2022 PHIP EOC request
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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 2022 PERS Health Insurance Program plan mailed to you.
Select your 2022 plan:
-- Please Select --
Providence Medicare Align Group Plan + RX (HMO)
Providence Medicare Flex Group Plan + RX (HMO-POS)
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.
First and last name:
Please include street address, city, state and ZIP code.