Large Business Plans (51+ Employees)

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.

2024 complete guide to health plan guide (51+ employees)

2024 Premera Blue Cross HMO health plan guide (51+ employees)

2023 complete guide to health benefit plans (51+ employees)

Essentials pharmacy plan guide (51+ employees)

Premera Blue Cross HMO

The HMO Core Plus plan is available in Pierce, Thurston, and Spokane counties and offers personalized healthcare with seamless and simplified experiences for employees and employers. Beginning January 1, 2024, the HMO is expanding into King County.

Want to learn more about what Premera Blue Cross HMO can offer your clients?

Contact your Premera Blue Cross HMO sales representative for details.

Go to the HMO

Premera Blue Cross HMO flyer

2024 Premera Blue Cross HMO health plan guide (51+ employees)

2024 Premera Blue Cross HMO Preferred Choice health plan guide 

Preferred Choice HMO: $500

Preferred Choice HMO: $1,000

Preferred Choice HMO: $1,500

Preferred Choice HMO: $2,000

Preferred Choice HMO: $3,000

Preferred Choice HMO: $4,000

Preferred Choice HMO: $5,000

Preferred Choice HMO: $6,000

Introducing our new health plan option that offers a balance between savings, access, and flexibility. Premera Pathfinder is an exclusive provider organization (EPO) plan designed to support primary care usage that can lead to overall lower costs and better health outcomes for an employer’s business and their workforce.

Savings and flexibility

Employers can save up to 10% over a traditional Premera Blue Cross PPO plan.

Members get $0 primary care office visit copays when they seek care with their designated primary care provider (PCP)—both in-person and virtually. While members can save by using their designated PCP, it’s not required, and referrals aren’t required either.

Network access

Premera Pathfinder uses the Heritage Prime network that offers easy access to care throughout Washington state. It also includes access to national BlueCard providers, and to primary care with Kinwell clinics just for Premera members.

Is Premera Pathfinder a fit for your employer clients?

Contact your Premera account representative today for more information and check out the Premera Pathfinder flyer.

Preferred Choice Producer Toolkit: Benefit highlights and step-by-step checklists for your new or renewing clients

Plan guides

2024 Premera Preferred Choice plans

2024 Premera Blue Cross HMO Preferred Choice health plan guide

2023 Premera Preferred Choice plans

2024 medical plans

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 HSA: $1,600

Preferred Choice HSA: $2,500

Preferred Choice HSA: $3,200

Preferred Choice HSA: $3,500

Preferred Choice HSA: $4,000

Preferred Choice HSA: $5,000

Preferred Choice HSA: $6,450

Preferred Choice Premera Pathfinder: $500

Preferred Choice Premera Pathfinder: $1,000

Preferred Choice Premera Pathfinder: $3,000

Preferred Choice Premera Pathfinder: $5,000

Preferred Choice HPN: $1,000

Preferred Choice HPN: $2,000

Preferred Choice HMO: $500

Preferred Choice HMO: $1,000

Preferred Choice HMO: $1,500

Preferred Choice HMO: $2,000

Preferred Choice HMO: $3,000

Preferred Choice HMO: $4,000

Preferred Choice HMO: $5,000

Preferred Choice HMO: $6,000

2024 pharmacy plans

$10/$25/$45

$15/$35

$15/$35-$150

$15/$35-$300

$15/$30/$50

$15/$30/$50-$150

$20/$50/50%/30%

Essentials $10/$25/$45/30% Plan

Essentials $15/$30/$50/30% Plan

Essentials $15/$60/$100/50%-$150 Plan

HMO $10/$25/$45/30% Plan

HMO $10/$35/$70/30% Plan

HMO $10/$35/$75/50% Plan

HMO $15/$30/$50/30% Plan

HMO $15/$60/$100/50% - $150 Plan

2024 dental plans

Optima $1,000 Max Plan

Optima $1,000 Max Plan (with Orthodontia)

Optima Flex $1,000 Max Plan

Optima Voluntary $1,000 Max Plan

Optima $1,500 Max Plan

Optima $1,500 Max Plan (with Orthodontia)

Optima $1,500 Shared Family Plan

Optima Flex $1,500 Max Plan

Optima Flex $1,500 Max Plan (with Orthodontia)

Optima Flex $1,500 Shared Family Plan

Optima Voluntary $1,500 Max Plan

Optima $2,000 Max Plan

Optima $2,000 Max Plan (with Orthodontia)

Optima $2,500 Max Plan

Optima $2,500 Max Plan (with Orthodontia)

Essentials $1,000

Essentials 20% $1,000

Willamette Dental $15/$30

Willamette Dental $20/$30

Willamette Dental $25/$30

2023 medical plans

2023 pharmacy plans

2023 dental plans

Good oral health is pivotal to overall health. When your clients offer their employees both dental and medical benefits from Premera, they encourage healthy habits and support early detection and management of diseases.

In addition, you clients will be pleased to learn that the size of the Premera dental network has increased for the second year in a row.

You’ll find details about Premera dental plans and the advantages of bundling Premera dental with medical in the following guides:

• 2024 Preferred Choice health plan guide
• 2024 large group health plan guide
• 2023 Premera Preferred Choice plans (large group)
• 2023 complete guide to health benefit plans (large group customizable)

For new and existing fully insured and self-funded groups who have 51+ employees.

Offer your group clients a dental product that combines the easy, streamlined experience you get with a Premera medical and Premera dental plan alongside the predictable out-of-pocket costs that you’ve come to know from Willamette Dental Group.

4 key benefits of Willamette Dental by Premera

When your clients purchase Willamette Dental through Premera they get simplified plan administration and billing by dealing with only one health plan.

Here’s how Willamette Dental is different:

• Members and their families get a dental plan with predictable out-of-pocket costs, so they’re not surprised by unknown costs.
• Every member gets affordable orthodontic coverage at any age with no waiting periods and a predictable copay.
• Members will never exhaust their dental coverage and will never need to satisfy a deductible before they can receive their benefits, because our Willamette dental plans feature no deductible, no annual maximum, and no waiting periods.
• Every member gets a personalized dental care plan that promotes long-term dental health.

An integrated approach to medical and pharmacy benefits simplifies administration; improves health and member experience; and manages total cost of care.

Choose from 2 pharmacy plans:

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.

Specialty Pharmacy program

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:

• Patient education
• Clinical support for dosing and potential side effects
• Medication ordering and delivery options
• Working with the member to assure they are taking their medications correctly and compliant with the drug therapy

Exclusive Specialty Pharmacy for self-funded groups

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.

Fully insured

Group pays a fixed rate for employee health coverage. Premera pays all claims and assumes all risks for the group's health coverage.

Self-funded

Group assumes all the risk for providing healthcare benefits to its employees. This funding type offers the greatest amount of flexibility and plan customization.

OptiFlex

Group pays a fixed rate for employee health coverage, but has more flexibility compared to fully insured funding.

Best-in-class benefits

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.

Did you know…

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:

Group life insurance

• Group term life
• Accidental death and dismemberment
• Supplemental life and AD&D
• Dependent life

Disability coverage

• Short-term disability coverage
• Supplemental short-term disability coverage
• Long-term disability coverage
• Supplemental long-term disability coverage

Worksite coverage

• Accident
• Critical illness
• Hospital indemnity

Preferred carriers

• MetLife
• Symetra
• The Hartford
• Equitable
• Principal

MetLife, Symetra, The Hartford, Equitable, and Principal are independent companies offering life, disability, and worksite 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.

24-Hour NurseLine

Members get free, confidential health advice from a nurse by phone any time, day or night, with our 24-Hour NurseLine.

Virtual care

Every medical plan comes with virtual care options.

The Premera mobile app

Our redesigned mobile app enables employees to find their health plan information, or search for a doctor at any time.

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.

Personal funding account benefits

• Members have more choices and control over their healthcare spending
• Members can offset out-of-pocket expenses with potential tax advantages
• Potential tax savings for employers

HSA On Demand

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 services.

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.

Heritage network

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.

Heritage Prime network

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.

The power of choice

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.

National and worldwide network coverage with BlueCard™

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.

Sherwood HMO network

Sherwood HMO is a high-value network with providers who are committed to delivering the best possible care at the lowest cost.

*Consortium Health Plans, Inc. Network Compare Key Findings as of June 5, 2015. Available at chpmarketquest.com.

Because healthier employees often lead to better bottom lines

When your group clients help their employees lead happier, healthier lives, they strengthen their organization through increased productivity and healthcare savings.

Vivacity offers a variety of wellness program options like physical activity challenges, stress management programs, health assessments, wellness communications and many other tailored programs that align with varying workplace cultures and values. Let's talk about how Vivacity can help your clients achieve their wellness goals. Call us today at 877-276-9953, or visit us at vivacity.com.

Group enrollment (51+ employees)

• 2024 Group master application 51+ fully insured
• 2024 Group master application 51+ self-funded
• 2024 Group master application 51+ OptiFlex
• 2024 Group master application 51+ for Premera HMO
• Group size certification
• Personal funding accounts enrollment and change application
• Late enrollment acknowledgement
• Quick reference guide for plan administrators

Member enrollment

• Deductible credit
• Member enrollment & Change application
• Inscripcion de Miembros de Grupos y Solicitud de Cambios (Member Enrollment & Change Application)
• Member Enrollment & Change Application HMO
• Inscripcion de Miembros y Solicitud de Cambios HMO - (Member Enrollment and Change Application HMO)
• Enrollment spreadsheet (in lieu of member enrollment applications)
• Other coverage questionnaire enrollment
• Request for certification of disabled dependent
• Waiver of coverage
• Premera HMO Waiver of Coverage

Member, other

• Dental provider nomination
• Transition of care

Personal funding accounts

• 2024 Personal funding account setup
• Funding account ACH authorization
• HSA account closure
• HSA designation of beneficiary
• HSA trustee to trustee transfer
• Personal funding accounts enrollment and change application
• HSA expense manual claim
• Funding Account Employer Admin Guide - large group

Preferred Choice creditable coverage status report

2024 Preferred Choice Creditable Coverage Status Report

2023-2024 Preferred Choice Creditable Coverage Status Report

2023 Preferred Choice Creditable Coverage Status Report

Medicare Part D testing options

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.

Choices for testing are:

• Premera can provide some of the data for employers to do their own testing.
• Premera's underwriting team can do the testing for employers, for a fee, using General Guidance methods.

The CMS website offers general Information about Medicare Part D.

To learn more about Medicare Part D testing and to discuss your client's options, contact your Premera account representative.

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.

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.