OptiFlex and Self-funded Groups Impacted by Sales Tax Changes

Effective October 1, 2025, Washington SB 5814 expanded state sales tax to include more services. Self-funded and OptiFlex groups with a Washington state address on their contract will be impacted by the sales tax expansion.

Premera provided core administrative bundle services

Premera Blue Cross completed a detailed review of all our service offerings available to self-funded and OptiFlex employers related to Washington SB 5814.

Premera has determined that newly taxable services make up a de minimis percentage of the Premera core administrative bundle, and therefore our bundle is not taxable under Washington law.

Separately billed services provided by Premera or Vendor

For buy-up service offerings purchased by employer groups that are not part of the core administrative bundle, Premera will separately list sales tax on applicable taxable services on invoice to self-funded and OptiFlex employer groups.

Premera and many of these vendors are currently assessing their services to determine if tax is applicable and the amount of tax due. The amount of taxable services used may change from month to month, and the amount of sales tax may change accordingly.

This determination is based on existing law and the Department of Revenue’s current guidance. Future changes made by courts, the legislature, or the Department of Revenue will require Premera to evaluate how those changes impact taxable services.

Key details

• Effective date: The expanded sales tax on more services is effective beginning October 1, 2025.
• Affected services: The tax applies to digital automated services provided by vendors, such as payment integrity.
• Invoices: Starting with the November 2025 claims invoice (for October services), self-funded groups will see sales tax added to taxable line items. OptiFlex groups will see any applicable sales tax on their payment integrity fees included on their Group Experience Report (GER) in a column listed as Sales Tax. This will reduce any refund that may be due to the group.

Options for groups

• Self-funded groups with a membership base outside of Washington State may qualify to self-assess and pay the tax directly to the state.
• Groups should consult with their own advisors to determine eligibility.
• If the group provides a valid, signed Multiple Point Use (MPU) or Direct Pay Permit (DPP) certificate to Premera by the 15th of the month, we won’t collect sales tax on their invoices for that month and going forward.
• While Premera will not collect sales tax upon receiving a valid, signed certificate, the group is still responsible for self-assessing proper amount of use tax on applicable taxable services.

We continue to review the guidance from the WA state Department of Revenue as it is updated and will be in touch as we know more. If you have any questions, please reach out to your account team.