2019 Providence Plan Documents

• Enrollment Application
• Dental Application – Only used if adding dental after time of plan enrollment
• Summary of Benefits – $0 Harbor HMO H9047-049 | King, Snohomish
• Summary of Benefits – $59 Summit HMO H9047-047 | King, Snohomish
• 2019 Star Ratings – Providence H9047 HMO, HMO-POS

A full list of plan PDFs can be found here: https://healthplans.providence.org/medicare/enroll-now/enrollment-forms/