This important alert applies to all 2020 Community-rated Premera plans other than Peak Care plans

​As of 1/1/2020, as groups renew or enroll with Premera on their Community-rated plans (other than Peak Care), there will be a serious limitation with regards to total knee & hip replacement:

• Members must receive services at a Center of Excellence in order to be covered
• The only exception will be if the member is approved for a different provider due to a Hardship Exception
• Centers of Excellence include:
  • Kadlec Regional Medical Center (Tri-Cities)
  • Providence Regional Medical Center (Everett)
  • Providence Sacred Heart Medical Center (Spokane)
  • Providence St. Peter Hospital (Olympia)
  • Swedish Ballard (Ballard)
  • Swedish Edmonds (Edmonds)
  • Swedish First Hill (Seattle)

 
To date, there have been no official producer announcements about this from Premera.  They included wording about this new requirement at the end of the table in each of their plan summaries (see page 5 of any of their summaries).
 
We did find an employer flyer for groups of 51+ with the information about which facilities will be considered Centers of Excellence; however, for groups of 51+ the member will have the option to utilize a Center of Excellence or another non-COE provider.  With Community-rated groups, members will not have coverage at a non-COE provider unless they obtain a Hardship Exception.
 
We have updated the Plan Comparison Tool output for Premera small group plans (other than Peak Care) to include additional wording under the Hospital benefit description. See this sample of how this now looks. 

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