Your cost: When you receive care through a Lantern Center of Excellence (COE), your coinsurance is waived, helping reduce your out-of-pocket costs. You are still responsible for meeting your annual deductible. If you choose not to use a Lantern Center of Excellence (COE) for an eligible procedure, coverage will be determined under the standard provisions of your Premera HSP plan.
What the plan covers
When your care is coordinated through Lantern and performed by a Lantern provider, the plan covers:
- Pre-surgical consultations and evaluations with your Lantern provider
- The surgical procedure and related facility, anesthesia, and professional charges in Lantern's bundled episode of care
- Post-surgical follow-up care included in the bundle
Covered surgical specialties
These specialties are the main categories Lantern covers and aren't an exhaustive list.
Specific procedures within each category are subject to Lantern's clinical criteria. Call a Lantern Care Advocate at 855-317-8684 to confirm your procedure before scheduling.
What's not covered under Lantern
- Emergency or urgent surgical care
- Procedures outside Lantern's covered specialties or that don't meet Lantern's clinical criteria (Oncology and Infusion are not included). Some procedures must meet Lantern’s medical review requirements before they qualify for coverage
- Care received outside the United States and Hawaii
- Care from providers who aren't part of the Lantern network
- Charges outside the bundled episode of care (e.g., unrelated services, imaging and labs, non-Lantern providers, or services after the bundle period) process under your standard Premera HSP benefits
Reminder! This is a snapshot of the most common benefits. Contact a Lantern Care Advocate at 855-317-8684 for more questions, limitations or exclusions.
