Premera vs. Regence vs. Kaiser: Washington Small-Group Health Carriers Compared for 2027

By Brandon Hoobler | 10/22/2026

Information current as of October 22, 2026. Premera contribution rules and paperwork deadlines updated October 26, 2026.

For 2027, Washington employers with 1 to 50 employees can buy fully insured small-group health plans from four carrier families: Premera Blue Cross, Regence BlueShield (with its sister plan, Asuris Northwest Health, in Eastern Washington), Kaiser Permanente and UnitedHealthcare. Premera and Regence are separate companies that each license the Blue Cross Blue Shield name, so their Washington networks are not the same. The right fit depends on where your employees live, which doctors they use and how you want to fund the plan.

“Fully insured” means you pay a set premium and the carrier carries the claims risk. Washington counts you as a small employer if you averaged 1 to 50 employees in the prior calendar year (RCW 48.43.005).

Who sells small-group plans in Washington, and where

The Office of the Insurance Commissioner (OIC) lists nine insurers that sell to small businesses, and nine filed 2027 small-group rates. By carrier family:

Premera Blue Cross: every county except Clark. Its HMO plan is for employees who live or work in King, Pierce, Spokane or Thurston County.
Regence BlueShield: 22 counties, mostly in Western Washington. In Clark County, Regence sells through Regence BlueCross BlueShield of Oregon.
Asuris Northwest Health: 16 Eastern Washington counties, including Spokane.
Kaiser Permanente: Kaiser Foundation Health Plan of Washington and its Options company sell in 17 counties. Kaiser’s Northwest plan covers Clark and Cowlitz.
UnitedHealthcare: statewide.

By region:

Puget Sound: all four carrier families sell here.
Eastern Washington: in most counties, Asuris takes Regence’s place. Kaiser is listed in Spokane, the Tri-Cities and Yakima, but not in counties such as Chelan or Okanogan.
Clark County: no Premera, so employers compare Kaiser, Regence and UnitedHealthcare.

Service areas change every year, so we quote each carrier only in the counties where it sells that year.

Washington Healthplanfinder won’t offer small-group plans for 2027, so you buy from a carrier directly or through a broker. Aetna, Cigna, PacificSource and Moda aren’t on the OIC’s 2026 list, so they don’t sell fully insured small-group plans here. That’s one market, not everything a carrier offers. Cigna, for example, offers level-funded plans, and Aetna reaches Washington employers through an association trust (see below).

Are Premera and Regence the same company?

No. They are separate companies. Each is an independent licensee of the Blue Cross Blue Shield Association, an association of independent, locally operated Blue companies. Premera serves Washington (except Clark County) and Alaska. Regence BlueShield serves select Washington counties as one of the regional plans of Cambia Health Solutions. Asuris is also a Cambia company and sells under its own name.

For your employees, that means:

Separate local networks. Premera uses its Heritage, Heritage Signature and Sherwood HMO networks. Regence has its own network. A clinic in one isn’t automatically in the other.
Similar travel coverage. Both offer BlueCard, the Blue companies’ program for care outside a plan’s home area. Out-of-area benefits vary by plan.

How the carriers differ

Start with the network model. A PPO (preferred provider organization) pays for care in and out of its network, with lower costs in network. An HMO (health maintenance organization) covers care inside its network, usually coordinated by a primary care provider.

Kaiser Permanente is built differently. In Washington, it combines its health plan with the Washington Permanente Medical Group, and it calls its small-business plans “fully integrated care and coverage.”

Carrier	Where it sells small group	Network approach for 2027	Options beyond fully insured	Worth knowing
Premera Blue Cross	Every county except Clark; HMO in King, Pierce, Spokane and Thurston	Choice PPO (Heritage network), Balance PPO (Heritage Signature network), HMO Core Plus (Sherwood HMO network); BlueCard outside Washington	OptiFlex for 51+ employees; self-funded for 150+	Offer two or three Premera plans. For 2027, groups of 1 to 3 must pay 100% of employee premiums, and groups of 4 to 50 need a 50% employer contribution and 75% participation. On 2026 plans, the 100% rule covered groups of up to 4.
Regence BlueShield	22 counties, mostly western; Clark through Regence BlueCross BlueShield of Oregon	Its own Washington network; BlueCard outside its four-state area	Ask	Ask for 2027 participation and contribution rules
Asuris Northwest Health	16 Eastern counties	Employee Select plans on two networks, Preferred and RealValue	Ask	Same Cambia family as Regence; sells under its own name
Kaiser Permanente	17 counties; Clark and Cowlitz through Kaiser’s Northwest plan	Core plans on Kaiser’s Core network; Access PPO plans add out-of-network benefits	Level-funded for 51 to 100 employees in southwest Washington (see below)	Must be the only health plan for employees in its area; 50% minimum employer contribution; quotes use composite rates (2026 rules)
UnitedHealthcare	Statewide	National and local networks that vary by where your employees live	Level-funded plans (see below)	Ask for 2027 participation and contribution rules

Premera, Kaiser and Asuris list HSA-qualified plans for 2027. These high-deductible plans let employees set aside pre-tax money in a health savings account (HSA).

Level-funded and self-funded options

Some carriers reach Washington employers through level-funded or self-funded plans instead. In a self-funded plan, your company pays employees’ claims, and stop-loss insurance limits how much you can owe. A level-funded plan adds a steady monthly payment that covers expected claims, stop-loss and administration. Pricing is based on your employees’ health, most state benefit mandates don’t apply, and a refund of unused claims money is possible, not promised.

Carrier	Program	Group size	Washington
UnitedHealthcare	Level Funded, with UnitedHealthcare stop-loss	2 to 50, and 51+	Yes, including groups of 2 to 4 since October 1, 2024
Kaiser Permanente	Level Funded, self-funded with stop-loss	51 to 100 eligible employees	Southwest Washington counties only
Nationwide	Self-Funded Program with built-in stop-loss	2 to 50, and 51 to 500	Yes; we quote it for groups of 2 or more (stop-loss from National Health Insurance Company)
Angle Health	Level-funded plans	2 or more	Yes; we quote it for groups of 2 or more
Cigna Healthcare	Cigna Level Funding, self-funded with built-in stop-loss	25 to 999 eligible employees	Yes; we quote it for groups of 25 or more

Refund terms differ. UnitedHealthcare pays surplus refunds only where the law allows, Nationwide’s refund is subject to a terminal liability fee, and Cigna gives renewing clients 50% or more of any surplus as an administrative fee credit. Our level-funded plans page and level-funded vs. fully insured guide cover the tradeoffs.

Association and trust plans

Carriers also reach Washington employers through association and industry trusts. For example, Aetna offers PPO plans through the Hospitality Health Insurance Trust to Washington Hospitality Association members, and the WTIA Employee Benefit Trust uses UnitedHealthcare. Our AWB HealthChoice guide covers the AWB plan in detail. Each trust has its own membership and eligibility rules. Our association plans overview explains how these plans are priced.

How small-group rates are set in Washington

Four factors only. Washington law lets carriers vary small-group rates only by geographic area, family size, age and wellness activities.
Your group’s health doesn’t set your price. Each carrier pools claims across all of its small groups.
Age counts, within limits. One adult’s rate can’t be more than three times another adult’s because of age.
Area comes from your business address. Washington has nine rating areas, and your principal business address sets yours.
Tobacco isn’t one of the four. The OIC’s 2027 filing checklist ties any tobacco factor to a wellness program, so ask each carrier.
Composite billing. Instead of billing each person’s age-based rate, some carriers can bill one average rate for adults and one for anyone under 21, fixed for the plan year.

What the 2027 filings say

Nine insurers filed 2027 small-group rate requests ranging from 7.91% to 19.99%. As of October 22, 2026, the OIC had not announced its decisions, and requests aren’t final. For 2026, the OIC approved an average 12.8% increase after insurers asked for 9.5%. Our group health insurance cost page lists each insurer’s request.

How to choose: questions to ask

Where do your employees live and work? Kaiser requires most covered employees to live or work in its service area, and Premera’s HMO covers four counties. Employees in other states need a national network or BlueCard.
Which doctors and hospitals matter? Look up each employee’s must-keep doctors in each carrier’s directory.
Can you meet participation and contribution rules? Washington lets carriers require up to 75% participation (100% for groups of three or fewer). Premera and Kaiser both require at least 50% of the employee’s premium for most groups, and Premera requires 100% from its smallest groups.
Can you meet the paperwork deadline? Premera needs completed enrollment materials 60 days before the effective date when only 1 or 2 employees enroll, including a Group Size Attestation and tax documents. Groups enrolling 3 or more have until the 20th of the month before. Other carriers set their own cutoffs.
Do employees want an HSA? Choose an HSA-qualified plan. See our HSA and pre-tax plans page and 2027 benefit numbers.
What prescriptions do employees take? Drug lists differ by carrier, so check specialty drugs.

Compare every carrier on the same census

A census lists each employee’s birth date, home ZIP code and who they’d cover. Every carrier rates on the same four factors, so quotes from one census show real differences in plans and networks. Use the same start date and similar metal levels (bronze through platinum).

How Washington Insurance Brokers fits

We quote multiple carriers side by side on your census and check each network against where your employees live and the doctors they use. The medical carriers we quote are Regence BlueShield, Kaiser Permanente, Premera Blue Cross, Asuris Northwest Health, UnitedHealthcare, Aetna, Cigna Healthcare, Nationwide and Angle Health. Not all of them sell fully insured small-group plans, and what each can offer depends on your group’s size and location.

For eligible members, we also quote association and trust plans: AWB HealthChoice, Business Health Trust, the Hospitality Health Insurance Trust, Olympic Benefits Trust, Vigilant Manufacturers’ Trust, the Washington Automotive Industry Association Health Trust, the Washington Farm Bureau Healthcare Trust, the WTIA Employee Benefit Trust and the Working Waterfront Coalition Health Trust. We also quote Northwest Employers Marketplace small-group plans. We’re an appointed AWB HealthChoice producer, so we can quote it for eligible members, but we aren’t owned by or endorsed by the Association of Washington Business.

For fully insured small-group plans (1 to 50 employees), the broker commission is already built into the rates carriers file with the OIC, so your premium is the same whether you buy directly or through us. We don’t charge a fee for our services; the carriers pay us. For groups of 51 or more, broker pay is negotiable. Whatever your size, we give you a written compensation disclosure for every carrier we work with.

Questions we hear

Are Premera and Regence the same?

No. They are separate companies, each an independent licensee of the Blue Cross Blue Shield Association with its own Washington network. Check your employees’ doctors in both directories.

Is Premera good insurance for a small business?

It can be a good fit when your employees’ doctors are in its Heritage or Heritage Signature network and the quote fits your budget. Compare it with other carriers on your census.

Can I offer Kaiser alongside Premera or Regence?

Generally not to the same employees. Kaiser’s 2026 Washington rules required it to be the only health plan for employees in its service area, so ask us whether that still holds for 2027. You can still offer more than one Kaiser plan, such as Core and Access PPO.

Do I pay more if I use a broker?

Not for fully insured small-group plans. For 1 to 50 employees, the commission is built into the rates carriers file with the OIC, so the premium is the same either way. For 51 or more, broker pay is negotiable. Either way, we disclose our pay in writing for every carrier we work with. More in Do I need an insurance broker, or can I call Regence or Kaiser directly?

When will 2027 small-group rates be final?

Not yet. As of October 22, 2026, the OIC hadn’t announced them. Last year’s approvals came on November 17, 2025. New rates start at your renewal date.

See every carrier on your census

Send us your census and we’ll compare the carriers that sell in your county side by side. Call (206) 653-9636 or request a quote for a no-obligation review.

About the author

Written by Brandon Hoobler, founder of Washington Insurance Brokers and a licensed Washington insurance broker (WA OIC #824207, verify a license). He has worked in insurance since 2009 and helps Washington employers with 5 to 500 employees compare group benefits. Questions about your plan? Call (206) 653-9636.

Sources

Posted in Employee Benefits