Premera knows how important it is for you to provide your clients with a comprehensive healthcare plan. That's why we offer medical, dental, and pharmacy plans that help control costs while providing coverage that balances personal responsibility and freedom of choice.
We make it easy and simple for you to support your clients by setting up new groups quickly and providing consultation that helps you and your clients better understand costs.
Our producer news center is the best source for tips and sales tools. You also get access to B’link – our ready-to-share communications that can help you address client and employee questions.
Our custom plans provide coverage for the whole health of your clients' employees while keeping your costs in mind. Check out the following guides to find the best plan for your clients' needs.
2019 complete guide to health benefit plans (100+ employees)
2019 PersonalCare Plans (51+ employees)
Essentials pharmacy plan guide (51+ employees)
Flex Advantage is part of our high-value care solutions. It's designed to increase your clients' savings by encouraging their employees to make healthcare decisions that maximize their benefits.
Learn more about Flex Advantage
For self-funded, OptiFlex, and Preferred Choice group clients with 51+ employees.
For group clients headquartered in the Pierce County area.
Peak Care is an exclusive provider organization (EPO) plan that will:
Check out our Peak Care producer toolkit. Here you will find videos, brochures, and resources all in one place, making it easy to find all the resources you need to sell this new plan.
*Comparison of Premera preferred provider organization plan pricing
Choosing the right health plan is with Preferred Choice – a collection of our most popular medical, pharmacy, and dental health plans.
Our new Preferred Choice guide now includes detailed benefit highlights. This makes it easier for you to help your clients choose a Preferred Choice plan.
2019 Premera Preferred Choice plans
Are you assisting new or renewing group clients with a proposal? You’ll find all the forms you need to help your clients complete their enrollment – plus employee-facing benefit highlights – on the Preferred Choice employer page.
When your group clients combine medical and pharmacy plans, they benefit from deeper, real-time insights into their complete healthcare costs and their 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). Share our Essentials pharmacy plan guide with your clients looking for more information.
Premera’s Specialty Pharmacy program is for member 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. Share this flyer on Exclusive Specialty Pharmacy with your group clients who want to learn more about the benefits.
Get predictable costs without the risk. We assume all of the financial risk and pay your client's employees' claims. Your clients pay a stable, monthly premium.
Opt for a payment option that directly reflects your client's employees' health needs. With this option, your client assumes the financial risk. However, this option may also give them the opportunity to reduce costs by encouraging their employees to actively engage
in their healthcare.
A combination of both fully insured and self-funded. Your clients get the protection and flexibility of a self-funded plan without being overly expensive or complicated.
Competing for talent means offering a comprehensive benefits package. Premera Blue Cross partners with best-in-class companies to allow you to offer life and disability products to your clients while extending additional cost savings.
When your group clients with 51-199 employees add life and disability products to their Preferred Choice plan, they may be eligible for discounts on Premera Blue Cross medical premiums.
Your group clients with 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.
LifeWise Assurance Company assists your group clients with creating the right medical stop loss for their needs. If they elect to self fund their medical plan, this product provides a reinsurance contract to protect them from catastrophic losses.
LifeWise Assurance Company is an independent company offering life and disability products to Premera Blue Cross employer groups and members. LifeWise Assurance Company do not provide 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 our members' health, nutrition, and fitness. That's why Premera offers members special perks at no extra costs.
Learn more about the member discounts that your client's employees can receive.
Note: Offers might not be available in all locations. Please have your employees check with the company offering the discount before making their purchase.
Our personal funding account options 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 increase their employees' responsibility for healthcare expenses and decisions.
Offered through ConnectYourCare, HSA on Demand gives members 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 a network is more than just a collection of contracts. For decades, Premera has maintained the large network of doctors and medical facilities in Washington. As a result, we offer greater network stability and deep discounts for covered in-network
For employers with 51 or more employees, we offer a choice of networks so your clients can select the level of provider access and cost that works best for their employees and business needs.
Our broadest provider network offers access to 100% of Washington hospitals and 99% of primary care doctors in Washington state. Includes CHI Franciscan Health and Providence Health & Services systems.
This tailored provider network offers access to more than 33,200 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 flyer to see the key benefits of this network and a partial list of current providers.
Whether your client and their 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.
Help your clients decide which network is right for their 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 group clients broad access to providers. All the while, it uses financial incentives to encourage their employees with a Premera medical plan to select the providers who can deliver the most cost-efficient
Premera Flex Advantage flyer
*Consortium Health Plans, Inc. Network Compare Key Findings as of June 5, 2015. Available at chpmarketquest.com.
Effective July 1, 2017, new and renewing large groups (51-499 employees) will have access to Premera's Wellness Program. The program offers fully insured and Optiflex groups support for creating a culture of wellness. It is a part of our health plan offering
and is simple to administer.
More information is available in the Wellness Program brochure. We encourage you to share this new program with your large group prospects and current clients.
Employers are automatically enrolled in the Premera Wellness Program as a part of their health plan benefits.
Are your prospects or current clients 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. Learn more.
Medical plans benefit guide (100+ employees)
Preferred Choice benefit guide (51-99 employees)
PersonalCare benefit guide (51+ 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 Flex Adv: $500/$1,000
Preferred Choice Flex Adv: $1,000/$2,000
Preferred Choice PPO: $4,000
Preferred Choice PPO: $5,000
Preferred Choice PPO: $6,350
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
Preferred Choice Flex Adv: $1,500/$3,000
Preferred Choice Flex Adv: $2,000/$4,000
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.
Employers offering group health plans must comply with the Medicare Secondary Payer (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. The MSP laws are complex and can be confusing even to a seasoned healthcare administrator.
This section has been designed to provide a general overview of what your group clients need to know about MSP and related issues. It's purely informational, does not modify their policy or coverage in any way, and should not be construed as legal advice or opinion.
MSP change form – Form used for employer groups 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 client's employees get care at the right time.
Learn more about how the outpatient rehabilitation management program works and what steps your client's 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 – group sales (51+)
800-722-5561, option 1, ext. 85064Fax: 425-918-5883
Eastern Washington – group sales (51+)
800-722-5561, option 1, ext. 27324Fax: 509-252-7075
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