BHT PSB Premera Booklets January 2020

Premera Blue Cross | Medical Plan Booklets

1/1/2020 - 12/31/2020

January – December 2020 Medical Booklet Endorsement with clarifications to benefits and exclusions

Agriculture

Premera Medical Plans	Agriculture Industry Health Trust
Sterling $250	Heritage Prime	Heritage
Sterling $500	Heritage Prime	Heritage
Sterling $750	Heritage Prime	Heritage
Sterling $1,000	Heritage Prime	Heritage
Sterling $1,500	Heritage Prime	Heritage
Sterling $2,000	Heritage Prime	Heritage
Sterling $2,500	Heritage Prime	Heritage
Sterling $3,000	Heritage Prime	Heritage
Sterling $4,000	Heritage Prime	Heritage
Sterling $5,000	Heritage Prime	Heritage
Titanium $200	Heritage Prime	Heritage
Titanium $350	Heritage Prime	Heritage
Titanium $500	Heritage Prime	Heritage
HSA $1,500	Heritage Prime	Heritage
HSA $2,500	Heritage Prime	Heritage
HSA $3,500	Heritage Prime	Heritage
HSA $5,000	Heritage Prime	Heritage

Business Services

Premera Medical Plans	Business Services Industry Health Trust
Sterling $250	Heritage Prime	Heritage
Sterling $500	Heritage Prime	Heritage
Sterling $750	Heritage Prime	Heritage
Sterling $1,000	Heritage Prime	Heritage
Sterling $1,500	Heritage Prime	Heritage
Sterling $2,000	Heritage Prime	Heritage
Sterling $2,500	Heritage Prime	Heritage
Sterling $3,000	Heritage Prime	Heritage
Sterling $4,000	Heritage Prime	Heritage
Sterling $5,000	Heritage Prime	Heritage
Titanium $200	Heritage Prime	Heritage
Titanium $350	Heritage Prime	Heritage
Titanium $500	Heritage Prime	Heritage
HSA $1,500	Heritage Prime	Heritage
HSA $2,500	Heritage Prime	Heritage
HSA $3,500	Heritage Prime	Heritage
HSA $5,000	Heritage Prime	Heritage

Community Service Organization

Premera Medical Plans	Community Services Org. Industry Health Trust
Sterling $250	Heritage Prime	Heritage
Sterling $500	Heritage Prime	Heritage
Sterling $750	Heritage Prime	Heritage
Sterling $1,000	Heritage Prime	Heritage
Sterling $1,500	Heritage Prime	Heritage
Sterling $2,000	Heritage Prime	Heritage
Sterling $2,500	Heritage Prime	Heritage
Sterling $3,000	Heritage Prime	Heritage
Sterling $4,000	Heritage Prime	Heritage
Sterling $5,000	Heritage Prime	Heritage
Titanium $200	Heritage Prime	Heritage
Titanium $350	Heritage Prime	Heritage
Titanium $500	Heritage Prime	Heritage
HSA $1,500	Heritage Prime	Heritage
HSA $2,500	Heritage Prime	Heritage
HSA $3,500	Heritage Prime	Heritage
HSA $5,000	Heritage Prime	Heritage

Construction

Premera Medical Plans	Construction Industry Health Trust
Sterling $250	Heritage Prime	Heritage
Sterling $500	Heritage Prime	Heritage
Sterling $750	Heritage Prime	Heritage
Sterling $1,000	Heritage Prime	Heritage
Sterling $1,500	Heritage Prime	Heritage
Sterling $2,000	Heritage Prime	Heritage
Sterling $2,500	Heritage Prime	Heritage
Sterling $3,000	Heritage Prime	Heritage
Sterling $4,000	Heritage Prime	Heritage
Sterling $5,000	Heritage Prime	Heritage
Titanium $200	Heritage Prime	Heritage
Titanium $350	Heritage Prime	Heritage
Titanium $500	Heritage Prime	Heritage
HSA $1,500	Heritage Prime	Heritage
HSA $2,500	Heritage Prime	Heritage
HSA $3,500	Heritage Prime	Heritage
HSA $5,000	Heritage Prime	Heritage

End-Line Manufacturing

Premera Medical Plans	End-Line Manufacturing Industry Health Trust
Sterling $250	Heritage Prime	Heritage
Sterling $500	Heritage Prime	Heritage
Sterling $750	Heritage Prime	Heritage
Sterling $1,000	Heritage Prime	Heritage
Sterling $1,500	Heritage Prime	Heritage
Sterling $2,000	Heritage Prime	Heritage
Sterling $2,500	Heritage Prime	Heritage
Sterling $3,000	Heritage Prime	Heritage
Sterling $4,000	Heritage Prime	Heritage
Sterling $5,000	Heritage Prime	Heritage
Titanium $200	Heritage Prime	Heritage
Titanium $350	Heritage Prime	Heritage
Titanium $500	Heritage Prime	Heritage
HSA $1,500	Heritage Prime	Heritage
HSA $2,500	Heritage Prime	Heritage
HSA $3,500	Heritage Prime	Heritage
HSA $5,000	Heritage Prime	Heritage

Information Technology

Premera Medical Plans	Information Technology Industry Health Trust
Sterling $250	Heritage Prime	Heritage
Sterling $500	Heritage Prime	Heritage
Sterling $750	Heritage Prime	Heritage
Sterling $1,000	Heritage Prime	Heritage
Sterling $1,500	Heritage Prime	Heritage
Sterling $2,000	Heritage Prime	Heritage
Sterling $2,500	Heritage Prime	Heritage
Sterling $3,000	Heritage Prime	Heritage
Sterling $4,000	Heritage Prime	Heritage
Sterling $5,000	Heritage Prime	Heritage
Titanium $200	Heritage Prime	Heritage
Titanium $350	Heritage Prime	Heritage
Titanium $500	Heritage Prime	Heritage
HSA $1,500	Heritage Prime	Heritage
HSA $2,500	Heritage Prime	Heritage
HSA $3,500	Heritage Prime	Heritage
HSA $5,000	Heritage Prime	Heritage

Retail

Premera Medical Plans	Retail Industry Health Trust
Sterling $250	Heritage Prime	Heritage
Sterling $500	Heritage Prime	Heritage
Sterling $750	Heritage Prime	Heritage
Sterling $1,000	Heritage Prime	Heritage
Sterling $1,500	Heritage Prime	Heritage
Sterling $2,000	Heritage Prime	Heritage
Sterling $2,500	Heritage Prime	Heritage
Sterling $3,000	Heritage Prime	Heritage
Sterling $4,000	Heritage Prime	Heritage
Sterling $5,000	Heritage Prime	Heritage
Titanium $200	Heritage Prime	Heritage
Titanium $350	Heritage Prime	Heritage
Titanium $500	Heritage Prime	Heritage
HSA $1,500	Heritage Prime	Heritage
HSA $2,500	Heritage Prime	Heritage
HSA $3,500	Heritage Prime	Heritage
HSA $5,000	Heritage Prime	Heritage

Wholesaling

Premera Medical Plans	Wholesaling Industry Health Trust
Sterling $250	Heritage Prime	Heritage
Sterling $500	Heritage Prime	Heritage
Sterling $750	Heritage Prime	Heritage
Sterling $1,000	Heritage Prime	Heritage
Sterling $1,500	Heritage Prime	Heritage
Sterling $2,000	Heritage Prime	Heritage
Sterling $2,500	Heritage Prime	Heritage
Sterling $3,000	Heritage Prime	Heritage
Sterling $4,000	Heritage Prime	Heritage
Sterling $5,000	Heritage Prime	Heritage
Titanium $200	Heritage Prime	Heritage
Titanium $350	Heritage Prime	Heritage
Titanium $500	Heritage Prime	Heritage
HSA $1,500	Heritage Prime	Heritage
HSA $2,500	Heritage Prime	Heritage
HSA $3,500	Heritage Prime	Heritage
HSA $5,000	Heritage Prime	Heritage

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