Washington balance billing attestation changes

For OptiFlex and self-funded groups.

The Washington state Balance Billing Protection Act (BBPA) became effective January 1, 2020. The law protects members from surprise or balance billing for emergency care or out-of-network care at in-network facilities. The WA BBPA applies only to our members residing in Washington state and covered under fully insured plans or participating self-funded plans.

In 2024, the legislature passed SB 5986, which adds ground ambulance services to the WA BBPA. Under the new law, out-of-network Ground Ambulance Service Organization (GASO) must bill the member’s health plan. The law limits the members’ cost-share amount to the cost of in-network GASO services. The amount members pay will count toward their deductible. GASO is also not permitted to balance bill members or request they waive their protections against balance billing.

Through December 31, 2027, the proposed rulemaking sets the rate payment formula for out-of-network transport as follows:

• The locally set rate as established by the local governmental entity
• Or if the local rate isn’t set, the lesser of billed charges or 325% of current Medicare rate

The new law takes effect beginning January 1, 2025.

Impact to self-funded and OptiFlex groups

On October 22, Premera Blue Cross received a notification from the Washington Office of the Insurance Commissioner (OIC) that participating self-funded and OptiFlex groups must opt in again to continue balance billing protections in 2025. Previously, participation for self-funded and OptiFlex groups was considered evergreen and didn’t require the group to opt in at each renewal.

What you need to know:

• All self-funded and OptiFlex groups must opt in again with their 2025 renewal
• To opt in again, you can:
  • Return a new attestation form indicating your decision to opt back into the protection
  • Return your Decision Point document with “Renew As-Is” or “Opt in” selected
  • Affirm your decision to continue opting in via email

• Your decision must be provided to Premera no later than December 16, 2024, to allow time for submission to the OIC

Next steps

Complete these steps with your Premera account representative or producer:

• Provide confirmation (using one of the options above) affirming your decision to opt in.
• Submit your decision to Premera by December 16, 2024.

For any inquiries or further clarification regarding the legislative changes to the Balance Billing Protection Act, contact your Premera account representative or producer.