Major 2017 changes to Premera's individual coverage could include eliminating coverage, exiting entire counties and excluding networks are in the works.
There are major changes that Premera is requesting; including where members will be able to purchase coverage, eliminating current plan offerings, pulling out of entire counties, and excluding most of Swedish, Providence, and Franciscan from their Signature provider network.
They’ll only sell products inside the Washington State Exchange. Only members on a PersonalCare plan in 2016 will be able to continue coverage directly through Premera, outside of the Exchange.
They’ll only be offering PersonalCare (narrow network) and EPO (in-network only) plans. All their multi-state plans will be terminated, as well as their Preferred plans. As of January 1st, if you step out of network or if you are outside your service area, you won’t be covered unless it’s a true emergency.
In King and Pierce counties, members will only be able to choose a PersonalCare plan. As a reminder, under a PersonalCare plan the member chooses one of five PersonalCare partner systems: Evergreen Health, Multicare, NW Physicians, University of Washington, or Virginia Mason. In Snohomish county they’ll be able to choose either a PersonalCare plan or an EPO plan. All other counties where Premera will continue to sell their individual plans will be limited to the EPO plans.
Currently Premera offers coverage in all counties with the exception of Clark. As of January 1st, the list of excluded counties will become much larger, including Chelan, Douglas, Ferry, Kittitas, Klickitat, Lewis, Lincoln, Mason, Pend Oreille, San Juan, Skagit, Skamania, Stevens, and Yakima.
There will be provider network changes, too, with most of Swedish, Providence, and CHI Franciscan being excluded. See our Premera Provider Network blog for more information, including a list of facilities that will remain in-network.
As for current members who have coverage under Premera, what can they expect?
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