• Applying Directly with Premera

    It’s easy. Your client can apply either online or by mail.

    Online Enrollment

    Your clients can apply using your own personal enrollment link. Applying online allows you to track your clients current status of their application.

    If you do not have a personal enrollment link please call Producer Support at 877-205-9725, Option 1.

    To Apply By Mail

    For effective dates starting January 1, 2014

    Starting January 1, 2014, applicants will only need to complete the application to apply for coverage as required by the Affordable Care Act (ACA) 

    1. Download and complete the application form:
      Individual and Family Application One application per family
    2. Then mail to:
      Premera Blue Cross
      PO Box 91120, MS 295
      Seattle, WA 98111-9220

    Applying through Washington Healthplanfinder?

    If your clients qualify for premium credit assistance, cost share reduction plans or American Indian/Alaska Native plans, they will want to enroll in a plan through Washington Healthplanfinder.

    Is Your Client Eligible to Apply?

    Eligibility Considerations

    Individuals eligible to apply for a Premera plan must be:

    • A resident of and have a principal residence in the state of Washington
    • Not entitled to Medicare. If 65 or older but not eligible for Medicare, the applicant must submit a “Not eligible for Medicare” document from the Social Security Administration
    • Applying during an open enrollment period or due to a qualifying event

    Eligible dependents that can enroll on a plan include:

    • Spouse or domestic partner
    • Natural or legally adopted child(ren) under the age of 26

    Open Enrollment Periods

    The open enrollment period this year is October 1, 2013 – March 31, 2014. Your client can select a new plan during this period. If they do not enroll during this period, they’ll have to wait until November 15, 2014, to change their plan or purchase coverage for January 1, 2015.

    Your Sales Executive and Producer Support are available to help answer any questions you might have about these plans.

    Grandfathered plans

    Your clients can retain their grandfathered plans (established prior to March 23, 2010) or select a new plan. If a grandfathered client wants to select a new plan, they'll have until March 31, 2014. After that, they will need to wait until November 15, 2014, to change plans for a January 1, 2015, effective date.

    Qualifying Events

    Individuals are eligible to apply for coverage outside of the annual open enrollment period only when they have a qualifying event.

    Individuals will report qualifying events through the enrollment application if purchasing through Premera or through the Exchange web portal if purchasing through the Exchange.

    A qualified individual has 31 days to report the event, and may then be determined eligible for a 60-day Special Enrollment period from the date of the qualifying event to select a Health Plan. In the case of reporting a birth or adoption, or placement for adoption, the household has 60 days to report the event. Premera and the Exchange will allow qualified individuals and enrollees to enroll in or change from one Qualified Health Plans to another as a result of the following events:

    • A qualified individual or dependent loses minimum essential coverage (Note: This condition excludes loss of coverage due to non-payment of premiums by the individual, but includes loss of coverage due to non-payment of premiums by an employer)
    • A qualified individual gains a dependent or becomes a dependent through marriage, birth, adoption, or placement for adoption
    • An individual, who was not previously a citizen, national, or lawfully present individual gains such status
    • A qualified individual’s enrollment or non-enrollment in a QHP is unintentional, inadvertent, or erroneous and is the result of the error, misrepresentation, or inaction of an officer, employee, or agent of the Exchange or HHS, or its instrumentalities as evaluated and determined by the Exchange. In such cases, the Exchange may take such action as may be necessary to correct or eliminate the effects of such error, misrepresentation, or inaction;
    • An enrollee adequately demonstrates to The Exchange that the QHP in which he or she is enrolled substantially violated a material provision of its contract in relation to the enrollee
    • An individual is determined newly eligible or newly ineligible for advance payments of the premium tax credit or has a change in eligibility for cost-sharing reductions, regardless of whether such individual is already enrolled in a QHP. The Exchange must permit individuals whose existing coverage through an eligible employer sponsored plan will no longer be affordable or provide minimum value for his or her employer’s upcoming plan year to access this special enrollment period prior to the end of his or her coverage through such eligible employer-sponsored plan;
    • A qualified individual or enrollee gains access to new QHPs as a result of a permanent move
    • An American Indian, as defined by Section 4 of the Indian Health Care Improvement Act, may enroll in a QHP or change from one QHP to another one time per month
    • A qualified individual or enrollee demonstrates to The Exchange, in accordance with guidelines issued by HHS, that the individual meets other exceptional circumstances as The Exchange may provide
      • To comply with WAC 284-43-985(3)(a), enrollees under age 19 will be eligible for special enrollment if they were to lose employer sponsored insurance coverage for any reason