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Premera Blue Cross & LifeWise Health Plan of WA Provider Updates

Effective September 1, 2014, Seattle Children's Hospital becomes part of Premera's value-based networks serving individual and small group customers. The expanded value-based networks (Heritage Signature) will have Children's Hospital and their specialists included as in-network.

Effective January 1, 2015, Swedish Health Services in King County will become a part of Premera's value-based networks serving individual and small group customers. The expanded value-based networks include:

• Swedish hospital campuses located at First Hill, Cherry Hill, Ballard, and Issaquah
• Ambulatory care centers in Redmond and Mill Creek
• All Swedish healthcare practitioners
• All locations of Swedish Medical Group

Premera Non-Contracted Provider Reimbursement Update

Supported by revised contract language, Premera will begin reimbursing non-contracted providers at 125% of Medicare, which provides a clear standard. This went into effect for Metallic Individual, Grandfathered Individual and Metallic Small Group plans August 1, 2014. Fully Insured Large Group 51+ plans will be changed over to this payment methodology at their renewal date, or their agreed upon acceptance date, with rolling effective dates into 2015.

Regence's New Serious Illness Services Program

Beginning July 1, 2014, Regence began offering a comprehensive serious illness services program. It will deliver comprehensive, patient and family centered care to include palliative care beginning at point of diagnosis, specialized care management, and caregiver support.

These services provide free, easy access to resources and one-on-one support when members face, or are caring for a loved one who faces, a serious or life-limiting illness. The services provide educational material, caregiver resources, support, guidance and a personal advocate to help navigate the health care system when members need it most.

Federal Subsidies For Dependents When Group Coverage Is Offered

Q: If a family has a household income that is below 400% of the federal poverty level, but the husband has employer-sponsored coverage (that meets the minimum value and affordability requirements) offered to him and his family, would the spouse and children still be eligible to receive a subsidy if they (the spouse and children) purchase health insurance on the state (federally facilitated) exchange?

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