March 15, 2018
Making healthcare work better is Premera’s primary focus. To support this goal, we’ve designed some of our new plans to include different benefit levels. The benefit levels show variation in medical costs across services and providers. When a member chooses a provider with a higher benefit level, the member will share more of the cost of care.
Why are we making this change?
Benefit levels help our members make informed choices about the cost of care.
What do the different benefit levels mean?
We’re making cost variation more visible to our provider groups and our customers through our online tools. Some Premera plans may have 2 levels and others may have 3 levels.
- Level1 (In-network): Highest benefit level: Lowest member out-of-pocket cost
- Level 2 (In-network): Medium benefit level: Medium member out-of-pocket cost
- Level 3 (In-network): Lower benefit level: Higher member out-of-pocket cost
- Out-of-network, Lowest benefit level: Highest member out-of-pocket cost
What do I need to do when seeing a Premera member?
Use our provider website to check eligibility, benefits, and claim status just as you do today. When checking member eligibility, you may note that the member has a higher cost share when visiting a Level 2, Level 3, or out-of-network provider. You can collect the appropriate cost share displayed for your office as you normally do. You don’t need to do anything differently when submitting your claim.
The diagrams below show an example of how the different benefit levels for a Premera member might display online. When you check a Premera member’s benefits online, the sample diagrams below will include additional details (deductible, out-of-pocket maximum, copay/coinsurance, etc.) about the member’s benefit plan.
