Medical

Premera Blue Cross (Premera) is the Trust’s preferred provider organization (PPO) nationwide. Participants have access to the BlueCard® PPO network, one of the largest national networks available.

The BlueCard® PPO network includes the Heritage and Heritage Plus 1 networks and provides for:

• Medical services, including physician and hospital services
• Behavioral health and chemical dependency services
• Medical supplies and equipment

The BlueCard® PPO network of physicians and other healthcare professionals provides eligible employees and dependents with efficient, cost-effective services and supplies at discounted rates. Although you may see any provider covered by the plan, you receive higher benefits if you use in-network Trust Medical Plan providers.

Find an in-network provider by searching the BlueCard® PPO network online, or call (800) 810-BLUE (2583) and reference the prefix TMP.

Log in or look to your benefits booklets for more information. Booklets are available online at www.nwadmin.com.

Premera Blue Cross is an Independent Licensee of the Blue Cross Blue Shield Association serving businesses and residents of Alaska and Washington state, excluding Clark County.

In addition to the BlueCard® PPO network, the Trust offers Member Assistance. The ComPsych® GuidanceResources® program offers free, confidential counseling, self-improvement tools and other resources to help you take charge of your life, physically and emotionally.

These services are available 24 hours a day, 7 days a week to you and covered household members.

Call (866) 301-0313 or visit GuidanceResources®, using Web ID: WATEAMSTERS. You may also download the “GuidanceResources® Now” app for your smartphone.

The Trust offers participants Premera’s Personal Health Support programs to help members with such things as managing complex medical conditions, a recent surgery, or admission to a hospital. Participants work with a trained Personal Health Support Clinician, who’s primary role is to support you and your entire family through a potentially difficult time.

Personal Health Support services include:

• Helping participants have access to health improvement resources and in following providers’ prescribed treatment plan,
• Coordinating care services as needed,
• Helping to understand your health plan’s coverage,
• Management and assistance with chronic conditions, and
• Finding useful community resources.

Premera’s Personal Health Support teams are made up of trained nurses and other certified health care specialists. Participation is voluntary. To request help from Premera’s Personal Health Support team, call 855-869-6775.

Pre-authorization is the process of determining if services, equipment or supplies are medically necessary and will be covered by your Plan prior to your obtaining them. This process protects you from unexpected costs. With pre-authorization you will have the assurance that the services you receive are medically necessary and eligible to be covered by the Plan prior to incurring the expense.

Some common services that require pre-authorization include:

• All planned inpatient stays
• Admission to a skilled nursing facility or rehabilitation facility
• Admission to behavioral health residential treatment centers
• Non-emergency and elective air ambulance services
• Some outpatient services
• Certain organ transplants
• Purchase of supplies, appliances, DME, and prosthetic devices over $500
• Provider-administered drugs

Doctors who are in the Premera network can request pre-authorization for you. Healthcare providers who are in the Premera network are familiar with the process for getting pre-authorization. Be sure to confirm with your provider that they will be contacting Premera on your behalf. In-network doctors have all of the medical information needed to ask that your medical service be reviewed and approved for coverage.

When you or a covered family member receives care from a participating Premera Blue Cross doctor or facility, your provider will arrange all the care you may need, including getting prior authorization and hospital inpatient precertification, as required.

Through Care Management, a participating Premera doctor or facility may be able to lower your out-of-pocket costs by recommending one of Premera’s preferred facilities, or by helping identify treatments or procedures that may be avoidable. This also keeps you in-network and possibly avoiding out-of-network uncovered costs.

Premera’s voluntary maternity program, BestBeginnings, offers education and support services as well as case management for pregnant participants identified as high risk. BestBeginnings helps educate mothers to-be about normal symptoms of pregnancy, as well as risks and problems, including warning signs.

BestBeginnings offers:

• Risk assessment to target high-risk pregnancies for case management
• Telephone support for covered persons, available 24/7
• Live chat via secure instant messaging, available Monday through Friday, 5:00 a.m. to 11:00 p.m. PST
• Your Journey Through Pregnancy handbook
• Website that offers educational tools, videos and articles on pregnancy and newborn care

To find out more, or contact a maternity specialist, visit the Premera website.

The Neonatal lntensive Care Unit (NICU) program provides case management for babies admitted to the NICU. The Network Administrator and/or the hospital refers those who are admitted to the NICU or a specialty care nursery to the NICU Program Manager. The Program Manager then contacts the parents to get consent for the baby to participate in the NICU Program. Participation in this program is voluntary.

Services of the program are:

• Coordination of care for newborns throughout their stays in the NICU
• Assistance with management of the baby’s care from discharge to the baby’s transition home
• Comprehensive booklet that educates parents about the NICU and the needs of the child in the NICU
• Measures of health outcomes