Out-of-Network Savings Solutions

At Premera, our purpose is to make healthcare work better for our customers. We’re dedicated to continuously improving the customer experience, increasing access to care, and providing cost protection for employers and members.

To further our commitment, Premera will implement Out-of-Network Savings Solutions, effective January 1, 2026, as self-funded and OptiFlex groups renew. Groups will continue to share in the savings generated through out-of-network (OON) claim management while paying a fee for the services.

Key components of the program include:

• Partnering with a vendor to apply their supplemental network contracted rates to OON providers in the Premera service area or perform negotiations with OON providers on a national basis.
• Continued monitoring and management of the federal No Surprises Act legislation.
• Enhancing OON dialysis administration with member and employer outreach and standardizing our reimbursement approach.
• Expanding Single Case Agreement capabilities through vendor partnerships.

Out-of-network shared savings programs are common in the market but often lack additional cost savings or balance-billing protection for members.

Pillars of Premera extended OON Savings Solution include:

Cost savings
Employers and members can manage costs for out-of-network provider care, resulting in significant claims savings.

Member protection
Members have more protection from balance billing when they use out-of-network providers.

Transparency
Employers will benefit from transparency on costs and savings. Detailed monthly claims invoices and reports will show savings and fees, like Payment Integrity programs.

Contact your Premera account representative for more information.