Senate Bill 5083 Affects Reimbursement Starting January 1, 2027

Starting January 1, 2027, reimbursement for some health care services provided to Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) members may change. This applies to Premera members and Uniform Medical Plan (UMP) members processed through BlueCard. Changes affect reimbursement for primary care, behavioral health, and hospital services.

Why it Matters

Washington’s Public Employee Access & Affordability Act (PEAA) requires changes to provider networks and claim reimbursement. These changes are established under Senate Bill (SB) 5083.

To support these requirements, Premera Blue Cross is introducing 2 new provider networks. Some claims will be priced using Centers for Medicare & Medicaid Services (CMS) methods.

• Health Care Authority (HCA) Glacier network includes providers from the Heritage Prime network.
• Health Care Authority Clearwater network includes providers from the Sherwood HMO network.

Next Steps

• Review any contract updates or fee schedule changes you receive.
• Visit the HCA website for details about SB 5083.
• Find details from CMS about Medicare claims processing.
• Watch for additional information in the December issue of Provider News.