2021 PHIP EOC request
Anonymous Login Code:
Code Entry Page
Save this code which is required to update your response at a later time.
Request your evidence of coverage document
Complete the form below to have the evidence of coverage (EOC) document for your 2021 PERS Health Insurance Program plan mailed to you.
Select your 2021 plan:
-- Please Select --
Providence Medicare Align Group Plan + RX (HMO)
Providence Medicare Flex Group Plan + RX (HMO-POS)
First and last name:
Please include street address, city, state and ZIP code.