Out-of-network Savings Solution evolves to support long-term affordability
In 2027, Premera is evolving the Out-of-Network (OON) Savings Solution to help self-funded groups manage healthcare costs while protecting member access to care. This change builds on the existing solution and reflects our continued commitment to long-term total cost of care (TCOC) stability.
While in-network utilization remains high, averaging 98%, a small number of out-of-network service categories have become significant drivers of cost volatility. In some cases, billed charges have moved well beyond market norms, creating unpredictable costs for employers and increasing the potential for member balance-bill exposure.
The OON Savings Solution enhancement introduces a more precise approach to managing these costs through service-specific, Medicare-based benchmarks in five categories where out-of-network pricing variability has been highest.
This market-aligned approach is designed to:
- Better reflect prevailing network reimbursement levels
- Help preserve incentives for provider network participation
- Support long-term affordability
New for 2027, the solution also includes a targeted member advocacy safety net. If a member receives an eligible high-dollar balance bill in one of the designated categories and prior repricing or negotiation efforts don’t resolve the issue, Premera will work directly with the provider on the member’s behalf.
What’s staying the same
The OON Savings Solution continues to include:
- Single Case Agreements
- No Surprises Act administration
- Dialysis management
- Supplemental network
- Supplemental negotiations
Together, these capabilities support a comprehensive strategy that applies the right protection to the right claim while helping employers maintain predictable healthcare spending and a strong provider network.
Contact your Premera account representative to learn more about OON Savings Solutions for your self-funded clients.