Applying Directly with Premera

  • It’s easy. Your client can apply either online or by mail.

    Online Enrollment

    Your clients can apply using your own personal enrollment link. Applying online allows you to track your clients current status of their application.

    If you do not have a personal enrollment link please call Producer Support at 877-205-9725, Option 5.

    To Apply By Mail

    For effective dates starting January 1, 2015

    Download and complete the following forms:

    2015 Individual and Family Application: One application per family.

    Adding a dependent to your current plan

    Use the Application for the Addition of Family Members to an Individual or Group Conversion plan

    Sign and mail the application to:

    Premera Blue Cross Blue Shield of Alaska
    2550 Denali Street, Suite 1404
    Anchorage, AK 99503-2753

    Dental, Vision and Hearing

    Premera Blue Cross Blue Shield of Alaska offers an adult dental plan. Benefits Highlights & Rates.

    To apply, complete the Preferred Adult Dental Plan Application.

    Sign and mail the application to:

    Premera Blue Cross Blue Shield of Alaska
    PO Box 91120
    Seattle, WA 98111-9220

    Applying through the Alaska's Federal Exchange?

    If your clients qualify for premium credit assistance, cost share reduction plans or American Indian/Alaska Native plans, they will want to enroll in a plan through AlaskaFFM.

    Is Your Client Eligible to Apply?

    Eligibility Considerations

    Individuals eligible to apply for a Premera plan must be:

    • A resident of and have a principal residence in the state of Alaska.
    • Not entitled to Medicare. If 65 or older but not eligible for Medicare, the applicant must submit a “Not eligible for Medicare” document from the Social Security Administration.
    • Applying during an open enrollment period or due to a qualifying event.

    Eligible dependents that can enroll on a plan include:

    • Spouse or domestic partner
    • Natural or legally adopted child(ren) under the age of 26
    • Children under age 26 when you, or your spouse are the legal guardian
    • A legally placed ward of the subscriber or spouse (including foster children)

    Open Enrollment Periods

    The open enrollment period this year ended February 15, 2015. But if your client or their family have experienced one of the life events listed below, they may be able to apply for coverage now, in a special enrollment period. 

    Your clients currently enrollment in a Premera grandfathered or non-grandfathered plan can remain on that plan or enroll in a plan that complies with the Affordable Care Act during the next open enrollment period starting November 1, 2015.

    For 2015 health plan options 

    Your Sales Executive and Producer Support are available to help answer any questions you might have about these plans.

    Qualifying Events

    Individuals are eligible to apply for coverage outside of the annual open enrollment period only when they have a qualifying event.

  • Qualifying event:

    The birth, placement for adoption, or adoption of the applicant for whom coverage is sought; for Qualified Health Plans (QHPs), this also applies to children placed in foster care, legal wards, guardianship, or medical support orders

    Required documentation:

    • Copy of birth certificate
    • Copy of the adoption papers
    • Copy of foster care papers
    • Copy of medical support order
    • Copy of the court order appointing a guardian

    Qualifying event:

    The COBRA coverage period ends (usually after 18 months) or the individual has exceeded the lifetime limit in the plan and no other COBRA coverage is available

    Note: Voluntary termination of COBRA is not a qualifying event. If you terminate or stop paying for your COBRA, you must wait for the next Open Enrollment Period to apply.

    Required documentation:

    Letter from the employer or COBRA administrator indicating that the loss of COBRA coverage is due to the individual's exhausting the COBRA period or exceeding the lifetime limit in the plan and that no other COBRA coverage is available

    Qualifying event:

    Marriage or entering into a domestic partnership, including eligibility as a dependent

    Required documentation:

    Copy of marriage certificate, or a Declaration of Domestic Partnership (a Declaration of Domestic Partnership form can be found on our website at premera.com)

    Qualifying event:

    The loss of coverage as the result of dissolution of marriage or termination of a domestic partnership

    Required documentation:

    Copy of divorce decree or annulment papers, a statement that includes the date that the Domestic Partnership ended, AND a letter from the prior health plan

    Qualifying event:

    Loss of minimum essential coverage, including loss of employer-sponsored insurance coverage (except for voluntary termination of health coverage, misrepresentation, or fraud)

    Required documentation:

    Your COBRA offer letter or a letter from your employer listing each applicant who experienced a loss of coverage AND the reason for termination of health coverage

    Qualifying event:

    Loss of coverage as the result of the death of an employee

    Required documentation:

    The COBRA offer letter or a letter from the employer indicating that the loss of coverage is due to the employee's death

    Qualifying event:

    Termination of employer contributions for coverage other than COBRA

    Required documentation:

    Letter from employer indicating that the loss of coverage is due to termination of employer contributions

    Qualifying event:

    Loss of coverage as the result of a termination in employment or reduction in hours

    Required documentation:

    Your COBRA offer letter or letter from your employer indicating that the loss of coverage is due to a termination in employment or a reduction in hours

    Qualifying event:

    A loss of Medicaid or other public program providing health benefits

    Required documentation:

    Letter from Medicaid or other program indicating ineligibility or loss of coverage

    Qualifying event:

    A qualified individual or enrollee gains access to new Qualified Health Plans (QHPs) as a result of a permanent move

    Required documentation:

    Utility bills from your prior address and new address from within the last 90 days

    Qualifying event:

    A situation in which a plan no longer offers benefits to the class of similarly situated individuals that includes the applicant

    Required documentation:

    Letter from the prior health plan indicating loss of coverage is due to not being in a class of similarly situated individuals

    Qualifying event:

    Loss of coverage as a dependent on a group plan due to age

    Required documentation:

    Letter from employer or insurance health plan indicating the loss of coverage is due to age

    Qualifying event:

    Loss of minimum essential coverage, including loss of employer sponsored insurance coverage; except for voluntary termination of health coverage, misrepresentation, or fraud

    Required documentation:

    Your COBRA offer letter or a letter from your employer listing each applicant who experienced a loss of coverage AND reason for termination of health coverage