Out-of-network Savings Solutions Offers Savings

At Premera Blue Cross Blue Shield of Alaska, 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 an Out-of-Network (OON) Savings Solution, effective January 1, 2026, as self-funded and OptiFlex groups renew. Clients will continue to share in the savings generated through the management of OON claims 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 and the Washington Balance Billing Protection Act.
• Enhancing OON dialysis administration with member and employer outreach and standardizing our reimbursement approach.
• Expanding Single Case Agreement capabilities through vendor partnerships.

OON 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
The program helps employers and members manage costs for care delivered by out-of-network providers, resulting in significant claims savings.

Member protection
The program includes increased member protections from balance billing when a member uses an out-of-network provider.

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 executive for more information.