Small Group Plans (1-50 Employees)

Choice plans paired with our broadest selection of in-network provider under the Heritage network. HSA-qualified plans offer tax savings for both employers and employees.

• Choice PPO
• Choice 750 Gold
• Choice 1000 Gold
• Choice 1500 Gold
• Choice 2500 Silver
• Choice 5500 Bronze

• Choice HSA Qualified
• Choice HSA Qualified 1500 Gold
• Choice HSA Qualified 3000 Silver
• Choice HSA Qualified 6000 Bronze

Balance plans paired with Heritage Signature, a slightly smaller network than Heritage, but providing added cost savings for employers.

• Balance PPO
• Balance 500 Gold
• Balance 1000 Gold
• Balance 1500 Gold
• Balance 2000 Silver
• Balance 3000 Silver

• Balance HSA Qualified
• Balance HSA Qualified 1500 Gold
• Balance HSA Qualified 3000 Silver
• Balance HSA Qualified 6000 Bronze

Medical plans with family dental benefits built right in – and the opportunity for employees to choose their desired network. By bundling pediatric and adult dental benefits with medical coverage, employees get well-rounded health coverage for their whole family and access to our large provider network. All the while, employers get a one-stop-shopping experience for managing your benefits.

• Balance Medical + Family Dental
• Balance 500 Gold + Family Dental
• Balance 1000 Gold + Family Dental
• Balance 2000 Silver + Family Dental

• Choice Medical + Family Dental
• Choice 750 Gold + Family Dental
• Choice 1000 Gold + Family Dental
• Choice 2500 Silver + Family Dental
• Choice HSA Qualified 3000 Silver + Family Dental

We also offer 2 separate dental plans. Employers can pair these to provide adult dental coverage with any medical plan you choose. With Adult Dental Optima, employers can offer their employees comprehensive coverage and flexibility to choose their dentist. Specifically for employers with 5 employees or more, Adult Dental Optima Voluntary provides dental coverage at little or no cost.

• Adult Dental Optima
• Adult Dental Optima 1000
• Adult Dental Optima 1500
• Adult Dental Optima 2000

• Adult Dental Optima Enhanced
• Adult Dental Optima 1000 Enhanced
• Adult Dental Optima 1500 Enhanced
• Adult Dental Optima 2000 Enhanced
• Adult Dental Optima 1500 Enhanced+

• Adult Dental Optima Voluntary
• Adult Dental Optima Voluntary 1000

Add a vision plan for adults to offer a complete benefits package. Pediatric vision benefits are included in each health plan.

• Vision
• Adult Vision Plan

Premera Wellness Program

At Premera, we know how important wellness is to your small group clients. Healthier employees are happier and more productive employees. That's why we include the Premera Wellness Program with every small group medical plan-at no additional cost to your group clients.

Here's what your small group clients get with the Premera Wellness Program.

New or renewing small groups with metallic plan start dates of January 1, 2018 or later

• Employers get quarterly wellness resources in an email from Premera. These resources will help employers promote wellness to their employees.
• Employees can get a free Fitbit Zip ™ or Fitbit Flex 2™ for completing the Wellness Program's online health assessment within 3 months of their health plan's start or renewal date.

Share this 2018 Wellness Program guide with your clients.

New or renewing small groups with metallic plan start dates before January 1, 2018

Employers:

• Save 7.5% on premiums for each employee who completes wellness activities.
• Can launch a successful wellness program with our wellness program employer toolkit.

Employees:

• Will earn a $100 Visa^® debit card after they have completed the wellness activities.
• Who qualify may receive telephonic health coaching at no additional cost.

Guides

• 2017 Medical Benefits Guide
• Medical Plan Options Flyer
• Dual Choice Matrix

Medical benefit highlights

• Balance Plans
• Balance 500 Gold
• Balance 750 Gold
• Balance 1000 Gold
• Balance 1500 Gold
• Balance 2000 Silver
• Balance 3000 Silver

• Balance HSA and HSA Qualified Plans
• Balance 3000 Qualified Silver
• Balance 4000 HSA Silver
• Balance 6000 HSA Bronze

• Balance Employee Only Plan
• Balance 500 Gold Employee Only

• Balance + Family Plans
• Balance 500 Gold+Family Dental
• Balance 1000 Gold+Family Dental
• Balance 2000 Silver+Family Dental

• Choice Plans
• Choice 750 Gold
• Choice 1000 Gold
• Choice 2500 Silver
• Choice 5500 Bronze

• PersonalCare Plans
• PersonalCare Gold 750
• PersonalCare Silver 2500
• PersonalCare Bronze 4500

Dental benefit highlights

• 2017 DentalBlue benefit guide

Vision benefit highlights

• Adult Vision Plan
• Adult Vision Plan - Employee Only
• Vision plan summary

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.

Small group creditable coverage status report

2018 small group creditable coverage status report
2017 small group creditable coverage status report

2017 small group creditable coverage tested against 2018 Medicare Part D threshold amounts (if your plan straddles 2017 and 2018 reference this list).

The CMS website offers general Information about Medicare Part D.

Important reminder

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:

• Creditable coverage
• Model notice letters

Submission of CMS Medicare Part D Disclosure Form

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.

Group Enrollment (up to 50 employees)

2018

• 2018 Group Master Application Up to 50
• 2018 Group Master Application Benefit Selections Up to 50
• 2018 Group Master Application Dental Benefit Selections Up to 50

2017

• 2017 Group Master Application Up to 50
• 2017 Group Master Application Benefit Selections Up to 50
• 2017 Group Master Application Dental Benefit Selections Up to 50

Additional group enrollment forms

• New Group Enrollment Checklist
• Renewal Group Enrollment Checklist
• Group Size Certification
• Groups of One Attestation
• Personal Funding Account Setup - For Metallic Groups (2018)
• Personal Funding Account Setup - For Metallic Groups (2017)
• Electronic Funding Authorization (HSA)
• Group Verification of Medicare Coverage
• Late Enrollment Acknowledgement
• Quick Reference Guide for Plan Administrators
• Key Employee Verification

Member enrollment and other forms

• Member Enrollment and Change Application
• Member Enrollment and Change Application Spanish Version
• Affidavit of Domestic Partnership Group Plans
• Deductible Credit Form
• Enrollment Spreadsheet (in lieu of member enrollment applications)
• HIPAA Pre-existing Change Notice and Instructions
• HIPAA Pre-existing Change Notice and Instructions Spanish Version
• Other Coverage Questionnaire Enrollment
• Personal Funding Accounts Enrollment and Change Application
• Request for Certification of Disabled Dependent
• Waiver of Coverage
• Transition of Care Form
• HRA Electronic Funding Authorization

Member, UMB Bank Forms

• UMB HSA Beneficiary Designation Form
• UMB HSA Name Change Request Form
• UMB HSA Account Closure/Withdrawal Request
• UMB HSA Funds Transfer
• HSA Expense Manual Claim Form