PersonalCare Plans and Partner Systems

  • Premera's PersonalCare Plans are primary care (PCP) referral-based plans in King, Pierce, and Snohomish counties. Providers, hospitals, and specialists work together as a Partner System to streamline patient care that’s high-quality and low cost. PersonalCare Plans promote an engaged relationship between patient and provider, offering members a new approach to healthcare that centers on them.

  • Premera assigns PersonalCare Plan members to one of 6 Partner Systems:

    • EvergreenHealth Partners
    • MultiCare Connected Care
    • Northwest Physicians Network
    • The Everett Clinic Integrated Care Network
    • UW Medicine Accountable Care Network
    • Virginia Mason Medical Center

    The Partner System is the member’s central point of care. Members select a PCP within their Partner System who coordinates their care with specialists and hospitals within the Partner System.

    If a provider recommends care that isn’t available within the member’s Partner System, the provider can submit a referral/waiver to Premera for the patient to see a provider in the Heritage Signature network.

    You must submit the referral/waiver to Premera before the member receives care outside their Partner System or the member may be responsible for the full cost of care.

    Starting January 1, 2018, Premera stopped accepting fax or email referral/waiver forms for PersonalCare Plan members. You must submit referrals/waivers using the new online referral/waiver tool. Contact your Premera Partner System liaison if you have questions or need help accessing or using the tool. To learn how to use the new tool, watch the training video.

    If you need further assistance, please reach out to your Premera Provider Network Associate/Executive.

    For UW Medicine patients: Only the UW Medicine Contracting and Payer Relations Department can submit referrals for those patients.

    For EvergreenHealth Partners patients: Contact the patient's EHP representative for assistance on referrals.

    Not all services require a referral/waiver. PersonalCare Plan members can receive these services from any provider in the Heritage Signature network without a referral/waiver. For complete information about referrals, please view the member contract booklets.

    Always verify eligibility and benefits before seeing a Premera Personal Care Plan member. Member ID cards include the name and logo of the patient’s Premera PersonalCare Plan Partner System:

    • Urgent care services don’t require a referral/waiver. PersonalCare Plan members can go to any urgent care center in the Heritage Signature network without a referral/waiver.
    • Urgent care services received outside of the Heritage Signature network are out of network and not covered.
    • Patients also have access to a free 24-Hour NurseLine and video-based doctor visits with Teladoc® virtual care services.
    • Check your PersonalCare Plan member list (sent monthly from Premera) and contact new members to let them know their PCP coordinates their primary and specialty care. Premera also sends members PersonalCare Plan information.
    • Help your patients schedule free annual preventive checkups with your primary care practice. If you address medical conditions during the preventive visit, there may be a member cost share.
    • Review the patient data we send you each month to identify patients who could benefit from outreach by our care management team.
    • A patient’s PCP, you’re responsible for taking the lead to make sure your PersonalCare Plan patients see a specialist when needed and help them select the best hospital or clinic within your Partner System for a procedure.

    Providers in the Heritage Signature network can only see PersonalCare Plan members if a provider from the member’s Partner System submitted a referral/waiver to Premera before delivery of services.

    If a PersonalCare Plan member comes to your office, always verify their eligibility and benefits and call Premera’s customer service line at 888-261-9562 to make sure there is a referral/waiver in place at Premera from a provider in their Partner System. If there isn’t a referral/waiver, the member may bear the full cost of the service.

    Not all services require a referral/waiver. PersonalCare Plan members can receive these services from any provider in the Heritage Signature network without a referral/waiver. For complete information about referrals, please view the member contract booklets.