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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
N/A
https://www.insurance.wa.gov/self-funded-opt-in/na-29
File Format:
Employer/sponsor name, Umoja Biopharma, Address, 1920 Terry Ave, City, Seattle, State, Washington, Zip, 98101, Phone, 206-327-1538, Email, sandi.gray@umoja-biopharma.com Automatic Renewal Opt-in Date: 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
N/A
https://www.insurance.wa.gov/self-funded-opt-in/na-28
File Format:
Employer/sponsor name, OBI Seafoods, Inc., Address, 1100 W. Ewing St., City, Seattle, State, Washington, Zip, 98119, Phone, 206-281-5339, Email, libbym@icicleseafoods.com Automatic renewal Opt-in Date: 01/01/2021, 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-27
File Format:
Employer/sponsor name, Willow Drive Nursery, Inc., Address, 3560 ROAD 5 NW, City, Ephrata, State, Washington, Zip, 98823, Phone, 509-787-1555, Email, roy@willowdrive.com Automatic Renewal Opt-in Date: 01/01/2020, 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
N/A
https://www.insurance.wa.gov/self-funded-opt-in/na-26
File Format:
Employer/sponsor name, Seagen Inc., Address, 21823 30th Dr. SE, City, Bothell, State, Washington, Zip, 98021, Phone, 425-527-4600, Email, rlabonite@seagen.com Automatic renewal Opt-in Date: 01/01/2021, 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