December 7, 2017
Making healthcare work better is Premera's primary focus. We've designed our new Premera Flex Advantage PPO plan to help us achieve this goal by being transparent about the variation in medical costs across services and provider organizations.
How does this new plan provide transparency in the variation of medical costs?
We're using our Heritage network to support the new Premera Flex Advantage plan. This broad network gives our customers the freedom to select the providers they want to see while making informed choices to get care at a lower cost.
We've grouped providers in the Heritage network in different benefit levels based on the cost of services. If a customer visits a Level 1 provider, the customer saves more money on their out-of-pocket costs than when they see a Level 2 or out-of-network provider.
How did you group providers in the different benefit levels?
Step 1: All hospitals and facilities, pharmacies, and BlueCard® out-of-area providers were assigned Level 1.
Step 2: We evaluated our top 15 practitioner specialties. These specialties represent 90 percent of healthcare spend.
- Cardiology
- Chiropractic
- Dermatology
- Emergency Medicine*
- Family and General Physicians
- Gastroenterology
- General Surgery
- Internal Medicine
- Using an industry standard approach, we assigned providers based on their average total cost of care and compared it to a provider peer group.
- We assigned provider organizations with a lower than average cost of care to the lowest cost provider group (Level 1).
- Neurology
- Obstetrics/Gynecology (OB/GYN)
- Oncology/Hematology
- Ophthalmology
- • Orthopedics
- Pediatrics
- Urology
Step 3: We assigned all other practitioner specialties to Level 1 unless they shared a Tax ID number with a Level 2 provider.
What does the Flex Advantage PPO plan customer ID card look like?
What do I need to do when seeing a Premera Flex Advantage customer?
Use our provider website to check eligibility, benefits, and claim status just as you do today. When checking customer eligibility, you may note that the customer has a higher cost share when visiting a Level 2 provider. You can collect the appropriate cost share in your office as you normally do. You don't need to do anything differently when submitting your claim.