Trust PPO Plan Medical Benefits

Preventive care includes covered well-adult and well-child physicals, immunizations, flu shots and appropriate preventive screening tests like mammograms, colonoscopies, and prostate exams. Covered eligible in-network preventive care is paid in full by the Trust — with no deductibles, co-insurance or co-pays. In some cases, if you already have a diagnosed medical condition, these types of services may be considered diagnostic rather than preventive and subject to annual deductible, copays, and coinsurance.

Sometimes it’s not convenient, or even possible, to talk to your doctor when you need information or answers to your questions. It’s nice to know that, even in the middle of the night or on weekends, you can call the 24-hour NurseLine to talk with a registered nurse about health concerns, determine next steps, home treatments or if you need to visit your doctor, urgent care, or the ER.

The NurseLine is available 24/7, confidential and provided at no cost to you. Call (855) 784-4561.

A nurse can help you:

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:

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 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.

Personal Health Management

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:

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.

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 helps:

To join, download the BestBeginnings app or contact a maternity specialist by calling (855) 756-0797.

Neonatal ICU Support

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: