Coming January 1, 2020: Premera Designated Centers of Excellence

  • Group Market News
    Published September 9, 2019

    Not available for groups with Peak Care or Flex Advantage

    Starting January 1, 2020, all fully insured and OptiFlex Washington-based employer group plans will include access to Premera Designated Centers of Excellence. Self-funded groups may also purchase this program.

    What is Premera Designated Centers of Excellence?

    With Premera Designated Centers of Excellence, we help your clients find another solution to keeping costs in check while attracting and retaining employees with attractive benefits.

    This new program will connect members to enhanced benefits and providers who are committed to delivering predictable, high-value specialty care. For your group clients’ employees, this means we are taking the guesswork out of selecting quality providers for high-cost specialty care procedures.

    Why is this great for your group clients?

    There are three reasons your clients will love Premera Designated Centers of Excellence*:

    1. Cost savings
    2. Quality patient outcomes
    3. Good member experiences

    What’s in it for the member?

    Members who get specialty care through the Premera Designated Centers of Excellence enjoy less guesswork and headaches when they need specialty care.

    With the program, most members get these three things*:

    1. Lower, predictable, out-of-pocket costs
    2. Travel benefits that include airfare, ground transportation, and lodging
    3. Personalized support from experts who coordinate care, schedule appointments, and make travel arrangements

    *There are differences between the program that’s offered for fully insured and OptiFlex groups and for groups that are self funded. Before talking with your clients about Premera Designated Centers of Excellence, you’ll want to understand the finer points. Refer to the additional resources and answers to frequently asked questions that follow.

    FAQ

    Specialty Care Areas

    Fully insured and OptiFlex Self funded
    All eligible fully insured group plans automatically include total joint replacement (knee and hip). Employers can choose from these specialty care areas:
    • Total joint replacement (knee and hip)
    • Spine surgery
    • Cardiac care
    • Bariatric surgery
    Additional specialty care areas are available on a custom basis, based on Blue Distinction Specialty Care, if your clients are interested in:
    • Cancer care
    • Maternity care
    • Transplant surgery
    • CAR T-cell therapy
    • Cellular immunotherapy
    • Fertility care
    • Substance use treatment and recovery

    If the nearest facility is more than 50 miles from member's home, Premera will arrange and pre-pay for eligible travel necessary to access care at a Premera Designated Center of Excellence. Covered benefits are subject to IRS limits, unless a self-funded group chooses to pay over the limit.

    Travel

    What travel is covered? What travel is not covered?
    Round-trip airfare to closest facility for member and care companion Private car mileage (if traveling less than 50 miles one way)
    Hotel accommodations Meals
    Airport parking Sightseeing costs (including mileage and parking)
    Private car mileage (if traveling more than 50 miles one way) Travel services for a procedure not included in the product
    Hospital parking  
    Ground transportation between airport, hotel, and hospital  

    Resources to share

    Use these flyers to start a conversation with your group clients about how Premera Designated Centers of Excellence can benefit them.

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