An important notice about pathology/laboratory services
CellNetix is a provider of pathology services that is no longer in Premera’s network. We have asked the healthcare providers in our network to send our members’ pathology work to an alternative pathology provider. Having your pathology tests performed by CellNetix could result in higher out-of-pocket costs. If you visit one of the following healthcare providers, they may send your pathology work to CellNetix: Swedish Hospitals and Swedish Medical Group; Northwest Hospital and Medical Center; Providence Regional Medical Center Everett and Providence Medical Groups; Minor & James Medical; Highline Medical Center; and The Everett Clinic.
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Large employers subject to the employer shared responsibility requirements under the Affordable Care Act (employers with 50 or more full-time employees and/ or full-time equivalents) must report to the IRS the minimum essential coverage offered to their full-time employees and their dependents in 2015.
In general, reporting is to be completed on IRS Form 1095 by February 28 (March 31 if filed electronically) following the 2015 calendar year. Additionally, large employers will also need to send copies of Form 1095-C to their employees by January 31.
Form 1095 responsibility to employees and their dependents
Members must report qualifying healthcare coverage on their 2015 federal tax return as a requirement of the Affordable Care Act.
Fully insured plans — If your health plan is fully insured, your employees will receive a 1095-B from Premera. Additionally, you will need to send your employees copies of the Form 1095-C that you file with the IRS.
Self-funding plans —If your health plan is self-funded, the IRS allows you to consolidate reporting requirements through Form 1095-C only. Employers must supply copies of 1095-C to their employees by January 31, 2016.
You can find more information on reporting requirements and Form 1095 by visiting the Affordable Care Act section of IRS.gov.
Our newly improved Find a Doctor tool (provider search engine) now offers members better cost information, smarter search features, and deeper quality reviews once logged in. Check out these new features by logging in or talking to your sales representative today.
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.
Our new virtual care solution is getting a lot of media coverage. Check out an article in the Seattle Times, Herald Business Journal, or State of Reform
Through October 31, Alaska residents who participate in Checkup Challenge by pledging to schedule a preventive visit to their doctor will be entered in a weekly drawing for a $200 Amazon gift card. For more information about the Checkup Challenge, read this press release and visit checkupchallenge.com.
To ensure the safety of our members, Premera is implementing a Controlled Substance Utilization service. We will review prescription drug use by our members to make sure it meets standards of medical need, safety and best medical practices. When our review identifies an instance where the use of addictive drugs may exceed safe levels, we contact the member.
Our Case Management team will work with the member using engagement and coaching techniques to uncover and address barriers to optimal health as well as coordinate services among healthcare providers.
Please contact your Premera Sales Representative if you have any questions.
Choosing Wisely® is a promotional campaign designed by the ABIM Foundation to increase physician/patient dialogue, employee health care literacy, and reduce waste in the healthcare system. It aims to promote conversations between physicians and patients by helping patients choose care that is:
General campaign messages include “Five Things Physicians and Patients Should Question” which is derived from twenty leading medical specialty societies. The campaign also promotes when specific tests and procedures such as imaging tests, EKG, and Pap tests may be appropriate, as well as the methodology used.
Check out Choosing Wisely: When to say ‘Whoa!’ to doctors or visit the Choosing Wisely website for more information.
CareCompass360° is a whole-person health support model that meets members' needs - whether they're healthy or navigating complex conditions. For more information about CareCompass360°, read this press release.
You may be familiar with ICD-9. This is the coding system used in healthcare to classify diseases and other health problems. It is also meant to promote international comparability in the collection, processing, classification, and presentation of mortality and health statistics. Premera uses these codes to standardize communication and payments to providers.
Many countries adopted ICD-10 in the 1990s. The United States will begin use of ICD-10 on October 1, 2015. The main difference in the two systems is the level of specificity. While ICD-9 contains 14,000 diagnosis codes, ICD-10 will have 69,000.
Premera has been preparing for ICD-10 for some time. We are working together with our contracted providers to ensure a smooth transition to the new system.
Rx Search - Use this tool to get information about your employees' prescription drugs, including how a drug is covered by a Premera plan.
PremeraNews.com - Check here for updates from Premera
Employee Communications Resources - A wealth of resources to help you communicate healthcare benefits, programs, and other wellness information.
Health Savings Account Calculator for Employers - Use this tool to compare potential costs for a high deductible health plan paired with a health savings account.
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