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SanMar Corporation Employee Benefits Plan
https://www.insurance.wa.gov/self-funded-opt-in/sanmar-corporation-employee-benefits-plan
File Format:
Employer/sponsor name, SanMar Corporation, Address, PO Box 529, City, Preston, State, Washington, Zip, 98050, Phone, 866-240-9580, Email, christine.wilkinson@regence.com One calendar year Opt-in date: 01/01/2024, 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
Proliance Surgeons, Inc. P.S.
https://www.insurance.wa.gov/self-funded-opt-in/proliance-surgeons-inc-ps
File Format:
Employer/sponsor name, Proliance Surgeons, Inc. P.S., Address, 805 MADISON ST STE 901, City, Seattle, State, Washington, Zip, 98104, Phone, 206-332-6077, Email, michelle.keith@regence.com One calendar year Opt-in date 01/01/2024, 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
Aetna
https://www.insurance.wa.gov/self-funded-opt-in/aetna
File Format:
Employer/sponsor name, Port of Seattle, Address, 2711 Alaskan Way, City, Seattle, State, Washington, Zip, 98121, Phone, 800-900-2013, Email, Benningtonv@aetna.com Automatic renewal Opt-in date: 1/1/2024, 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
Northwest Pipe Company
https://www.insurance.wa.gov/self-funded-opt-in/northwest-pipe-company
File Format:
Employer/sponsor name, Northwest Pipe Company, Address, 201 NE Park Plaza Drive Suite 100, City, Vancouver, State, Washington, Zip, 98684, Phone, 541-318-2901, Email, darci.anderson@regence.com One calendar year Opt-in date: 01/01/2024, 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
Banfield Pet Hospital
https://www.insurance.wa.gov/self-funded-opt-in/banfield-pet-hospital
File Format:
Employer/sponsor name, Medical Management International, Inc., Address, 1801 SE 6th Way, City, Vancouver, State, Washington, Zip, 98683, Phone, 503-225-4932, Email, bruce.fessenden@regence.com One calendar year Opt-in date: 01/01/2024, 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
W Lease Lewis Company
https://www.insurance.wa.gov/self-funded-opt-in/w-lease-lewis-company
File Format:
Employer/sponsor name, Lease Crutcher Lewis, Address, 2200 Western Ave Ste 500, City, Seattle, State, Washington, Zip, 98122, Phone, 206-332-5217, Email, Derek.villeneuve@regence.com One calendar year Opt-in date: 01/01/2024, 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
King County
https://www.insurance.wa.gov/self-funded-opt-in/king-county
File Format:
Employer/sponsor name, King County, Address, 201 S Jackson St., Suite 801, City, Seattle, State, Washington, Zip, 98104, Phone, 206-332-5217, Email, Derek.villeneuve@regence.com Automatic renewal Opt-in date: 01/01/2024, See also, How self-funded group health plans can protect their enrollees from surprise billing Self-funded group health plan opt-in form/attestation (5667), Need more help?, Contact us with your self-funded group health plan opt-in questions
Kindering
https://www.insurance.wa.gov/self-funded-opt-in/kindering
File Format:
Employer/sponsor name, Kindering Center, Address, 16120 NE 8th Street, City, Bellevue, State, Washington, Zip, 98008, Phone, 206-332-6077, Email, michelle.keith@regence.com One calendar year Opt-in date: 1/1/2024 , 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
JeffreyM Consulting
https://www.insurance.wa.gov/self-funded-opt-in/jeffreym-consulting
File Format:
Employer/sponsor name, JeffreyM Consulting, Address, 600 University St STE 601, City, Seattle, State, Washington, Zip, 98101, Phone, 425-225-8156, Email, myra.faulconer@regence.com Automatic renewal Opt-in date: 01/01/2024, 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
Groundspeak Inc
https://www.insurance.wa.gov/self-funded-opt-in/groundspeak-inc
File Format:
Employer/sponsor name, Groundspeak Inc, Address, 837 N 34th St Ste 300, City, Seattle, State, Washington, Zip, 98103, Phone, 206-332-6445, Email, aster.teferi@regence.com One calendar year Opt-in date: 01/01/2024, 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