Use these categories for quick access to the forms you need. If you require further assistance, please contact us.
Completed enrollment materials must be received at Premera for new groups by the 20th of the month to ensure eligibility by the plan start date.
Send completed enrollment materials to AKPBCSmallGrpSS@PREMERA.com.
No action is necessary unless plan or group information changes are requested. Send change requests to AKPBCSmallGrpSS@premera.com and your designated account team no later than the 10th of the
month prior to the group’s renewal date by completing the group verification report and/or benefit selection worksheet.
Groups with 100 or more employees enrolled, please contact your Premera sales representative.
Completed enrollment materials must be received at Premera well in advance of the first of the month to ensure eligibility and receipt of ID cards by the plan start date.
Return completed enrollment materials to Senior Sales Manager Bradley.Olson@premera.com and Implementation Account Specialist Kristin.Lara@premera.com.
Note: Additional forms will be provided for self-funded and Optiflex funding arrangements.
Completed renewal documents and written confirmation must be received at Premera well in advance of the first of the month to ensure eligibility and receipt of ID cards by the group's renewal date.
Return completed renewal documents to your designated Account Manager and Implementation Account Specialist.
Note: Additional forms will be provided for any groups moving to self-funded or Optiflex funding arrangements.