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https://www.insurance.wa.gov/self-funded-opt-in/na-6
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Employer/sponsor name, J&L Holdings, Inc., Address, 13817 NE 20th St, City, Bellevue, State, Washington, Zip, 98005, Phone, 425-373-9222, Email, samantha@autocenternw.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
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https://www.insurance.wa.gov/self-funded-opt-in/na-5
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Employer/sponsor name, Integrus Architecture, P.S., Address, 10 S Cedar ST, City, Spokane, State, Washington, Zip, 99201, Phone, 509-838-8681, Email, keckwortzel@integrusarch.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
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https://www.insurance.wa.gov/self-funded-opt-in/na-4
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Employer/sponsor name, Healthcare Resource Group, Inc, Address, 12610 E MIRABEAU PKWY STE 800, City, Spokane Valley, State, Washington, Zip, 99216, Phone, 509-209-2015, Email, drobertson@hrgpros.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
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https://www.insurance.wa.gov/self-funded-opt-in/na-3
File Format:
Employer/sponsor name, Dynon Avionics, Inc., Address, 19825 141st Pl NE, City, Woodinville, State, Washington, Zip, 98072, Phone, 425-402-0834, Email, eileen.zhange@dynonavionics.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
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https://www.insurance.wa.gov/self-funded-opt-in/na-2
File Format:
Employer/sponsor name, Core Design, Inc., Address, 12100 NE 195th St Ste 300, City, Bothell, State, Washington, Zip, 98011, Phone, 425-885-7877, Email, jrs@coredesigninc.com Automatic renewal Opt-in Date: 12/01/2020, 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
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https://www.insurance.wa.gov/self-funded-opt-in/na-1
File Format:
Employer/sponsor name, Cheema Freightlines LLC, Address, 2720 East Valley Hwy E, City, Sumner, State, Washington, Zip, 98390, Phone, 253-733-5755, Email, Hkcheema@cheemafreightlines.com Automatic Renewal 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
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https://www.insurance.wa.gov/self-funded-opt-in/na-0
File Format:
Employer/sponsor name, Audio Visual Management Solutions, Address, 814 6th Ave S, City, Seattle, State, Washington, Zip, 98134, Phone, 206-694-4444, Email, Dpeiler@avms.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
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https://www.insurance.wa.gov/self-funded-opt-in/na
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Employer/sponsor name, A Place for Mom, Inc., Address, 701 5TH AVE STE 3200, City, Seattle, State, Washington, Zip, 98104, Phone, 206-802-1541, Email, Heathers@aplaceformom.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
Premera Blue Cross
https://www.insurance.wa.gov/self-funded-opt-in/premera-blue-cross-206
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Employer/sponsor name, Saltchuk Marine Shared Services, LLC, Address, 450 Alaskan Way S. Ste 708, City, Seattle, State, Washington, Zip, 98104, Phone, 425-918-3618, Email, linda.wambold@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-208
File Format:
Employer/sponsor name, Foss Maritime Company, LLC, Address, 450 Alaskan Way S. Ste 708, City, Seattle, State, Washington, Zip, 98104, Phone, 425-918-3618, Email, linda.wambold@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