Premera Blue Cross is a nonprofit health insurance provider serving residents of Washington and Alaska. As an independent licensee of the Blue Cross Blue Shield Association, Premera offers a variety of health plans designed to meet the diverse needs of individuals, families, and employers. This article provides an in-depth look at Premera Blue Cross’s coverage options, benefits, and considerations for 2025.
Overview of Premera Blue Cross Coverage
Premera Blue Cross offers a range of health insurance plans, including:
- Individual and Family Plans: ACA-compliant plans available through the Health Insurance Marketplace, with various metal tiers (Bronze, Silver, Gold) to suit different healthcare needs and budgets.
- Employer-Sponsored Plans: Customized group plans for small, medium, and large businesses, offering comprehensive coverage options for employees.
- Medicare Supplement Plans: Medigap plans that help cover out-of-pocket costs not paid by Original Medicare, such as deductibles, coinsurance, and copayments.
- Dental and Vision Plans: Standalone or integrated plans providing coverage for routine dental and vision care.
Key Features and Benefits
1. Extensive Provider Network
Premera’s network includes a wide range of healthcare providers, hospitals, and clinics throughout Washington and Alaska, ensuring members have access to quality care. Additionally, the BlueCard® program provides nationwide access to participating providers.
2. Preventive Care Services
All Premera plans cover preventive services at no additional cost to members, including annual check-ups, immunizations, and screenings, helping to detect health issues early.
3. Virtual Care Options
Members have access to 24/7 virtual care services, allowing them to consult with healthcare professionals remotely for non-emergency medical issues, increasing convenience and accessibility.
4. Wellness Programs
Premera offers various wellness programs aimed at promoting healthy lifestyles, such as fitness discounts, smoking cessation programs, and personalized health coaching.
Claims Submission Address
For providers and members submitting paper claims, the primary mailing address is:
Premera Blue Cross
PO Box 91059
Seattle, WA 98111-9159
This address is used for most claim submissions, including medical and dental claims. However, it’s essential to verify the correct address for specific plans or services, as there may be different addresses for certain types of claims or member plans.
Electronic Claims Submission
Premera encourages electronic claims submission for faster processing. Providers can submit claims electronically using the following payer IDs:
- Professional and Institutional Claims: 00430
- Dental Claims: 47570
Providers should contact their clearinghouse for the appropriate submitter ID and ensure all electronic claims meet Premera’s submission requirements.
Customer Service and Support
For assistance with claims, benefits, or other inquiries, Premera offers dedicated customer service lines:
- General Customer Service: Call the number on the back of the member’s ID card for plan-specific assistance.
- Provider Customer Service: 877-342-5258, option 1, available from 6 a.m. to 5 p.m., Pacific Time, Monday through Friday.
Additionally, providers can access online tools through Availity Essentials for eligibility verification, claims status, and more.
Premera Blue Cross offers comprehensive health insurance coverage with a broad network of providers and a commitment to member wellness. Understanding the correct claims submission process, including the appropriate mailing addresses and electronic submission methods, is crucial for timely reimbursement and efficient service.