2019 Large Business Plans (51+ Employees)

Our custom plans provide coverage for the whole health of your employees while keeping your costs in mind. Check out the following guides to find the best plan for your employees' needs.

2019 complete guide to health benefit plans (100+ employees)

Our Peak Care plans offer lower costs for your bottom line and an innovative healthcare experience for your employees.

See how Peak Care will benefit your business at peakcare.com/employer or download the Peak Care brochure.

If you want to control costs and provide your employees with a health plan that offers access to a broad network of doctors and facilities, you want a health plan with flexibility. That’s why we designed Premera Flex Advantage.

Preferred Choice plans offer a well-rounded benefits package, and variety of provider network options.

Preferred Choice plans are available with two funding options: Fully insured and OptiFlex. Speak to your producer to learn more, or see the Large Group Funding Types section on this page for more info.

Plan guide

2019 Premera Preferred Choice plans

2019 benefit highlights

Benefit highlights are a quick and handy resource for information about your Preferred Choice plan(s). We carefully designed these highlights to make understanding plan benefits easier. Please share with your employees!

2019 Medical plans

2019 Pharmacy plans

2019 Dental plans

For new and existing fully insured and self-funded groups who have 51+ employees (excludes OptiFlex groups).

Offer a dental product that combines the easy, streamlined experience you get with a Premera medical and Premera dental plan alongside the predictable out-of-pocket costs that you’ve come to know from Willamette Dental Group.

4 key benefits of Willamette Dental by Premera

When you purchase Willamette Dental through Premera, you get simplified plan administration and billing by dealing with only one health plan.

Here’s how Willamette Dental is different:

• Members and their families get a dental plan with predictable out-of-pocket costs, so they’re not surprised by unknown costs.
• Every member gets affordable orthodontic coverage at any age with no waiting periods and a predictable copay.
• Members will never exhaust their dental coverage and will never need to satisfy a deductible before they can receive their benefits, because our Willamette dental plans feature no deductible, no annual maximum, and no waiting periods.
• Every member gets a personalized dental care plan that promotes long-term dental health.

What about the network?

Willamette Dental Group is the Northwest’s largest multi-specialty group dental practice with more than 50 locations throughout the Pacific Northwest. Out-of-network dental providers are not covered.

Questions? If you have more questions about this new product, please reach out to your Premera representative or producer.

When you combine medical and pharmacy plans, you benefit from deeper, real-time insights into your complete healthcare costs and your employees benefit from whole-health care.

Here are a few other advantages of integrated care:

¹Blue Cross Blue Shield Association Pharmacy Benefit Integration Study

Choose from two pharmacy plans:

Preferred is a more comprehensive list of prescription drugs and provides access to a full spectrum of brand-name medications.

Essentials is a restricted list of prescription drugs that meets basic pharmacy needs. Essentials keeps costs as low as possible by focusing on high-value drugs that are approved by the U.S. Food and Drug Administration (FDA). View our Essentials pharmacy plan guide for more information.

Specialty Pharmacy Program

Premera’s Specialty Pharmacy Program is for your employees who may require specialty medications usually used to treat complex or rare conditions. Premera partners with Specialty Pharmacies that help these members manage their specialty medications through:

• Patient education
• Clinical support for dosing and potential side effects
• Medication ordering and delivery options
• Working with the member to assure they are taking their medications correctly and compliant with the drug therapy

Exclusive Specialty Pharmacy for Self-Funded Groups

As the specialty pharmacy market rapidly evolves, Premera Blue Cross continues to work toward providing the best quality and savings on high-cost prescriptions for our members with complex or rare conditions. That’s why we offer our self-funded groups a more focused approach to specialty pharmacy providers that maximizes plan savings while delivering individualized patient care to these members. View this flyer on Exclusive Specialty Pharmacy to learn about the benefits.

Fully insured

Get predictable costs without the risk. We will assume all of the financial risk and pay your employees' claims. You pay a stable, monthly premium.

Self-funded

Opt for a payment option that directly reflects your employees' health needs. With this option, you assume the financial risk. However, this option may also give you the opportunity to reduce your costs by encouraging your employees to actively engage in their healthcare.

OptiFlex

A combination of both fully insured and self-funded. Get the protection and flexibility of a self-funded plan without being overly expensive or complicated.

LifeWise Assurance Company assists groups with creating the right medical stop loss for their needs. If you elect to self fund your medical plan, this product provides a reinsurance contract to protect your group from catastrophic losses.

Ask your Premera Blue Cross representative or producer for details.

LifeWise Assurance Company is an independent company offering life and disability products to Premera Blue Cross employer groups and members. LifeWise Assurance Company does not provide Blue Cross Blue Shield products or services.

Best-in-class benefits

Competing for talent means offering a comprehensive benefits package. Premera Blue Cross partners with best-in-class companies to offer life and disability products to our employer groups and members while extending additional cost savings.

Did you know…

By adding life and disability products to Preferred Choice plans, you may be eligible for discounts on Premera Blue Cross medical premiums. Check out the advantages of adding dental, life, and disability to a Preferred Choice plan. Contact your Premera representative or producer to discuss your options.

Employers of 10 or more enrolled employees can choose from the following:

Group Life Insurance

• Group Term Life
• Accidental Death and Dismemberment
• Dependent Life
• Disability Coverage
• Supplemental Life and AD&D

Disability coverage

• Short-Term Disability Coverage
• Long-Term Disability Coverage

Preferred carriers

• MetLife
• Symetra
• The Hartford

MetLife, Symetra, and The Hartford, are independent companies offering life and disability products to Premera Blue Cross employer groups and members, are solely responsible for their products and services, which are not Blue Cross Blue Shield products or services.

By helping your employees lead happier, healthier lives, you strengthen your organization through increased productivity and healthcare savings.

Getting started

For fully insured and Optiflex groups, the Premera Wellness Program is automatically included in your health plan and is simple for you to administer. Your employees are automatically enrolled in the Premera Wellness Program as a part of their health plan benefits.

Take a look at what the Premera Wellness Program offers fully insured and OptiFlex groups:

• Health plans with a start date in 2019

For self-funded groups, discuss your wellness program options with your Premera representative or producer.

Want more wellness options?

Vivacity offers a variety of wellness program options like physical activity challenges, stress management programs, health assessments, wellness communications and many other tailored programs that align with varying workplace cultures and values. Let's talk about how Vivacity can help you achieve your wellness goals. Call us today at 877-276-9953, or visit us at vivacity.com.

Preferred Choice creditable coverage status report

2019-2020 Preferred Choice Creditable Coverage Status Report

2018-2019 Preferred Choice creditable coverage status report

Medicare Part D testing options

Premera Blue Cross offers employers two options to support their Medicare Part D testing obligations. The testing tells if the pharmacy plan you offer meets the creditable coverage standard as compared with Medicare Part D.

The Centers for Medicare and Medicaid Services (CMS) says drug coverage is creditable if the actuarial value of the coverage equals or exceeds the actuarial value of standard Medicare prescription drug coverage.

Your choices for testing are:

• Premera can give you some of the data to do your own testing.
• Premera's underwriting team can do the testing for you, for a fee, using General Guidance methods.

The CMS website offers general Information about Medicare Part D.

To learn more about Medicare Part D testing and to discuss your options, contact your producer or Premera account representative.

Important reminder

Premera no longer sends creditable coverage status notices to members on behalf of groups with pharmacy plans.

Employers will need to provide the notifications as required by the Medicare Modernization Act (MMA) to their Medicare-eligible employees and dependents. This act requires employers to let their Medicare-eligible employees and dependents know whether the prescription drug coverage pays on average as much as the standard Medicare prescription drug coverage.

Additional information is found at the following pages of the Centers for Medicare & Medicaid Services:

• Creditable coverage
• Model notice letters

Submission of CMS Medicare Part D Disclosure Form

Federal law requires employer groups to notify the Centers for Medicare and Medicaid Services (CMS) if their prescription drug coverage for Medicare beneficiaries is creditable. CMS requires employer groups to submit a creditable coverage disclosure form each year or upon any change that could affect whether the drug coverage offered is creditable.

Medicare secondary payer (MSP) laws are complex and can be confusing even to a seasoned healthcare administrator. Employers offering group health plans must comply with the MSP statute and regulations (the MSP laws). These laws establish Medicare as the secondary payer to group health plan coverage in certain instances of dual healthcare coverage. 

This information is purely informational, does not modify your policy or coverage in any way, and should not be construed as legal advice or opinion. Additional information is available on the Centers for Medicare & Medicaid Services (CMS) website.

You can use the MSP change form to report group size and Medicare beneficiary changes to Premera that may impact MSP rules.

Premera is dedicated to helping our members get the best care after an illness or injury. Our outpatient rehabilitation management program reviews treatment plans to help your employees get care at the right time.

Learn more about how the outpatient rehabilitation management program works and what steps your employees can take if a treatment plan is denied.

As part of the Affordable Care Act of 2010, all health plans must provide a summary of benefits in a standard four-page format. These summaries help you understand how a plan works and makes comparing plans easier.

View summary of benefits coverage.