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  • PCORI fee deadline approaching

    If you have self-funded employer group clients with a calendar year plan, they need to know the PCORI fee deadline is July 31st. More information is available on the IRS website.

    Find a Doctor tool enhancements

    Our newly improved Find a Doctor tool (provider search engine) now offers members better cost information, smarter features, and deeper quality reviews once logged in. Check out these new features by logging in or talking to your sales representative today.

    Removing member prior authorization pentalty with contracted providers

    As business renews, beginning January 1, 2015, members will no longer be financially liable if contracted providers fail to obtain a required prior authorization. This affects Individual and Small Group Metallic plans and Large Group fully-insured non-grandfathered plans.

    • Contracted providers- If the provider fails to obtain prior authorization, the member is not penalized.
    • Non-contracted providers- If the provider fails to obtain prior authorization, the claim is paid to the allowed amount, less 50% to a maximum of $1,500 and the provider may bill the member.

    This change is designed to improve compliance with the prior authorization program and make coverage more predictible for members.

    Premera now covers virtual care

    Virtual care gives members immediate and convenient access to care whenever and wherever they need it (except in Idaho).

    Members who are covered (as plans enroll or renew beginning January 1, 2015) receive care virtually from their own doctor or from a doctor at our national provider service, Teladoc®.

    Covered members can get care via phone call, online video, or other online media at least as easily as they walk into an office and get care face to face.

    To find out more about Virtual Care, contact your Premera sales representative.