Medical
Medical
Sana offers medical coverage through Premera Blue Cross and Kaiser Permanente.
Please note, after you enroll in your benefits, ID cards can take up to two weeks to receive in the mail.
| Premera Blue Cross PPO Group # 4020791 Phone: 800-722-1471 Website: www.premera.com Kaiser Washington HMO Group # 2341400 Phone: 888-901-4636 Website: www.kp.org Kaiser California HMO Group # 607203 Phone: 800-464-4000 Website: www.kp.org |
Thinking of switching to Kaiser or simply curious? Review this document to learn what considerations to be aware of when making the switch from the Premera to Kaiser. Wondering when to use telemedicine, urgent care, or the emergency room? Read here to learn about the differences of each care, including costs. |
Premera Blue Cross PPO:
The Premera Blue Cross Preferred Provider Organization (PPO) plan provides a national network of doctors, hospitals, and other providers. There is in-network and out-of-network coverage through this plan although in-network providers are always recommended.
- In Washington state: Heritage
- All other state: U.S. Blue Card PPO
- Globally: BCBS Global Core
Kaiser Permanente HMO:
The Kaiser Health Maintenance Organization (HMO) is offered to Washington and California residents. Medical care at Kaiser is limited to the Kaiser network only. There is no coverage outside of the Kaiser network.
- Coverage for outside of the US: As a BCBS member you take your healthcare benefits with you when you are abroad through the Global Core Program.
- Primary Virtual Care: You can talk to any board-certified doctor any time by phone, video, or through their HIPAA secure app 24 hours a day
- Mental Health Virtual Care: An expanded behavioral health network virtually. With these providers, you can easily connect to mental health therapists and psychiatrist by video and text. They will match you with a dedicated therapist based on your personal preferences.
- www.doctorondemand.com/premera (18+ only)
- www.talkspace.com/premera or 855-835-2362
- Mental Health MatchMaker
- Brightline Childhood Mental Health Care
- Primary, Urgent, and Mental Health Care
- Create a Premera Account
- Premera Mobile App
- Find a Doctor
- Prescription Plan Overview
- Making the Most of Your Medical
- Mail Order Rx
- Mail Order Health Allergy Questionnaire
- Premera MRF Hub
- Livongo
- Livongo - Diabetes & Hypertension
- Premera Price Comparison Transparency Tool
|
Medical |
|
|
|
In-Network |
Out-of-Network |
|
|
Deductible (Individual / Family) |
$300 / $600 |
$300 / $600 |
|
Coinsurance |
0% / 100% |
50% / 50% |
|
Out-of-Pocket Maximum |
$3,500 / $7,000 |
No limit |
|
Preventive Care |
Covered in full |
Not covered |
|
Office Visit / Virtual Visit |
$25 / $10 |
50% / Not covered |
|
Chiropractic Manipulations |
$25; limit 12 visits per year |
50%; visits shared with in-network |
|
Outpatient Rehabilitation |
$25; limit 45 visits per year |
50%; visits shared with in-network |
|
Lab and X-Ray |
0% |
50% |
|
Urgent Care Visit |
$25 |
50% |
|
Emergency Room |
$200 + 0% |
$200 + 0% |
|
Prescription Drugs |
$10 / $30 / $60 (retail) |
$10 + 40% / $30 + 40% / $60 + 40% |
Please note that the information above only provides the highlights of our plan. Please refer to the full Plan Documents if you have questions about a plan or your coverage.
Deductible - The amount you must pay for medical services, before the plan pays a benefit. Preventative care is always covered at 100% with no deductible required.
Coinsurance - This is the percentage of the cost you pay for certain services after the deductible has been met. You can think of this as “cost sharing”. For example, once your deductible has been met you could pay 20% for the cost of certain services and the plan could pay 80%.
Copay - The flat fee paid by the member when a medical service is received, i.e. $20 for a doctor's visit or $20 for a prescription.
In Network Provider - An in-network provider is a hospital, doctor, medical group, and/or other healthcare provider contracted to provide services to insurance company customers for a discounted fee.
Using these providers will lessen your medical expenses when using your benefits.
Out of Network Provider - An out of network provider is a hospital, doctor, medical group, or other healthcare provider who are not contracted to provide services to insurance company customers. Because the fees are not negotiated in advance with the insurance company, the provider can charge the member as much as they wish.
Out of Pocket Maximum - The maximum amount a member would have to pay out of their pocket for medical expenses for the year, with the exception of benefit premiums (which come out of your paycheck). Your out-of-pocket maximum includes your deductible, any coinsurance paid and all co-payments (medical and prescription drug).
Coinsurance - This is the percentage of the cost you pay for certain services after the deductible has been met. You can think of this as “cost sharing”. For example, once your deductible has been met you could pay 20% for the cost of certain services and the plan could pay 80%.
Copay - The flat fee paid by the member when a medical service is received, i.e. $20 for a doctor's visit or $20 for a prescription.
In Network Provider - An in-network provider is a hospital, doctor, medical group, and/or other healthcare provider contracted to provide services to insurance company customers for a discounted fee.
Using these providers will lessen your medical expenses when using your benefits.
Out of Network Provider - An out of network provider is a hospital, doctor, medical group, or other healthcare provider who are not contracted to provide services to insurance company customers. Because the fees are not negotiated in advance with the insurance company, the provider can charge the member as much as they wish.
Out of Pocket Maximum - The maximum amount a member would have to pay out of their pocket for medical expenses for the year, with the exception of benefit premiums (which come out of your paycheck). Your out-of-pocket maximum includes your deductible, any coinsurance paid and all co-payments (medical and prescription drug).