Forms & benefit information

Providence Health Plan makes it easy to find important details about your plan coverage. Whether you’re looking for your handbook, benefit summary, claims forms, or other plan information, you can find everything in one place.

Member handbooks

PEBB Statewide plan:

• 2025 Member Handbook (PDF coming soon)
• 2024 Member Handbook (PDF)

PEBB Choice plan:

• 2025 Member Handbook (PDF coming soon)
• 2024 Member Handbook (PDF)

Benefit summaries

2025 Statewide plan benefit summaries:

• PEBB Statewide plan (PDF coming soon)
• PEBB Statewide +100 plan (PDF coming soon)
• PEBB Statewide prescription drug plan (PDF coming soon)
• PEBB Statewide plan (part-time) (PDF coming soon)
• PEBB Statewide +100 plan (part-time) (PDF coming soon)
• PEBB Statewide prescription drug plan (part-time) (PDF coming soon)

2025 Choice plan benefit summaries:

• Providence Choice plan (PDF coming soon)
• Providence Choice +100 plan (PDF coming soon)
• Providence Choice prescription drug plan (PDF coming soon)
• Providence Choice plan (part-time) (PDF coming soon)
• Providence Choice +100 plan (part-time) (PDF coming soon)
• Providence Choice prescription drug plan (part-time) (PDF coming soon)

2024 Statewide plan benefit summaries:

• PEBB Statewide plan (PDF)
• PEBB Statewide plan - Spanish (PDF)
• PEBB Statewide +100 plan (PDF)
• PEBB Statewide +100 plan - Spanish (PDF)
• PEBB Statewide prescription drug plan (PDF)
• PEBB Statewide prescription drug plan - Spanish (PDF)
• PEBB Statewide plan (part-time) (PDF)
• PEBB Statewide plan (part-time) - Spanish (PDF)
• PEBB Statewide +100 plan (part-time) (PDF)
• PEBB Statewide +100 plan (part-time) - Spanish (PDF)
• PEBB Statewide prescription drug plan (part-time) (PDF)
• PEBB Statewide prescription drug plan (part-time) - Spanish (PDF)

2024 Choice plan benefit summaries:

• Providence Choice plan (PDF)
• PEBB Choice plan - Spanish (PDF)
• Providence Choice +100 plan (PDF)
• PEBB Choice +100 plan - Spanish (PDF)
• Providence Choice prescription drug plan (PDF)
• PEBB Choice prescription drug plan - Spanish (PDF)
• Providence Choice plan (part-time) (PDF)
• PEBB Choice plan (part-time) - Spanish (PDF)
• Providence Choice +100 plan (part-time) (PDF)
• PEBB Choice +100 plan (part-time) - Spanish (PDF)
• Providence Choice prescription drug plan (part-time) (PDF)
• PEBB Choice prescription drug plan (part-time) - Spanish (PDF)

Summaries of Benefits and Coverage (SBCs)

Summaries of Benefits and Coverage, or SBCs, are required under the Affordable Care Act. The intent is to allow an “apples to apples” comparison of medical health plan benefits across carriers. For more information about SBCs, visit HealthCare.gov.

2025 PEBB Statewide plans SBCs:

• PEBB Statewide (PDF coming soon)
• PEBB Statewide (part-time) (PDF coming soon)
• PEBB Statewide +100 (PDF coming soon)
• PEBB Statewide +100 (part-time) (PDF coming soon)

2025 PEBB Choice plans SBCs:

• Providence Choice (PDF coming soon)
• Providence Choice (part-time) (PDF coming soon)
• Providence Choice +100 (PDF coming soon)
• Providence Choice +100 (part-time) (PDF coming soon)

2024 PEBB Statewide plans SBCs:

• PEBB Statewide (PDF)
• PEBB Statewide - Spanish (PDF)
• PEBB Statewide (part-time) (PDF)
• PEBB Statewide (part-time) - Spanish (PDF)
• PEBB Statewide +100 (PDF)
• PEBB Statewide +100 - Spanish (PDF)
• PEBB Statewide +100 (part-time) (PDF)
• PEBB Statewide +100 - Spanish (part-time)(PDF)

2024 PEBB Choice plans SBCs:

• Providence Choice (PDF)
• PEBB Choice - Spanish (PDF)
• Providence Choice (part-time) (PDF)
• PEBB Choice (part-time) - Spanish (PDF)
• Providence Choice +100 (PDF)
• PEBB Choice +100 - Spanish (PDF)
• Providence Choice +100 (part-time) (PDF)
• PEBB Choice +100 (part-time) - Spanish (PDF)