicare Non-Creditable Pharmacy Disclosure
Primary Care Provider Model Disclosure
Notice of Rights Under The Women’s Health and Cancer Rights Act (WHCRA)
HIPAA Special Enrollment Rights Notice
Premium Assistance under Medicaid and the Children’s Health Insurance Program (CHIP)
Notice Regarding Patient Protections Against Surprise Billing
Paid Leave Model Notice-Poster

IRS Forms
Form W-4
Form I-9

Eligibility and Contribution
40 hours per week on a regularly scheduled basis

Coverage begins first of the month following 60 days of working the required amount of hours


Open enrollment is from March 1 through March 31 for an April 1 start date annually


Employer pays 100% for employee only on the Providence Standard Bronze plan


Employees may enroll dependents on the plan with premium contributions


Premium Contribution Summary


Account Manager and Support Staff Contact Information
Contact Katie Ostgarden – Account Manager
Contact Sarah Selix – Assistant

We make finding affordable insurance easy. We shop the market for the provider with the lowest price to fit your needs. Do you know if you are saving the maximum amount possible on your current insurance policy? We can review it for you to find out.

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