Benefit Summary

  • How to know which healthcare costs are covered

    Your Benefit Summary shows you the healthcare service costs covered by your plan. If you check your Benefit Summary before visiting your doctor, then you can be better prepared for any healthcare costs that are likely to be your responsibility.

    We encourage you to compare healthcare costs. Some doctors and healthcare facilities are less expensive than others. You'll also save money by using in-network doctors and hospitals.

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    Check my benefits for an upcoming service

    Log in to your account. In My Premera Plan, go to Benefit Plans and you'll find essential plan details.

    Log in

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    Need another ID card?

    Log in, then in the Member Services section, go to Print & Order ID Card. Or, use our mobile app.

    Log in

    Other coverage information

    Here are some more details

    Frequently asked questions and answers

    Medical costs depend on whether you visit an in-network doctor or hospital, how much is billed, and what the coverage is for your specific plan.

    You can see general treatment costs for your plan by logging into your account. From your dashboard, use the Compare Treatment Costs tool. Or, log in, choose Find a Doctor, and then choose Find a cost:

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    Or, you can call your doctor's office to ask what your specific service will be, and what the procedure and diagnosis codes are. Then, you can call us and we can let you know the coverage for that service based on your plan.

    All plans cover an annual preventive care visit to your primary care doctor. What's covered depends on how old you are, and, in some cases, whether you're at high risk for certain health issues or diseases. Find out more about preventive health coverage.

    Note: Diagnostic tests given during your preventive visit, such as laboratory work, may not be covered. Check with Customer Service if you have any questions.

    You have 3 options:
    1. Call Customer Service at 800-508-4722 to get your ID number.
    2. Download our Mobile app to get access to your ID number.
    3. Or, you can go to the doctor, pay for your healthcare services in full, and then submit your claim for reimbursement. Once you do have your ID number, you can contact your in-network provider and they'll submit the claim for you. If you visited an out-of-network provider, you can submit your claim for reimbursement using our medical claim form.

    You can view our guide to your Premera ID card to learn more about your ID card. This section explains what the member number, prefix, suffix, and group numbers mean and how we use them to process your healthcare claims.

    When you have more than one health plan, your health coverage is subject to what's known as coordination of benefits. Please complete the other coverage questionnaire to let us know that you have another policy. One policy will be primary, and the other will be secondary. You'll want to make sure both plans know you'll need coordination of benefits to help process your claims more quickly.

    If you have had an accident and there's another type of insurance such as auto insurance, you can use the incident questionnaire. These forms usually take 30 to 45 days to process once we receive them. You can find this form under Manage My Account.

    Some health care facilities such as some hospitals or outpatient clinics will add what's called a facility fee to healthcare bills. These charges are intended to help hospitals provide specialty services. Your facility fee does count toward your deductible or coinsurance (if applicable).

    First, keep in mind that an explanation of benefits is not a bill. It explains how your benefits were applied to a specific healthcare service. You typically receive an EOB from us before you receive any bills from your doctor or healthcare facility. The amount billed listed on the EOB is typically not the amount you will owe your doctor. To find the amount you will owe, review the amount under "Your Total Responsibility."

    Sample explanation of benefits

    You can find details in the Explanation of Benefits section of our site.

    You have a right to file a complaint with customer service at 800-508-4722. You can also file a formal appeal using our member appeal form. For more information, go to Forms. There's a section dedicated to information about complaints and appeals.

    You can cancel your plan several ways.

    • Secure email: You can log in to our member website to send us a secure email. Under Member Services, choose Secure Inbox, and email us your cancellation. Please include your ID number, the names of the people on the plan being cancelled, and the date you would like your cancellation to take effect.
    • Letter or fax: You can fax or send us a letter to cancel your health plan. We need a written or typed cancellation letter with your ID number, the names of the people on the plan being cancelled, the date you would like your cancellation to take effect, and your signature.

      Mailing address:
      PO Box 91120
      Seattle, WA 98111
      Fax number: 425-918-3727

    • Call us: at 800-508-4722 and we can take your cancellation over the phone.
    You can connect with a Personal Health Support clinician who can help you navigate the healthcare system, provide support and resources for unexpected healthcare costs, as well as personal health coaching by phone. When logged in to your Premera account, you can find more information under Stay Healthy, or call our health coaches at 888-742-1479.
    1. Log in to your Premera account.
    2. Under Manage My Account, go to Personal Funding Account. You can then arrange payments through ConnectYourCare, which provides payment services for Premera HSA members. Additional information is found on Welcome to Your HSA Plan.