Premera Adds Seattle Children’s to its Individual and Small Group Metallic Networks

Premera and Seattle Children’s Hospital are pleased to announce an agreement that provides expanded access to care at Children’s for Premera members on individual and small group metallic health plans both inside and outside the Exchange. The agreement brings Children’s Hospital and the Children’s University Medical Group into our Heritage Signature network beginning September 1. The change will also apply to Heritage Prime, the network that serves employers with 51 or more employees.

We’re very happy to be able to expand access to care at Children’s for our members on these plans without raising rates for our customers. Premera will not change currently-filed rates for individual and small group customers in 2014 and 2015.

This news further enhances our individual and small group metallic network, providing our members even more choice and flexibility in choosing a healthcare provider.

Members can find information about which doctors and hospitals are covered by their plan using our online “Find a Doctor” tool. Children’s physicians and associated providers will soon be added to this tool.

Three Reasons Washington Metallic Plan Members Should Consider Dental Coverage

Dental healthIf you bought a 2014 metallic plan either directly from Premera or through Washington Healthplanfinder, your coverage includes 10 essential medical benefits. Based on the Affordable Care Act and Washington state mandate, these 10 benefits include dental coverage for kids under age 19, but not for adults.

The good news is 2014 metallic plan members can increase their health protection by adding adult individual dental coverage by July 31. Here’s why it might make sense for you to add dental to your coverage:

  1. Dental health is related to overall health. Research shows a link between inflammation in the mouth and the potential for disease elsewhere in the body, heart disease and diabetes in particular. Learn more from WebMD.
  2. Low cost for preventive care. You can get routine preventive services with deductible waived and little or no cost. Annual services covered at 100% include: up to two oral exams, bitewing x-rays, and up to two cleanings per year.
  3. Predictable cost for a broad range of basic and major services. For more than 200 dental procedures, you pay a fixed copay after meeting your deductible. See what’s covered and what you would pay.

Please note that, unlike health plans offered on Washington Healthplanfinder, an individual adult dental plan’s costs can’t be reduced through premium tax credits.

Find out more about Premera’s individual adult dental plans for metallic plan members, or apply now. Questions? Call us at 877-PREMERA.

Don’t Miss Your Shot! Immunizations are Key to Your Health

Did you know that as a Premera member, you can get many immunizations for free? Shots to prevent everything from the flu to Measles are covered under all of our ACA individual and family insurance plans, generally at no cost to you.  Most Premera group plan members also have coverage for immunizations.

Why are vaccines important?

Immunization shots introduce your body to a heavily weakened form of the specific disease you are being immunized against. This gives your immune system the chance to build antibodies that can prevent, or severely reduce, the disease and its harm to your body. It’s far easier to prevent a dangerous disease than it is to treat one. Check out the CDC’s immunization schedules to find its recommended vaccinations.

Where can you conveniently get vaccines?

Premera members can get covered immunizations from any in-network pharmacy that offers them. All you have to do is show your Premera card to your pharmacist.

There are no fees upfront for you. To find an in-network pharmacy use our Find a Doctor tool. Just make sure to double check with them that they offer the vaccine you need!

What shots are covered by your Premera health plan?

For members who purchased a new individual health plan effective Jan. 1 2014 or later, check here to see which vaccinations are covered at 100%… meaning no cost to you.

For those who elected to continue a health plan that was in effect prior to March 23, 2010, go here to find which immunizations are covered.

If you get your health plan through your employer, please know that the shots covered at no cost may vary from those linked above. Check with your plan benefits department to ensure you have an accurate list of what is covered.

To find out the specifics of what is covered under your plan call customer service at the number on the back of your ID card.

Have additional questions? Please leave us a comment or reach out on our Facebook or Twitter channels.

Out-of-Pocket Maximum Reduces Your Financial Risk

Shared Payment of Healthcare CostsWhen it comes to your out-of-pocket maximum, reaching your limit can actually be considered a good thing. An out-of-pocket maximum is the most amount of money you pay toward the cost of your healthcare in one year with the exception of your monthly premium.

Your deductible, copays and coinsurance all go toward your out-of-pocket maximum for in-network doctors. Once you’ve reached that amount your health plan pays for the rest of your healthcare that year. The out-of-pocket maximum is designed to limit your financial risk  when you are dealing with a chronic or serious healthcare issue.

The 2010 Affordable Care Act (ACA) set a limit on the maximum out-of-pocket cost for individual or group health plans effective Jan. 1, 2014 and later.  The limit is $6,350 for individuals and $12,700 for families and could change in 2015. Your out-of-pocket maximum may vary depending on the plan you choose: Gold plans generally have the lowest and Bronze plans have the highest.

What Counts?

  • Your annual deductible
  • Coinsurance and copayments for doctor visits and other medical treatment
  • Prescription drugs

What Doesn’t Count?

  • Your monthly bill (premium)
  • Your share of bills from non-network providers
  • Spending for treatments that are not eligible for coverage by your plan
  • Payments for adult vision or adult dental care

Hit Your Limit ?

You can find out how much you’ve spent toward your out-of-pocket maximum by logging in to the member area of In the left nav, select Benefit Plans, then click on the Medical Plans link to see your deductibles and maximums.

Questions?  Call customer service at the number on the back of your ID card.

Taxes and Your Health Plan: Use our Tool to Track Medical Expenses for Tax Time

Spring’s here and that means…


Did you know that you could deduct qualified medical expenses?

But rather than needing to scour through your receipts drawer, we figured it would be easier to create a quick and handy tool to track your health-related expenses.

That’s where our Spending Activity Report comes in! It’s a tool that automatically sums up your health expenses that have been funneled through Premera.

Here’s a quick guide to introduce you to it:Spending Activity Report Page

First go to and hover over Member Services on the navigation panel. Under Manage My Account is the link for the Spending Activity Report. Alternatively, you can scroll to the bottom of the screen, and under New Features is a link to the report.

Next, click on the Spending Activity Report hyperlink. You’ll then be prompted to log-in to your account.Spending Activity Report

Now you’re in the tool! Here you’ll find a summary of your health claims. It includes the total amount billed by your doctor or health professional, the amount of this total your health plan paid for and the amount you paid for out-of-pocket. Also displayed are any discounts provided and the total amount you saved because of your health plan.

You can choose to see a report of your healthcare expenses in different time periods (Jan. 1, 2013 – Dec. 31, 2013 is the timeframe you want). Now, the only number you need to worry about for tax purposes is the amount paid under Your Responsibility.

Have questions? Please leave us a comment or reach out on our Facebook or Twitter channels. Happy tax season!


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