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Kaiser Foundation Health Plan of Washington
https://www.insurance.wa.gov/self-funded-opt-in/kaiser-foundation-health-plan-washington-2
File Format:
Employer/sponsor name, Greater Lakes Mental Health care, Address, 9330 59th Ave SW, City, Lakewood, State, Washington, Zip, 98499, Phone, 253-620-5014, Email, annew@glmhc.org 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-76
File Format:
Employer/sponsor name, Ferry County Public Hospital District No. 1, Address, 36 Klondike Rd, City, Republic, State, Washington, Zip, 99166, Phone, 425-918-4000, 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
United Health Care
https://www.insurance.wa.gov/self-funded-opt-in/united-health-care
File Format:
Employer/sponsor name, Fairway Independent Mortgage Corp, Address, 4750 S. Biltmore Ln., City, Madison, State, Wisconsin, Zip, 53718, Phone, 608-571-0476, Email, krisk@fairwaymc.com Opted out effective 12:00 AM on 01/01/2022., 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
Premera Blue Cross
https://www.insurance.wa.gov/self-funded-opt-in/premera-blue-cross-42
File Format:
Employer/sponsor name, CREO Industrial Arts, LLC, Address, 8329 216th St SE, City, Woodinville, State, Washington, Zip, 98072, Phone, 425-918-4668, Email, mikelle.harness@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-32
File Format:
Employer/sponsor name, Community Health Association of Spokane, Address, 203 N Washington St, Suite 300, City, Spokane, State, Washington, Zip, 99201, Phone, 425-918-400, Email, keith.pearson@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-25
File Format:
Employer/sponsor name, Coastal Community Bank, Address, 5415 Evergreen Way, City, Everett, State, Washington, Zip, 98203, Phone, 425-918-4000, Email, amy.stires@premera.com Opt 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-20
File Format:
Employer/sponsor name, Atlas Dental Group LLC, Address, 2407 Pacific Ave SE, Suite B, City, Olympia, State, Washington, Zip, 98501, Phone, 425-918-4000, Email, Lindsey.Carlson@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-17
File Format:
Employer/sponsor name, Appen Butler Hill Inc, Address, 12131 113th Ave, Suite 100, City, Kirkland, State, Washington, Zip, 98034, Phone, 206-459-5141, Email, Jsosh@appen.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-2
File Format:
Employer/sponsor name, Amplio Corporation dba Guidant Financial, Address, 1100 112th AVE NE, Suite 100, City, Bellevue, State, Washington, Zip, 98004, Phone, 425-918-4000, Email, brannen.lundberg@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-0
File Format:
Employer/sponsor name, GLY Construction, Inc., Address, 200 112TH Ave NE, Suite 300, City, Bellevue, State, Washington, Zip, 98004, Phone, 425-451-8877, Email, Ashley.p@gly.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