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The Employees of WHG III

https://www.insurance.wa.gov/self-funded-opt-in/employees-whg-iii-1
File Format:
Employer/sponsor name, Global Health Labs, LLC, Address, 14360 SE Eastgate Way, City, Bellevue, State, Washington, Zip, 98007, 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

Expedia Health & Welfare Benefit Plan

https://www.insurance.wa.gov/self-funded-opt-in/expedia-health-welfare-benefit-plan
File Format:
Employer/sponsor name, Expedia, Inc., Address, 1111 Expedia Group Way W., City, Seattle, State, Washington, Zip, 98119, Phone, 206-332-4859, Email, Elain.Hunsaker@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

N/A

https://www.insurance.wa.gov/self-funded-opt-in/na-30
File Format:
Employer/sponsor name, Expedia Group, Address, 333 108th Ave. NE, City, Bellevue, State, Washington, Zip, 98004, Phone, 425-590-6383, Email, mobridges@expediagroup.com Automatic Renewal Opt-in Date: 02/01/2020, 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

United Healthcare/ Allsavers

https://www.insurance.wa.gov/self-funded-opt-in/united-healthcare-allsavers
File Format:
Employer/sponsor name, Eagle Transport, Inc, Address, 18900 8th Ave, Suite #1100, City, Seattle, State, Washington, Zip, 98148, Phone, 425-968-0545, Email, jnaranjo@aristapoint.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

Premera Blue Cross

https://www.insurance.wa.gov/self-funded-opt-in/premera-blue-cross-13
File Format:
Employer/sponsor name, E&E Foods, Inc., Address, 900 POWELL AVE SW, City, Renton, State, Washington, Zip, 98057, Phone, 425-918-6498, Email, Georgia.tsangmuichung@premera.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

Delta Dental of Washington

https://www.insurance.wa.gov/self-funded-opt-in/delta-dental-washington
File Format:
Employer/sponsor name, Delta Dental of Washington, Address, 400 Fairview Ave N Suite 800, City, Seattle, State, Washington, Zip, 98109, 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.

Darigold Inc

https://www.insurance.wa.gov/self-funded-opt-in/darigold-inc
File Format:
Employer/sponsor name, Darigold Inc, Address, 5601 6th Avenue South Suite 300, City, Seattle, State, Washington, Zip, 98101, Phone, 253-382-7731, Email, Eileen.Walker@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

Ilani Health and Welfare Plan

https://www.insurance.wa.gov/self-funded-opt-in/ilani-health-and-welfare-plan
File Format:
Employer/sponsor name, Cowlitz Tribal Gaming Authority, dba ilani, Address, 1 Cowlitz Way, City, Ridgefield, State, Washington, Zip, 98642, Phone, 503-276-1855, Email, jason.isenstein@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

Clark Public Utilities

https://www.insurance.wa.gov/self-funded-opt-in/clark-public-utilities
File Format:
Employer/sponsor name, Clark Public Utilities, Address, 1200 Fort Vancouver Way, City, Vancouver, State, Washington, Zip, 98669, Phone, 503-276-1855, Email, jason.isenstein@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

Clark County

https://www.insurance.wa.gov/self-funded-opt-in/clark-county
File Format:
Employer/sponsor name, Clark County, Address, 1300 Franklin St 5th Floor Suite 560, City, Vancouver, State, Washington, Zip, 98660, Phone, 866-240-9580, Email, Christopher.Hudson@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