Premera Blue Cross of WA
About Premera Blue Cross Health Insurance Plans
Premera Blue Cross Health Plan of Washington (aka Premera) is a member of a family of companies headquartered in Washington state, with operations in Mountlake Terrace and Spokane, Washington; Portland and Bend, Oregon; Anchorage, Alaska; and Scottsdale, Arizona. Premera Blue Cross and its affiliates employ about 3,000 people and provide healthcare coverage and related services to 1.5 million subscribers and their families.
Premera offers ACA/Obamacare individual/family plans and small group plans. Individual/family plans are all offered through the WA Health Plan Finder exchange.
Premera Blue Cross Plan Benefits
Here you will find downloadable benefit grids/brochures and other information for Premera plans:
Individual Plans:
On the Premera Individual and Family Health Plans website you will find detailed information on all individual and family plans offered in Washington.
NOTE: The above link is the Agent (Producer) page. We include it here because it contains more detailed information than Premera’s “consumer” page.
This includes the following:
- Benefit guides and plan brochures for ALL individual and family health plans
- Plan Features for all plans
- Information on their individual plans (EPO) provider networks
- Other Resources
Small Group Plans:
On the Premera Small Business Plans (1-50 Employees) website you will find detailed information on all small group health plans offered in Washington.
NOTE: The above link is the Agent (Producer) page. We include it here because it contains more detailed information than Premera’s “consumer” page.
This includes the following:
- Benefit guides and plan brochures for ALL small group health, dental and vision plans
- Plan Features for all plans
- Information on their small group plan (PPO) provider networks
- Resources – Including Enrollment Forms for all small group health plans.
Individual and Small Group Summaries of Benefits & Coverage (SBC)
NOTE: Premera is the ONLY company we know of in Washington that will write a small group, PPO network health plan for a “group of ONE.” In other words a small business that does not have any additional employees other than the owner. Certain rules and restrictions apply. So, if you think you might qualify, let’s talk!
In addition to the information available above, you can go to Premera’s Summary of Benefits and Coverage (SBC) page and download SBCs for all individual and group plans.
Premera Blue Cross Provider Networks
To find a provider in the appropriate network in your area go to the Premera Find a Provider Tool. If you are a current Premera policyholder, click to login to your account to view providers in your plan’s network. If you are not a current policyholder, click the link to search all plan networks.
You will note that there are multiple networks. Please note the following about some of the different networks:
Individual Plans:
The Premera network for individual plans is the Individual Signature network. You have access to major hospital systems such as University of Washington Medical Center, Virginia Mason Medical Center, Swedish Medical Center, and Providence Health and Services.
Small Group Plans:
Premera has many different small group plans offered through various trusts and associations, as well as direct plans. Premera’s direct small group plans have two networks to choose from.
Balance Plans – Use the smaller Heritage Signature provider network. This network includes Swedish and Providence doctors and hospitals.
Choice Plans – Use the Heritage provider network. This network includes just about every provider in the state.
Peak Care EPO Plans – Beginning in 2020 these plans are available in Pierce, Thurston and Spokane counties and will use the the Tahoma provider network. This network includes MultiCare Connected Care Clinically Integrated Network, Physicians of Southwest Washington, Capital Medical Center, and Vivacity Care Clinics.
Premera Blue Cross Prescription Coverage and Formulary Information
To learn more about prescription drug coverage on all Premera health plans go to their Pharmacy page.
To search for prescriptions in their plan formularies go to their Rx Search page. On this page you will be able to see which formulary applies to your specific health plan as follows:
Individual Plans:
Individual plans will use formularies M2 or M4. Bronze plans will use M2. Silver and Gold plans will use M4.
Small Group Plans:
Small group plans will use formularies M1 or M4. Choice and Balance PPO (non-HSA) plans will use M4. Choice and Balance HSA plans will use M1.
Premera Blue Cross Member Tools, Resources and Plan Highlights
Individual Plans:
In addition to the 10 essential health benefits, most plans feature:
- First two visits with a designated primary care provider (PCP) at no cost to the member
- Unlimited PCP and specialist visits (copay, deductible, and coinsurance may apply)
- No referrals are needed to see a specialist, but you must receive care from a network provider except for emergencies.
- $15 copay for telehealth video or phone consultations
- Low copay and no deductible for preferred generic drugs on gold and silver plans
Small Group Plans:
All Premera Small Group plans come with:
Premera’s small group 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 registered nurse by phone any time, day or night, with our 24-Hour NurseLine.
Virtual care
Every medical plan comes with virtual care options. Video or phone consultations with a Teladoc® physician are available any time for a low copay.
The Premera mobile app
Premera’s redesigned mobile app enables employees to find their health plan information, or search for a doctor at any time.
Additional Resources and Discounts
Premera offers a variety of special discounts on a wide variety of products and services. Check them out on the Member Discounts page.
Optional Riders/Coverage
In addition to their individual and family and small group health plans, Premera offers the following supplemental coverages:
Small group dental and vision plans are available for groups of 2 or more. See the Small Business Plans website above for details, plan brochures, etc.
Premera Blue Cross Individual and Family Plan Quotes
To see if Premera plans are available in your area and the other available insurance companies and plans, just go to our ACA Quotes page. From here you can run your own preliminary quotes on the WA Health Plan Finder exchange.
Premera Blue Cross Small Group Plan Quotes
If you would like to get a group health insurance quote for a Premera group health plan your business, the first step is to download and complete our Group Census form.
Please email the completed form to: robtavis@ushealthinsurancesolutions.com
Once we receive your group census form, it is important that we have a discussion by phone to review your current plan benefits and premiums (if any), and discuss your situation so that we can work to find the BEST plan for your business. To do that, please see the following…
Remember, you are NOT in this alone…I am here to help! As your Personal Health Insurance Advisor, my goal is to make your life easier by taking the hassle out of finding the right health plan for your situation and needs.
To discuss your health insurance options and make sure you have the best possible health plan for your situation, please go to the link above with the image that says CALL ME and schedule a call with me on a day and time that works for you, and I will call you to review your options.