View Individual Plan Deductibles, Benefits, and PCPs

  • March 19, 2020

    The tools on the 2020 Individual Plans secure website are different than the tools for other Premera plans. The most common questions we’ve received about the new tools relate to the “Search Member Eligibility” function. Our Eligibility and Benefit Guide, posted in our Learning Center, uncluded step-by-step screenshots to show how to use the Search Member Eligibility tool.

    Here are the top 3 questions we’ve received from providers about looking up member eligibility and benefits:

    1. How can I see a member’s current deductible and maximum amounts?
      a. Search for the member by entering the member ID or the member’s last name and date of birth.
      b. Under “Benefit” in Member Eligibility List, select the “Usage” link.

      c. Scroll down to the gray bar that says “Accumulator” in Deductibles & Maximums and beneath it you can see the member’s deductible and maximum information.

    2. Where can I see a member’s plan benefits?
      a. Search for the member by entering the member ID or the last name and date of birth.

      b. Under “Plan name” in Member Eligibility List, select the name of the member’s plan. In this example, it’s “Premera Blue Cross Preferred Gold 1500.”

      c. After you select the plan name, select the “Description” link under “Benefit Details” in Benefit Plan Summary of Benefits. This link will export a .PDF with the member’s benefit details.

    3. How can I find a member’s PCP?
      a. Search for the member by entering the member ID or their last name and date of birth.
      b. Click on the member’s name in Member Eligibility List.

      c. Scroll down until you see the gray bar titled “Primary care physician.” Beneath it you’ll see the name of the member’s primary care provider.

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