September 21, 2022
In order for Premera to comply with state and federal regulations, it is necessary for employer groups to provide certain information, a Group Size Attestation form, for determining their group size
eligibility. When groups with less than three subscribers submit the completed form, they need to also provide a copy of the most recent IRS form W-2 for one eligible enrolled employee. This is required annually prior to each group’s renewal.
Why is this important?
To help you answer questions you might have, refer to this handy FAQ.
| Who needs to complete this form? |
Renewing groups with 1–50 subscribers must complete the new Group Size Attestation form. |
| When will we send this request? |
Groups will receive the form annually within their renewal package. |
| What will we ask them to do? |
Complete the Group Size Attestation form as well as a W-2, if required, and return it to their producer or general agency within 15 business days for submission to Premera Blue Cross. |
| Why are we making this request? |
This is needed to comply with state and federal regulations. |
| What do you need to know? |
Groups with fewer than 3 enrolled employees:
You must provide a copy of the most recent IRS form W-2 for at least one eligible enrolled employee.Groups with 3 or more enrolled employees:
If the Group Size Attestation form is not returned, we will deem the information included in the renewal package to be accurate and unchanged from the previous plan year.
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If you have questions about this requirement, you may reach out to your affiliated General Agency partner.