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City of Vancouver
https://www.insurance.wa.gov/self-funded-opt-in/city-vancouver
File Format:
Employer/sponsor name, City of Vancouver, Address, 415 W 6th Street, City, Vancouver, State, Washington, Zip, 98668, Phone, 503-414-6494, Email, Janny.chan@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
The Employees of WHG III
https://www.insurance.wa.gov/self-funded-opt-in/employees-whg-iii
File Format:
Employer/sponsor name, Cascade Asset Management Company, Address, 2365 Carillon Point, City, Kirkland, State, Washington, Zip, 98033, 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
The Employees of WHG III
https://www.insurance.wa.gov/self-funded-opt-in/employees-whg-iii-2
File Format:
Employer/sponsor name, Breakthrough Energy, LLC, Address, 4110 Carillon Point, City, Kirkland, State, Washington, Zip, 98033, 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
Association of Washington Cities Benefit Trust
https://www.insurance.wa.gov/self-funded-opt-in/association-washington-cities-benefit-trust-0
File Format:
Employer/sponsor name, Association of Washington Cities Benefit Trust, Address, 1076 Franklin St SE, City, Olympia, State, Washington, Zip, 98501, Phone, 253-381-7731, 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
Bargreen Ellingson & Welfare Plan
https://www.insurance.wa.gov/self-funded-opt-in/bargreen-ellingson-welfare-plan
File Format:
Employer/sponsor name, Bargreen Ellingson, Address, 6626 Tacoma Mall Blvd STE B, City, Tacoma, State, Washington, Zip, 98409, Phone, 206-332-5628, 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
Association of Washington Cities Benefit Trust
https://www.insurance.wa.gov/self-funded-opt-in/association-washington-cities-benefit-trust
File Format:
Employer/sponsor name, Association of Washington Cities Benefit Trust, Address, 1076 Franklin St SE, City, Olympia, State, Washington, Zip, 98501, Phone, 253-381-7731, 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 (5702)
Premera Blue Cross
https://www.insurance.wa.gov/self-funded-opt-in/premera-blue-cross-51
File Format:
Employer/sponsor name, Novinium, Inc., Address, 22820 Russell Rd, City, Kent, State, Washington, Zip, 98032, Phone, 425-918-4000, Email, Kelly.Alexander@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
Premera Blue Cross
https://www.insurance.wa.gov/self-funded-opt-in/premera-blue-cross-9
File Format:
Employer/sponsor name, Jamco America, Inc., Address, 1018 80th ST SW, City, Everett, State, Washington, Zip, 98203, Phone, 425-918-5560, Email, michelle.davis@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
Premera Blue Cross
https://www.insurance.wa.gov/self-funded-opt-in/premera-blue-cross-113
File Format:
Employer/sponsor name, Igneous Systems, Address, 2401 4th Ave., Suite 200, City, Seattle, State, Washington, Zip, 98121, Phone, 425-918-6076, Email, travis.ramirez@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
Premera Blue Cross
https://www.insurance.wa.gov/self-funded-opt-in/premera-blue-cross-195
File Format:
Employer/sponsor name, Hospice of Spokane, Address, 121 S Arthur St, City, Spokane, State, Washington, Zip, 99202, Phone, 509-252-7265, Email, sue.newman@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