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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
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