Premera Blue Cross | Washington State Health Care Authority (2024)

Learn about the Premera plans.

On this page: Full benefits | Summary of benefits | Costs | Find providers | Plan options | About Premera
Return to Medical plans and benefits: School employees | SEBB Continuation Coverage

Full benefits

The following documents—called a Benefits Booklet—provide in-depth descriptions of the benefits for each plan.

  • Premera High PPO Benefits Booklet (2004)
  • Premera HMO Benefits Booklet (2024)
  • Premera Standard PPO Benefits Booklet (2024)

Summary of benefits

The following documents—called a Summary of Benefits and Coverage (SBC)—provide summaries of what each plan covers and what it costs.

  • Premera High PPO SBC (2024)
  • Premera HMO SBC (2024)
  • Premera Standard PPO SBC (2024)

Costs

  • School employee monthly premiums 2024
  • SEBB Continuation Coverage monthly premiums 2024

Find providers

Visit one of Premera's online provider directories.

Plan options

Premera High PPO

The High PPO Plan comes with in-network access to over 1.7 million providers nationwide. Watch a video to learn more about the High PPO plan or view the plan summary.

Annual costs

  • Medical deductible: $750 per person / $1,875 family
  • Prescription drug deductible: $125 per person / $312 family, waived for generic drugs
  • Out-of-pocket limit: $3,500 per person / $7,000 family

Key features

  • $0 preventive care
  • No referrals for specialty care
  • 24 annual visits each for massage, chiropractic and acupuncture
  • Virtual care
  • Access to 63,000 in-network pharmacies

Available counties

In most cases, you must live or work in the medical plan's service area to join the plan. All school employees are offered a selection of plans based on their county of residence or the county where their employment location is based. Some school employees may have more plan options if they work in a district that crosses county lines.

You can choose this plan if you live or work in one of these counties:

  • Adams
  • Asotin
  • Benton
  • Chelan
  • Clallam
  • Columbia
  • Cowlitz
  • Ferry
  • Franklin
  • Garfield
  • Grant
  • King
  • Kitsap
  • Kittitas
  • Lewis
  • Lincoln
  • Mason
  • Okanogan
  • Pend Oreille
  • Pierce
  • Skagit
  • Skamania
  • Spokane
  • Stevens
  • Thurston
  • Wahkiakum
  • Walla Walla
  • Whatcom
  • Whitman
  • Yakima

If you move out of your plan's service area or change jobs to a different employment location, and your plan is no longer available, you must select a new plan. If you do not, the SEBB Program will enroll you in one. You must report your new address and any request to change your medical plan no later than 60 days after your move.

Who should consider this plan?

This plan is great for those looking for a lower deductible and predictable office visit copays.

Premera HMO

The Premera HMO provides in-network access to over 22,000 healthcare providers, including 28 hospitals, dozens of urgent care, primary care, and specialty care clinics. The growing network includes: EvergreenHealth, MultiCare Health System, Kinwell (primary care clinics), Mary Bridge Children's Hospital, Shriners Hospital for Children, Seattle Children's, and Virginia Mason. There is no out-of-network coverage except for urgent and emergency care (covered nationwide). Watch a video to learn more about Premera HMO or view the Plan summary.

Annual costs

  • Medical deductible: $750 per person /$1,500 family
  • Prescription drug deductible: none
  • Out-of-pocket limit: $3,500 per person / $7,000 family

Key features

  • $0 preventive care
  • Referrals required for specialty care and some specialty prescriptions
  • 24 annual visits each for massage, chiropractic, acupuncture
  • Virtual care
  • Access to 1,300 in-network pharmacies in Washington.

Available counties

In most cases, you must live or work in the medical plan's service area to join the plan. All school employees are offered a selection of plans based on their county of residence or the county where their employment location is based. Some school employees may have more plan options if they work in a district that crosses county lines.

You can choose this plan if you live or work in one of these counties:

  • King
  • Pierce
  • Spokane
  • Thurston

If you move out of your plan's service area or change jobs to a different employment location, and your plan is no longer available, you must select a new plan. If you do not, the SEBB Program will enroll you in one. You must report your new address and any request to change your medical plan no later than 60 days after your move.

Who should consider this plan?

This plan is great for those who want the lowest cost monthly premium available and low out-of-pocket costs.

Premera Standard PPO

Premera’s Standard PPO Plan comes with in-network access to over 1.7 million unique providers nationwide. Watch a video to learn more about the Standard PPO plan or view the Plan summary.

Annual costs

  • Medical deductible: $1,250 per person / $3,125 family
  • Prescription drug deductible: $250 per person / $750 family, waived for generic drugs
  • Out-of-pocket limit: $5,000 per person / $10,000 family

Key features of the plan

Best-in-class customer service, 24-hour virtual care, $0 preventive care, no referrals for specialty care, 24 annual visits each for massage, chiropractic, acupuncture, and access to 63,000 in-network pharmacies.

Available counties

In most cases, you must live or work in the medical plan's service area to join the plan. All school employees are offered a selection of plans based on their county of residence or the county where their employment location is based. Some school employees may have more plan options if they work in a district that crosses county lines.

You can choose this plan if you live or work in one of these counties:

  • Adams
  • Asotin
  • Benton
  • Chelan
  • Clallam
  • Columbia
  • Cowlitz
  • Ferry
  • Franklin
  • Garfield
  • Grant
  • Grays Harbor
  • Jefferson
  • King
  • Kitsap
  • Kittitas
  • Lewis
  • Lincoln
  • Mason
  • Okanogan
  • Pacific
  • Pend Oreille
  • Pierce
  • Skagit
  • Skamania
  • Snohomish
  • Spokane
  • Stevens
  • Thurston
  • Wahkiakum
  • Walla Walla
  • Whatcom
  • Whitman
  • Yakima

If you move out of your plan's service area or change jobs to a different employment location, and your plan is no longer available, you must select a new plan. If you do not, the SEBB Program will enroll you in one. You must report your new address and any request to change your medical plan no later than 60 days after your move.

Who should consider this plan?

This plan is great for those looking for a lower employee monthly premium and predictable office visit copays.

About Premera Blue Cross

Premera Blue Cross has provided health plans to school employees across the state since 1962. Premera is headquartered in Washington State and provides health benefits to 2.8 million people nationwide. Our SEBB plans are designed with school employees in mind and are backed by best-in-class customer service and the Blue Cross Blue Shield Association.

Premera Blue Cross | Washington State Health Care Authority (1)

Ready to enroll

Use Benefits 24/7 to enroll or make changes.

Contact information

Premera

  • Phone

    1-800-807-7310

  • TRS

    711

  • Monday through Friday
    5 a.m. to 8 p.m. Pacific Time

Premera Blue Cross | Washington State Health Care Authority (2024)

FAQs

Is Premera Blue Cross only in Washington state? ›

We've provided access to healthcare for people in Washington state since 1933, and in Alaska since 1952. Our goal has always been to provide quality and cost-effective healthcare plans for our members.

Is Premera different from Blue Cross Blue Shield? ›

Premera Blue Cross HMO is an independent licensee of the Blue Cross Blue Shield Association serving businesses and residents of Washington State, excluding Clark County.

Is Premera Blue Cross an HMO or PPO? ›

Premera Blue Cross HMO complies with applicable Federal and Washington state civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, gender identity, or sexual orientation.

Does Premera accept paper claims? ›

If you are unable to submit claims electronically, you can submit paper claims on CMS-1500 or UB-04 forms. To speed claims processing, we use document imaging and optical character recognition (OCR) equipment to read your claims.

Can I use Premera Blue Cross out of state? ›

As a Premera Blue Cross member, your healthcare benefits travel with you wherever you go. In spirited cities and peaceful countryside, Premera is there wherever you need care. The BlueCard® program is your ticket to a nationwide network of providers. Call Premera for prior authorization, if necessary.

Is Premera Blue Cross a high deductible plan? ›

Premera Blue Cross offers certain high-deductible health plans that are qualified for use with Health Savings Accounts. HSA's allow members to save for qualified medical expenses their health plan may not cover.

Is there a Blue Cross Blue Shield of Washington state? ›

About Premera Blue Cross

Premera is headquartered in Washington State and provides health benefits to 2.8 million people nationwide. Our SEBB plans are designed with school employees in mind and are backed by best-in-class customer service and the Blue Cross Blue Shield Association.

Who are Premera Blue Cross competitors? ›

Premera Blue Cross competitors include Aetna, Cambia Health Solutions, Group Health Cooperative and Jacada.

Is Premera Blue Cross credit rating? ›

Oldwick //BestWire// - A.M. Best has revised the outlooks to positive from stable and affirmed the Financial Strength Rating of A- (Excellent) and the Long-Term Issuer Credit Ratings of “a-” of Premera Blue Cross (Premera) and its subsidiaries, LifeWise Assurance Company and LifeWise Health Plan of Washington (all ...

Which insurance is better PPO or HMO? ›

Is an HMO or PPO better? An HMO is better if you're looking for cheaper health insurance costs, but a PPO is superior if you want the option of out-of-network care and don't want to get primary care physician referrals to see a specialist.

What is the other name for Premera Blue Cross? ›

Premera was founded as Washington Hospital Service in 1933, and began operating in Alaska in 1957. In 1969, the company's name was changed to Blue Cross of Washington and Alaska. In June 1998, Blue Cross of Washington and Alaska merged with Spokane's Medical Service Corporation under the name Premera Blue Cross.

Is Premera Blue Cross the same as Anthem? ›

Anthem Inc., a separate company from Premera that is also an independent licensee of the Blue Cross Blue Shield Association, recently suffered a cyber-attack which has been widely reported in the media.

What is the 72 hour rule for Premera? ›

Emergency room visits that occur within 3-calendar days or the immediate 72 hours prior to an inpatient admission that are diagnostically related to the inpatient admission will be considered part of the inpatient admission.

How long does it take for a claim to process with Premera? ›

When you're looking up a claim using member information, make sure you click on the provider name to get details like the claim receipt date, pended reasons, and claim payment codes. We process most of our claims within 30 days and we pay claims every Saturday and on the last day of the month.

Is Premera Blue Cross different from Blue Cross? ›

And, as part of the Blue Cross Blue Shield Association, Premera members have access to the largest nationwide network of any other major health plan.

Can I use Premera Blue Cross in California? ›

Premera Blue Cross is listed as a payer for Authorizations & Referrals in all states. You can also sign in to your service area's Blue plan website to find tools for out-of-area members.

What is Blue Cross called in Washington state? ›

Premera Blue Cross | Washington State Health Care Authority.

Are Premera Blue Cross and Regence the same? ›

In Washington, Premera Blue Cross and Regence BlueShield share responsibility for claims processing, customer service, and prior authorization requests based on where the patient receives the service and what kind of service was received.

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