Health Data Transfer


Select the previous insurer from the list. If you cannot find it, Request a New Payer.


Enter the first name of the person making the request.
Enter the name of the person making the request.


Enter the email address of the person making the request.
Enter the Member ID assigned by the current insurer to the person for whom data is being requested.


Enter the given name of the person for whom data is being requested.
Enter the family name of the person for whom data is being requested.


You’re about to initiate a data transfer of health information from the above listed previous insurer to the Premera Health Plan. Please note, this will be a one-time transfer of the requested health information. Any additional data transfers will have to be requested and consented to separately. By proceeding you consent to this data transfer.