Preventive services update coming in January 2027
Premera is updating its preventive services list beginning Jan. 1, 2027. The changes are the result of a comprehensive review of preventive benefits, including preventive services, coding, age parameters, frequency limits, claims configuration, utilization patterns, and clinical recommendations.
The review was conducted to identify opportunities to improve clarity, consistency, and the administration of preventive benefits. A multidisciplinary team of experts in clinical care, medical policy, coding, claims, product, and compliance examined the findings to support evidence-based decisions and help ensure preventive coverage reflects current regulations and clinical recommendations.
Why it matters
Premera has long offered broad preventive benefits. The recent review identified opportunities to better align preventive coverage with current federal requirements, clinical recommendations, and industry standards. The updates will help ensure preventive benefits remain compliant, evidence-based, and operationally consistent.
What to expect
Changes to preventive services will take effect Jan. 1, 2027, as groups renew.
More information about the updates will be available before they take effect. Relevant medical policies and preventive services resources also will be updated.
How the review was conducted
A comprehensive audit evaluated preventive services against guidance from:
- Affordable Care Act (ACA)
- U.S. Preventive Services Task Force (USPSTF)
- Health Resources and Services Administration (HRSA)
- Bright Futures
- Advisory Committee on Immunization Practices (ACIP)
- Centers for Disease Control and Prevention (CDC)
The review examined covered services, diagnosis codes, procedure codes, age requirements, frequency limits, and claims practices. Findings were reviewed by a multidisciplinary team that includes experts in clinical care, medical policy, coding, claims, product, and compliance.
What you should know
For group plans, preventive coverage will continue to include preventive services required under federal law and applicable state requirements.
Please reach out to your Premera Account Manager with questions.