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Premera Blue Cross
https://www.insurance.wa.gov/self-funded-opt-in/premera-blue-cross-3
File Format:
Employer/sponsor name, American Drilling Corporation, Address, 19208 E. Broadway Ave., City, Spokane Valley, State, Washington, Zip, 99016, Phone, 509-252-7265, Email, sue.newman@premera.com Automatic renewal Opt-in date: 1/1/2020, See also, How self-funded group health plans can protect their enrollees from surprise billing Self-funded group health plan opt-in form/attestation, Need more help?, Contact us with your self-funded group health plan opt-in questions
Premera Blue Cross
https://www.insurance.wa.gov/self-funded-opt-in/premera-blue-cross-67
File Format:
Employer/sponsor name, Ambitions, Inc., Address, 3019 Duportail St., Suite 202, City, Richland, State, Washington, Zip, 99352, Phone, 425-918-4000, Email, keith.pearson@premera.com Automatic renewal Opt-in date: 1/1/2020, See also, How self-funded group health plans can protect their enrollees from surprise billing Self-funded group health plan opt-in form/attestation, Need more help?, Contact us with your self-funded group health plan opt-in questions
All Savers by UnitedHealthcare
https://www.insurance.wa.gov/self-funded-opt-in/all-savers-unitedhealthcare
File Format:
Employer/sponsor name, Advanced Electric, Inc, Address, 21811 NE 58th Street, City, Vancouver, State, Washington, Zip, 98682, Phone, 800-291-2634, Email, dsullivan@laport-insurance.com Automatic renewal Opt-In date: 1/1/2021, See also, How self-funded group health plans can protect their enrollees from surprise billing Self-funded group health plan opt-in form/attestation, Need more help?, Contact us with your self-funded group health plan opt-in questions
ADK Electric Inc. All Savers
https://www.insurance.wa.gov/self-funded-opt-in/adk-electric-inc-all-savers
File Format:
Employer/sponsor name, ADK Electric, Inc., Address, 9000 NE 90th Street, City, Vancouver, State, Washington, Zip, 98662, Phone, 800-357-1371, Email, uhoadminallsavers@uhc.com Automatic renewal Opt-in date: 1/1/2021, See also, How self-funded group health plans can protect their enrollees from surprise billing Self-funded group health plan opt-in form/attestation, Need more help?, Contact us with your self-funded group health plan opt-in questions
Premera Blue Cross
https://www.insurance.wa.gov/self-funded-opt-in/premera-blue-cross-264
File Format:
Employer/sponsor name, AA Asphalting LLC, Address, 14720 Puyallup St. E., City, Sumner, State, Washington, Zip, 98390, Phone, 425-918-4000, Email, Chris.McKeon@premera.com Automatic renewal Opt-In date: 1/1/2022, See also, How self-funded group health plans can protect their enrollees from surprise billing Self-funded group health plan opt-in form/attestation, Need more help?, Contact us with your self-funded group health plan opt-in questions
N/A
https://www.insurance.wa.gov/self-funded-opt-in/na
File Format:
Employer/sponsor name, A Place for Mom, Inc., Address, 701 5th Ave., Suite 3200, City, Seattle, State, Washington, Zip, 98104, Phone, 206-802-1541, Email, Heathers@aplaceformom.com Automatic renewal Opt-in date: 1/1/2020, See also, How self-funded group health plans can protect their enrollees from surprise billing Self-funded group health plan opt-in form/attestation, Need more help?, Contact us with your self-funded group health plan opt-in questions
Premera Blue Cross
https://www.insurance.wa.gov/self-funded-opt-in/premera-blue-cross-202
File Format:
Employer/sponsor name, 1st Security Bank of Washington, Address, 6920 220th St SW Ste 202, City, Mountlake Terrace, State, Washington, Zip, 98043, Phone, 425-918-6077, Email, brannen.lundberg@premera.com Automatic renewal Opt-in date: 1/1/2021, See also, How self-funded group health plans can protect their enrollees from surprise billing Self-funded group health plan opt-in form/attestation, Need more help?, Contact us with your self-funded group health plan opt-in questions
Axon Enterprise Inc
https://www.insurance.wa.gov/self-funded-opt-in/axon-enterprise-inc
File Format:
Employer/sponsor name, Axon Enterprise Inc, Address, 1100 OLIVE WAY STE 1300, City, Seattle, State, Washington, Zip, 98101, Phone, 425-225-8156, Email, myra.faulconer@regence.com One Calendar Year Opt-in Date: 01/01/2023, See also, How self-funded group health plans can protect their enrollees from surprise billing Self-funded group health plan opt-in form/attestation, Need more help?, Contact us with your self-funded group health plan opt-in questions
Premera Blue Cross
https://www.insurance.wa.gov/self-funded-opt-in/premera-blue-cross-54
File Format:
Employer/sponsor name, Nelson and Sons Construction, Inc., Address, 21820 87th Ave SE, City, Woodinville, State, Washington, Zip, 98072, Phone, 425-918-4000, Email, natasha.atkins@premera.com Opted out, SEE ALSO, How self-funded group health plans can protect their enrollees from surprise billing Self-funded group health plan opt-in form/attestation, Need more help?, Contact us with your self-funded group health plan opt-in questions
N/A
https://www.insurance.wa.gov/self-funded-opt-in/na-32
File Format:
Employer/sponsor name, Prime 8 LLC, Address, 1125 SE 6th Ste 280, City, Bellevue, State, Washington, Zip, 98004, Phone, 425-444-8185, Email, darlac@prime8consulting.com Automatic renewal Opt-in date: 1/1/2022, See also, How self-funded group health plans can protect their enrollees from surprise billing Self-funded group health plan opt-in form/attestation, Need more help?, Contact us with your self-funded group health plan opt-in questions