At Premera Blue Cross, we serve more than 2 million people - from individuals and families to Fortune 100 employer groups - with a focus on making healthcare work better for everyone.
As a leader with over 500 multi-state large groups, we deliver the industry’s best pricing in total cost of care, best-in-class customer service, and superior depth in network access and integration.
In addition, we invest in new tools and fresh-thinking employees to help us find new, simpler ways to deliver care to our customers. As a not-for-profit company based in the Northwest for more than 80 years, Premera is the perfect blend of deep-rooted heritage and forward-focused innovation.
Our custom plans provide coverage for the whole health of your employees while keeping your costs in mind. Check out the following guides to find the best plan for your employees' needs.
2019 complete guide to health benefit plans (100+ employees)
2019 PersonalCare Plans (51+ employees)
If your business is headquartered in Pierce County, Peak
Care may be the right plan for you!
Our Peak Care plans offer lower costs for your bottom line
and an innovative healthcare experience for your employees.
See how Peak Care will benefit your business at peakcare.com or download the Peak Care brochure.
If you want to control costs and provide your employees with a health plan that offers access to a broad network of doctors and facilities, you want a health plan with flexibility. That’s why we designed Premera Flex Advantage.
With Preferred Choice plans, selecting your health plan is as easy as 1-2-3.
2019 Premera Preferred Choice plans
With Preferred Choice plans, two funding options are available: Fully insured and OptiFlex. Check out the Funding Types section on this page for more information.
Benefit highlights are a quick and handy resource for information about your Preferred Choice plan(s). We carefully designed these highlights to make understanding plan benefits easier. Please share with your employees!
Preferred Choice PPO: $250
Preferred Choice PPO: $500
Preferred Choice PPO: $750
Preferred Choice PPO: $1,000
Preferred Choice PPO: $1,500
Preferred Choice PPO: $2,000
Preferred Choice PPO: $2,500
Preferred Choice PPO: $3,000
Preferred Choice PPO: $4,000
Preferred Choice PPO: $5,000
Preferred Choice PPO: $6,350
Preferred Choice Flex Adv: $500/$1,000
Preferred Choice Flex Adv: $1,000/$2,000
Preferred Choice Flex Adv: $1,500/$3,000
Preferred Choice Flex Adv: $2,000/$4,000
Preferred Choice HSA: $1,500
Preferred Choice HSA: $2,500
Preferred Choice HSA: $3,000
Preferred Choice HSA: $5,000
Preferred Choice HSA: $6,450
Preferred Choice Peak: $0
Preferred Choice Peak: $100
Preferred Choice Peak: $250
Preferred Choice Peak: $500
Essentials $15/$60/$100/50%-$150 Plan
Essentials $10/$25/$45/30% Plan
Essentials $15/$30/$50/30% Plan
Optima $1,000 max Plan
Optima $1,500 max Plan
Optima $2,000 max Plan
Optima $2,500 max Plan
Preference $1,000 max Plan
Optima $1,000 max Plan (with Orthodontia)
Optima $1,500 max Plan (with Orthodontia)
Optima $2,000 max Plan (with Orthodontia)
Optima $2,500 max Plan (with Orthodontia)
Essentials Voluntary $1,000 max Plan
When you combine medical and pharmacy plans, you benefit from deeper, real-time insights into your complete healthcare costs and your employees benefit from whole-health care.
Here are a few other advantages of integrated care:
1Blue Cross Blue Shield Association Pharmacy Benefit Integration Study
Preferred is a more comprehensive list of prescription drugs and provides access to a full spectrum of brand-name medications.
Essentials is a restricted list of prescription drugs that meets basic pharmacy needs. Essentials keeps costs as low as possible by focusing on high-value drugs that are approved by the U.S. Food and Drug Administration (FDA). View our Essentials pharmacy plan guide for more information.
Premera’s Specialty Pharmacy Program is for your employees who may require specialty medications usually used to treat complex or rare conditions. Premera partners with Specialty Pharmacies that help these members manage their specialty medications through:
As the specialty pharmacy market rapidly evolves, Premera Blue Cross continues to work toward providing the best quality and savings on high-cost prescriptions for our members with complex or rare conditions. That’s why we offer our self-funded groups a more focused approach to specialty pharmacy providers that maximizes plan savings while delivering individualized patient care to these members. View this flyer on Exclusive Specialty Pharmacy to learn about the benefits.
Get predictable costs without the risk. We will assume all of the financial risk and pay your employees' claims. You pay a stable, monthly premium.
Opt for a payment option that directly reflects your employees' health needs. With this option, you assume the financial risk. However, this option may also give you the opportunity to reduce your costs by encouraging your employees to actively engage in their healthcare.
A combination of both fully insured and self-funded. Get the protection and flexibility of a self-funded plan without being overly expensive or complicated.
LifeWise Assurance Company assists groups with creating the right medical stop loss for their needs. If you elect to self fund your medical plan, this product provides a reinsurance contract to protect your group from catastrophic losses.
Ask your Premera Blue Cross representative or producer for details.
LifeWise Assurance Company is an independent company offering life and disability products to Premera Blue Cross employer groups and members. LifeWise Assurance Company does not provide Blue Cross Blue Shield products or services.
Competing for talent means offering a comprehensive benefits package. Premera Blue Cross partners with best-in-class companies to offer life and disability products to our employer groups and members while extending additional cost savings.
By adding life and disability products to Preferred Choice plans, you may be eligible for discounts on Premera Blue Cross medical premiums. Check out the advantages of adding dental, life, and disability to a Preferred Choice plan. Contact your Premera representative or producer to discuss your options.
Employers of 10 or more enrolled employees can choose from the following:
MetLife, Symetra, and The Hartford, are independent companies offering life and disability products to Premera Blue Cross employer groups and members, are solely responsible for their products and services, which are not Blue Cross Blue Shield products or services.
Premera's large business medical plans include convenient options for employees to access care or their health plan information online, with our mobile app, or by phone.
Members get free, confidential health advice from a registered nurse by phone any time, day or night, with our 24-Hour NurseLine.
Every medical plan comes with virtual care options. Video or phone consultations with a Teladoc® physician are available any time for a low copay.
Our redesigned mobile app enables employees to find their health plan information, or search for a doctor at any time.
We care about your employee's health, nutrition, and fitness. That's why Premera Blue Cross offers members special perks at no extra costs.
Learn more about our range of member discounts
Note: Offers might not be available in all locations. Please have your employees check with the company offering the discount before making their purchase.
Take advantage of our personal funding account options to combine quality healthcare coverage with access to health savings accounts (HSAs), health reimbursement arrangements (HRAs), and flexible spending accounts (FSAs). These accounts are ideal for
employers who are looking to control healthcare costs or increased employee responsibility for healthcare expenses and decisions.
Offered through ConnectYourCare, HSA on Demand gives employees up-front funds when they don’t have enough money in their HSA account to cover qualified medical expenses.
(This option is available for self-funded groups.)
Learn more about
personal funding accounts and HSA On Demand
We believe in working closely with doctors and hospitals to deliver for the customer together. That’s why our provider networks are more than just a collection of contracts—they give members access to quality care, good experiences, and services at a
For decades, Premera has maintained the largest network of doctors and medical facilities in Washington*. As a result, we offer greater network stability and deep discounts for covered in-network services.
For employers with 51 or more employees, we offer a choice of networks so you can select the level of provider access and cost that works best for your employees and business needs.
Our broadest provider network offers access to 100% of Washington hospitals and 99% of primary care doctors - more than 38,400 providers, clinics, and hospitals across
This tailored provider network offers access to more than 34,765 doctors, clinics, and hospitals across Washington state that commit to quality care, managed costs, and a focus on the customer. (Does not include CHI Franciscan Health and Providence Health
& Services systems.)
Check out the Heritage Prime Network flyer to see the key benefits of this network and a partial list of current providers.
Whether your employees want access to the most providers in Washington state, or the highest savings, give them the ability to choose their network by offering both Heritage and Heritage Prime networks.
Get help deciding which network is right for business, or if a dual offering is the way to go with the Heritage or Heritage Prime flyer.
With any Premera health plan, you have access to the BlueCard Program, which provides access to networks of contracted preferred and participating Blue Cross Blue Shield providers across the country. Just like here at home, these networks provide valuable
discounts on billed charges and the added advantage of direct billing. The BlueCard Program includes the added benefit of worldwide coverage with Blue Cross Blue Shield Global Core. This program provides members access to an international network
of participating doctors and hospitals for a broad range of medical care services so they can feel safe wherever they go.
Premera Flex Advantage is designed to give your employees broad access to providers. All the while, it uses financial incentives to encourage them to select the providers who can deliver the most cost-efficient services.
See our Premera Flex Advantage flyer for more information.
By helping your employees lead happier, healthier lives, you strengthen your organization through increased productivity and healthcare savings.
Premera’s Wellness program is automatically included in your health plan and is simple for you to administer. For our fully insured and Optiflex groups, this program offers added
support for creating a culture of wellness within your organization.
Your employees are automatically enrolled in the Premera Wellness Program as a part of their health plan benefits.
Are you looking for additional wellness support? We can help with that too. Our packaged wellness options feature consulting time with wellness experts, incentive assistance, and health education sessions. See our wellness package options.
Medical plans benefit guide (100+ employees)
Preferred Choice benefit guide (51-99 employees)
PersonalCare benefit guide (51+ employees)
Preferred Choice Agg HSA: $1,500
Preferred Choice Agg HSA: $2,500
Preferred Choice Agg HSA: $3,000
Preferred Choice Emb HSA: $5,000
Preferred Choice Emb HSA: $6,450
Essentials: 15/30-50 Plan
OPTIMA $1,000 max (with Orthodontia)
OPTIMA $1,500 max (with Orthodontia)
OPTIMA $2,000 (with Orthodontia)
OPTIMA $2,500 (with Orthodontia)
Preference Essentials Voluntary $1,000
2018-2019 Preferred Choice creditable coverage status report
Premera Blue Cross offers employers two options to support their Medicare Part D testing obligations. The testing tells if the pharmacy plan you offer meets the creditable coverage standard as compared with Medicare Part D.
The Centers for Medicare and Medicaid Services (CMS) says drug coverage is creditable if the actuarial value of the coverage equals or exceeds the actuarial value of standard Medicare prescription drug coverage.
Your choices for testing are:
The CMS website offers general Information about Medicare Part D.
To learn more about Medicare Part D testing and to discuss your options, contact your producer or Premera account representative.
Premera no longer sends creditable coverage status notices to members on behalf of groups with pharmacy plans.
Employers will need to provide the notifications as required by the Medicare Modernization Act (MMA) to their Medicare-eligible employees and dependents. This act requires employers to let their Medicare-eligible employees and dependents know whether
the prescription drug coverage pays on average as much as the standard Medicare prescription drug coverage.
Additional information is found at the following pages of the Centers for Medicare & Medicaid Services:
Federal law requires employer groups to notify the Centers for Medicare and Medicaid Services (CMS) if their prescription drug coverage for Medicare beneficiaries is creditable. CMS requires employer groups to submit a creditable coverage disclosure form each year or upon any change that could affect whether the drug coverage offered is creditable.
Medicare secondary payer (MSP) laws are complex and can be confusing even to a seasoned healthcare administrator. Employers offering group health plans must comply with the MSP statute and regulations (the MSP laws). These laws establish Medicare as the
secondary payer to group health plan coverage in certain instances of dual healthcare coverage.
This information is purely informational, does not modify your policy or coverage in any way, and should not be construed as legal advice or opinion. Additional information is available on the Centers for Medicare & Medicaid Services (CMS) website.
You can use the MSP change form to report group size and Medicare beneficiary changes to Premera that may impact MSP rules.
Premera is dedicated to helping our members get the best care after an illness or injury. Our outpatient rehabilitation management program reviews treatment plans to help your employees get care at the right time.
Learn more about how the outpatient rehabilitation management program works and what steps your employees can take if a treatment plan is denied.
As part of the Affordable Care Act of 2010, all health plans must provide a summary of benefits in a standard four-page format. These summaries help you understand how a plan works and makes comparing plans easier.
View summary of benefits coverage.
Western Washington John Casper425email@example.com
You'll get the most out of your benefits when you choose in-network doctors, healthcare providers, and hospitals.