Costs, benefits, savings, deductibles. Watch 3 short videos and understand your healthcare better.
Use in-network providers for greatest savings, otherwise if you use out-of-network providers you may be responsible for additional costs.
While this is general information about how plans work, get your personalized plan details.
Services can be covered, but that doesn’t always mean covered at 100 percent. They are subject to copay, coinsurance, and deductible.
Benefits are health products and services your plan covers—subject to copay, coinsurance, or deductible. Services include emergency care, pregnancy, mental health, prescription medication, and more. To see your specific plan’s benefits, sign into your account and review your summary of benefits and coverage. You can also ask your plan administrator or Premera customer service.
Health plans contract with a specific group of doctors, hospitals, and other healthcare providers to offer services and supplies at a discounted price—that’s your plan network.
Because you pay part of the costs for your medical care, it's important to know that you pay less when you get care from providers in your plan network. Care from providers that are not in your plan's network:
Premera offers a variety of plan options that come with different networks. Some are broad, with providers across the country. Other Premera plan networks are narrower, with providers only in a region.
That means a doctor who is in-network for one Premera plan might not be in-network for your plan. Often providers will say they bill or accept Premera, so it's important to confirm that they are in your plan network.
The name of your plan network can be on the front of your member ID card. Sign in to your online account and use Find Care to search for providers in your plan network.
Office visit costs:
$100
You pay:
$100
Your plan pays:
$0
Preventive care is covered in full on most plans.
Office visit costs:
$100
You pay 20% (coinsurance):
$20
Your plan pays 80%:
$80
You had a few doctor visits and reached your deductible. Your plan now begins paying most of your qualified medical costs.
Office visit costs:
$100
You pay:
$0
Your plan pays:
$100
You have seen the doctor several times and have paid $5,000 out of pocket this year. Now your plan will pay the full cost of your qualified medical costs this year.
When you buy something at a store, you know exactly how much it costs when you leave. Unfortunately, healthcare doesn’t work quite like that. Your costs include the monthly premium, which might be paid by your employer or through your paycheck. When you receive care or pick up medication, you might also pay a deductible, and copay or coinsurance. The video explains more.
A health savings account (HSA) is like a bank account for your healthcare expenses. You can tuck money aside pre-tax. The money can be used to pay for your out-of-pocket costs at the doctor’s office or pharmacy. You can also use it to pay for eligible items like glasses, first-aid items, and family planning supplies. The money is yours, so if you don’t use it, it keeps growing.
Sign in to your online account and use Find Care to get personalized results, including providers in your network.
Sign in to search your Network
If you do not sign in, you can use Find Care, and select the network yourself. Get the name of your network from the front of your member card.
If you do not sign in, you can use Find Care, and select the network yourself. Get the name of your network from the front of your member card.
Out-of-network providers can charge additional amounts for services that don’t apply to your annual out-of-pocket maximum.
For example, if you have a procedure with an in-network provider who usually charges $200, but the allowed plan amount is $150, they can only charge $150. The doctor writes off the other $50. If you have the same procedure with an out-of-network provider, the provider can bill you the additional $50. If your Premera plan has out-of-network benefits, it will only cover the allowed amount that they would pay a contracted provider.
An in-network provider will bill Premera on your behalf and then the provider will bill you any costs that are remaining, including deductible or coinsurance. If you see an out-of-network provider, you may submit a claim to Premera.We will process it within 30 days of receipt. Premera explains how a claim has been processed in the form of an explanation of benefits statement (EOB).
The EOB is not a bill. It simply explains how your plan benefits apply to that particular claim. It includes:
You will receive a separate bill from your healthcare provider for any payment owed. We recommend comparing that bill to your EOB, and then pay them directly.
*This information is not applicable for members on an Individual or Family plan.
