If you’re looking for a comprehensive health insurance plan with broad provider access and robust benefits, the Premera Blue Cross Heritage Plan may be a strong fit. Designed to offer flexibility, preventive care, and extensive provider choice, the Heritage Plan is one of Premera’s most popular networks for individuals, families, and employer-sponsored groups.
This in-depth guide covers everything you need to know about the Premera Heritage Plan, including its coverage options, provider network, costs, advantages, and how it compares to other Premera plans.
What Is the Premera Blue Cross Heritage Plan?
The Heritage Plan is a preferred provider organization (PPO) network offered by Premera Blue Cross. Unlike HMO (Health Maintenance Organization) plans that require referrals or restrict care to in-network providers, Heritage gives members greater freedom of choice, including:
- No referrals required to see specialists
- Nationwide provider access
- Coverage for in-network and out-of-network services (with higher out-of-pocket costs for out-of-network care)
This makes the Heritage Plan particularly attractive to individuals who want flexibility in their healthcare decisions, frequent travelers, or families needing access to a wide range of providers.
Key Features of the Premera Heritage Plan
1. Extensive Provider Network
The Heritage Plan gives members access to one of the largest networks in Washington State, along with nationwide access through the BlueCard® Program.
- Over 50,000 healthcare providers in the Pacific Northwest
- Access to 95% of U.S. hospitals and 90% of physicians nationwide
2. Preventive Care Coverage
All Heritage plans comply with the Affordable Care Act, meaning preventive services are 100% covered when in-network, including:
- Annual check-ups
- Immunizations
- Screenings (blood pressure, cholesterol, mammograms, etc.)
- Colonoscopies
- Pediatric visits and immunizations
3. No Referrals Required
You do not need a referral from a primary care provider to see a specialist. This makes scheduling appointments and receiving specialized care faster and more convenient.
4. Out-of-Network Coverage
The Heritage Plan allows you to receive care outside the Premera network, but with higher deductibles and coinsurance. This is ideal if you have preferred doctors not listed in Premera’s network or travel frequently.
Who Is Eligible for the Heritage Plan?
The Premera Heritage Plan is available through:
- Employer-sponsored group coverage
- Individual and family plans (in selected counties in Washington)
- Association health plans (for small businesses or trade groups)
Eligibility may vary by location and enrollment period. It’s best to verify with Premera or a licensed agent.
Costs and Deductibles
Costs under the Heritage Plan vary depending on whether you’re part of a group/employer plan or purchasing individual coverage.
Typical Cost Structure:
| Coverage Type | In-Network | Out-of-Network |
| Annual Deductible | $500 – $1,500 (individual) | $1,000 – $3,000+ (individual) |
| Coinsurance | 10% – 30% | 40% – 60% |
| Out-of-Pocket Max | $3,000 – $8,700 | Often higher or unlimited |
| Office Visit Copay | $25 – $50 | Subject to deductible/coinsurance |
Plan benefits and costs can vary significantly, so it’s important to review the Summary of Benefits and Coverage (SBC) document for your specific policy.
What Does the Heritage Plan Cover?
The Heritage Plan typically includes the following services:
- Doctor visits (primary and specialist)
- Emergency services
- Hospital stays and surgeries
- Mental health and substance abuse treatment
- Prescription drugs
- Maternity and newborn care
- Rehabilitation therapy (physical, speech, occupational)
- Lab work and imaging (MRI, CT, etc.)
- Home health services
- Durable medical equipment
Note: Some services may require prior authorization. Always consult the plan’s coverage manual or check with Premera Member Services.
Prescription Drug Coverage
Most Heritage Plans come with comprehensive pharmacy benefits, including:
- Tiered formulary (generic, preferred brand, non-preferred, specialty)
- Access to nationwide pharmacy networks
- Mail-order pharmacy options for long-term prescriptions
- Prior authorization or step therapy for high-cost medications
Use the Premera Drug Lookup Tool online to check medication coverage and cost tiers.
How to Find Providers in the Heritage Network
- Visit www.premera.com
- Click on “Find a Doctor”
- Select “Heritage Plus/Heritage Prime” as your network (if prompted)
- Filter by specialty, location, or provider name
You can also use the Premera mobile app for quick access to network providers, billing information, and ID card management.
Heritage vs. Heritage Prime: What’s the Difference?
- Heritage: Broader access, more flexible with fewer restrictions, slightly higher premiums
- Heritage Prime: Offers savings with a narrower group of preferred providers but still retains many PPO benefits
Choosing between the two depends on your preferred doctors, budget, and how much you travel or use healthcare services.
The Premera Blue Cross Heritage Plan stands out as a strong PPO option for those who want flexibility, direct access to specialists, and nationwide coverage. With a broad network, preventive services included, and robust prescription benefits, it’s well-suited for families, professionals, and those with ongoing healthcare needs.
Before enrolling, compare available plan tiers, provider directories, and benefit summaries to ensure it meets your medical and financial requirements.