Request your evidence of coverage document

2024 Medicare EOC request

The Evidence of Coverage (EOC) is a comprehensive handbook to understanding your Providence Medicare Advantage Plan coverage. It details important information about your benefits, what Providence Health Assurance must do, your rights, and what you have to do as a member of our plan.

Complete the form below to have the evidence of coverage (EOC) document for your 2024 Providence Medicare Advantage Plan mailed to you.

	Select your 2024 Providence Medicare Advantage Plan:

Select if you would like to receive your hardcopy annually each year before the Annual Enrollment Period begins or just this one time:
Your selection will be documented on your member account. Please contact customer service to make any changes. Non-member requests will be completed as a one-time request.*

	Annual request
	One-time request

	Member ID number

	First and last name:*

	Mailing address:* Please include street address, city, state and ZIP code.

	Phone number:

	Email address: