Due to COVID-19, HCA’s lobby is closed. Learn more about your customer service options.
HCA is closed Thursday, November 26 and Friday, November 27. All Apple Health (Medicaid), PEBB, and SEBB customer services phones lines will be down after 5 p.m. Wednesday, November 25 through Monday morning, November 30.
Get plan benefits booklets, find out what is covered, and your costs for care.
The certificates of coverage (COCs), also called benefits booklets, are produced by the health plans to provide detailed information about plan benefits and what is and is not covered. The COC is the primary source of coverage provisions offered under the plan.
Summaries of benefits and coverage (SBCs) are required under the federal Affordable Care Act to help members understand plan benefits and medical terms. SBCs are not available for Medicare Advantage plans and Medicare supplement plans. For PEBB Program Medicare plan summaries, use the medical benefit comparison tool.
SBCs help you compare things like:
The PEBB Program and/or medical plans provide SBCs, or notice of how to get one, at different times throughout the year (like when you apply for coverage, renew your plan, or request an SBC). SBCs are available (upon request) in English, Spanish, Tagalog, Chinese, and Navajo.
SBCs don't replace PEBB's medical benefit comparison tool, or the plans' certificates of coverage.
Preauthorization is when you seek approval from your health plan for coverage of specific services, supplies, or drugs before receiving them. Some services or treatments (except emergencies) may require preauthorization before the plan pays for them. Preauthorization is not a guarantee, however, that your plan will pay for those services, supplies or drugs.
The criteria included in the preauthorization requirements below state how a plan determines when a service, supply, or drug is medically necessary and will be covered.
Kaiser Foundation Health Plan of the Northwest, with plans offered in Clark and Cowlitz counties in Washington and select counties in Oregon.
Kaiser Permanente NW has issued a COVID-19 endorsement for their Certificates of Coverage.
Kaiser Permanente NW has issued a COVID-19 endorsement for their Certificates of Coverage.
Kaiser Permanente NW preauthorization requirements
These criteria do not imply or guarantee approval. Please check with your plan to ensure coverage. Preauthorization requirements are only valid for the month published. They may have changed from previous months and may change in future months.
Kaiser Foundation Health Plan of Washington.
Kaiser Permanente WA preauthorization requirements
These criteria do not imply or guarantee approval. Please check with your plan to ensure coverage. Preauthorization requirements are only valid for the month published. They may have changed from previous months and may change in future months.
Summaries of benefits and coverage are not available for Medicare supplement plans. For PEBB Program Medicare plan summaries, see the medical benefits comparison tool.
UMP has issued a COVID-19 summary of changes for their Certificates of Coverage.
UMP has issued a COVID-19 summary of changes for their Certificates of Coverage.
These criteria do not imply or guarantee approval. Please check with your plan to ensure coverage. Preauthorization requirements are only valid for the month published. They may have changed from previous months and may change in future months.
Washington State Rx Services preauthorization requirements
These criteria do not imply or guarantee approval. Please check with your plan to ensure coverage. Preauthorization requirements are only valid for the month published. They may have changed from previous months and may change in future months.
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