Premera Blue Cross is one of the leading health insurance providers in the Pacific Northwest, offering a wide range of medical coverage options designed to meet the evolving needs of individuals, families, and businesses. Headquartered in Mountlake Terrace, Washington, Premera has served members across Washington and Alaska for decades, combining innovation, comprehensive care, and customer-focused solutions.
In this article, we provide an in-depth look at Premera Blue Cross medical policies, what they cover, how they work, and why they are among the top choices in the U.S. health insurance market.
What is Premera Blue Cross?
Premera Blue Cross is a not-for-profit Blue Cross Blue Shield licensee serving nearly 2 million people. With a strong focus on affordable access to high-quality care, Premera partners with a wide network of providers, hospitals, and pharmacies.
They offer:
- Individual & family plans
- Employer-sponsored group plans
- Medicare Advantage and Supplement Plans
- Dental and vision add-ons
- Behavioral and mental health services
Understanding Premera Blue Cross Medical Policy
Premera’s Medical Policies are evidence-based guidelines used to determine coverage eligibility for medical services, devices, and treatments. These policies help ensure that members receive care that islarly updated in collaboration with medical experts and is grounded in clinical research, public health data, and national guidelines.
Key Components of Premera Medical Policies
- Coverage Determination
- Policies indicate if a medical service is considered medically necessary, investigational, or not covered.
- Coverage is often based on whether the service improves health outcomes compared to alternatives.
- Policies indicate if a medical service is considered medically necessary, investigational, or not covered.
- Clinical Criteria
- Detailed clinical benchmarks guide physicians and insurers in assessing eligibility.
- For example, a policy on spinal surgery may specify diagnostic imaging results and non-surgical attempts required before coverage.
- Detailed clinical benchmarks guide physicians and insurers in assessing eligibility.
- Pre-authorization Requirements
- Some services and medications require prior authorization to verify medical necessity.
- This ensures cost-effective care and prevents misuse of services.
- Some services and medications require prior authorization to verify medical necessity.
- Updates & Transparency
- Premera maintains an online database where providers and members can view current policies.
- Updates are made periodically to reflect new medical research and regulatory changes.
- Premera maintains an online database where providers and members can view current policies.
Common Medical Policy Categories
Premera has hundreds of medical policy documents across various health domains. Some of the most commonly referenced categories include:
- Cardiology: Stents, pacemakers, heart surgery
- Oncology: Chemotherapy, immunotherapy, genetic testing
- Orthopedics: Joint replacement, spinal procedures
- Imaging & Diagnostics: MRI, PET scans, genetic diagnostics
- Mental Health: Telehealth services, therapy sessions, medication management
- Durable Medical Equipment (DME): Wheelchairs, CPAP machines, prosthetics
- Pharmacy & Specialty Drugs: Coverage guidelines for high-cost medications
Special Features of Premera Medical Policies
1. Value-Based Care
Premera emphasizes value over volume, aiming to improve health outcomes while managing costs.
2. Digital Tools
- Premera offers an intuitive member portal and mobile app where you can:
- Track claims
- Review policy guidelines
- Estimate costs
- Access virtual care
- Track claims
3. Personalized Member Services
- Nurse consultation lines
- Case management for complex conditions
- Behavioral health support with licensed therapists
Premera Medical Policy vs. Other Insurers
| Feature | Premera Blue Cross | Other Major Insurers |
| Policy Transparency | Public medical policy database | Often requires login or approval |
| Update Frequency | Quarterly updates | Varies, less consistent |
| Regional Network Strength | Strong in WA & AK | Broader but less personalized |
| Integration of Tech | Member app, telehealth, tools | Some lack intuitive interfaces |
| Customer Satisfaction | 4.2/5 average on major platforms | Varies, often below 4.0 |
How to Use Premera’s Medical Policy Search
Premera offers a searchable portal where you can:
- Visit Premera Medical Policies.
- Search by keyword (e.g., “back surgery”, “MRI”, “weight loss”).
- Filter by effective date or medical category.
- View downloadable PDFs for details.
Final Thoughts: Should You Trust Premera Blue Cross Medical Policy?
If you’re looking for a transparent, research-based, and customer-centric health insurer, Premera Blue Cross stands out. Their medical policies are not just insurance fine print—they are detailed, evidence-based resources that prioritize quality care, member rights, and cost-effective solutions.
Premera’s consistent ranking among top regional providers, high customer satisfaction, and proactive updates make their policies reliable and trustworthy.