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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
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