Frequently Asked Questions

The Health Connect Plan is built around a network of select providers on the Eastside who are committed to delivering high-quality care. To help you coordinate your care, you are encouraged to work closely with a Primary Care Provider of your choice – though you always have the option of coordinating your own care, without any referrals. Your out-of-pocket costs are lowest when you use a Health Connect network provider – and for some everyday services, a convenient copayment applies. You also can use other Premera providers, but your out-of-pocket costs may be higher. Most out-of-network providers will be covered at 50% of allowed amount, after deductible. For more information, visit How the Plan Works.

For an overview of the differences between the Health Connect Plan and the Health Savings Plan, see the Plan Comparison.

The plan includes two networks:

• The Health Connect Network
  • Eastside Health Network
  • Allegro Pediatrics
  • Living Well Health Center
• Extended network includes other Premera providers and gives you access to certain hospitals, including Seattle Children’s.

Yes. In those cases, coverage is provided at the Health Connect level when you see an Extended network provider. There may be cases where a specialist is not available in the Health Connect network. If that happens, your PCP may refer you to a provider in the Extended network. See Explore Providers for a list of specialists.

If you or a family member experiences a life-threatening condition, go to the nearest emergency room or call 911. The Health Connect Plan covers care received at any emergency room at the Health Connect network benefit level, no matter what emergency room you use.

Yes. Your out-of-pocket costs are lowest when you use a Health Connect network provider, and copayments apply to some basic health care services, like office visits and prescription drugs. You also can see Extended network providers, but you pay coinsurance for most of your care, making your out-of-pocket costs higher. Most out-of-network providers will be covered at 50% of allowed amount, after deductible.

The Health Connect Plan is offered only to employees who reside in King County and Snohomish County in the Puget Sound region. We will consider introducing it in other locations in the future where we have a high concentration of employees and dependents, which is a prerequisite for a plan of this type.

Emergency services received outside the United States will be paid as emergency care, subject to the emergency room $250 copay (waived if admitted). Covered non-emergency facility and professional services are considered under the Extended network and covered at 60% of billed charges. Standard deductible and coinsurance would apply. Other benefit guidelines apply. Please review your Summary Plan Description or contact customer service at 800-676-1411 for information on whether specific services are covered.

Most out-of-network providers will be covered at 50% of allowed amount, after deductible.

Your Primary Care Provider (PCP) gets to know you and creates a personalized care plan, addresses your day-to-day health care needs, and works with all your other providers to coordinate care if you have more complex health needs. Your PCP also works with a care team to make sure you get the right care at the right time. This can help reduce duplicate tests and services, unnecessary treatment, and avoidable health care costs over time.

PCP’s are most often doctors but can also be Nurse Practitioners or Physician Assistants. PCP types are:

• Family Medicine providers
• Internal Medicine providers
• Pediatric Medicine providers
• Geriatric Medicine providers

You are encouraged, not required, to choose a PCP to ensure you get the most out of the plan. If you don’t choose a PCP, the plan will automatically assign a PCP to you and each of your covered family members based on where you live. If you’d like, you can select a new PCP at any time.

You can call the Microsoft-dedicated customer service team at 800-676-1411 (TTY: 711) and select the Health Connect Navigator option. Representatives are available to help find a PCP for you and your covered family members, 7:00 AM—7:00 PM Pacific Time, Monday—Friday.

No. Your PCP can only provide a referral (waiver) to see an Extended network provider if the services you need are not available in the Health Connect network.

You have the freedom to see any provider you want in the Extended network without a waiver, but you will pay more out of pocket, unless your PCP submits a waiver for you to see that provider. Typically, waivers are only provided when the services you need are not available in the Health Connect network.

Yes. You will be covered even if you don’t select a PCP. However, you need to select a PCP if you want to get the most out of the plan. Your PCP will focus on your individual needs and goals and work closely with their Health Connect partners as needed if you have more complex health needs. Plus, your PCP and care team will ensure you get the right care at the right time.

Yes. You’re free to choose a different PCP for yourself or your covered family members at any time.

If you go to a Health Connect network specialist, no referral is needed. Most health care services are available in the Health Connect network. You may also see specialists in the Extended network but there may be higher costs.

If your PCP determines the services you need are only available from an Extended network provider, your PCP will submit a waiver to cover those services at the higher Health Connect network benefit levels.

Yes. You can use the money in your Health Savings Account to pay for eligible expenses when you participate in the Health Connect Plan. The account is yours to keep and use for future eligible health care expenses.

No. Per IRS rules, you can only contribute to a Health Savings Account if you participate in the Health Savings Plan.

Yes. You can contribute up to $2,750 in pre-tax money to a Health Care Flexible Spending Account if you enroll in the Health Connect Plan. Keep in mind that you need to spend the money in your FSA by December 31 each year—up to $550 will carry over and any remaining balance will be forfeited, per IRS rules.

Yes, you can contribute up to $2,750 to a Health Care Flexible Spending Account (FSA). If you elect to contribute to a Health Care FSA, remember to spend the money in your FSA to avoid forfeiting any remaining balance at the end of the year.

To determine if your current provider is in the Health Connect network or Extended network, use the Provider Finder Tool

If you have questions about the Health Connect Plan, call the Microsoft-dedicated customer service team at 800-676-1411 (TTY: 711) 5:00 a.m. to 8 p.m. Pacific Time, Monday through Friday, or email Microsoft@premera.com.