Premera Blue Cross HMO

Consumer Advisory Committee Application

Thank you for your interest in improving the Premera Blue Cross HMO member experience.

Please complete and submit the application:

Submitting this form does not ensure Consumer Advisory Committee assignment. Premera Blue Cross HMO will select members based on whether the applicant lives in the regional board area, diversity, and representation of other members.

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Premera Blue Cross HMO complies with applicable Federal and Washington state civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, gender identity, or sexual orientation.

© 2023 Premera Blue Cross HMO is an independent licensee of the Blue Cross Blue Shield Association serving businesses and residents of Washington state, excluding Clark County.

Y0134_PBC3000_C | 055122 (02-06-2023)

Premera Blue Cross HMO Consumer Advisory Committee Application

Premera Blue Cross HMO

Consumer Advisory Committee Application