Submit a Claim - Claim Instructions

If you were notified that your private information (“Personal Information”) could have been accessed in the Security Incident wherein Premera’s computer network was the target of an external criminal cyberattack that began in May 2014, you are a “Class Member.” If you received a Notice about this class action Settlement addressed to you, then the Settlement Administrator has already determined that you are a Class Member.

As a Class Member, you are eligible to receive:

  1. Two years of free Credit Monitoring and Identity Theft Insurance Services (“Credit Monitoring & Insurance Services”); and
  2. A cash payment for:
    1. Either up to a $10,000 cash payment for reimbursement of costs or expenditures actually incurred and that are plausibly traceable to the Security Incident (“Out-of-Pocket Losses”)
    2. Or up to $50 of alternative settlement compensation (“Default Settlement Payment”); and
  3. A cash payment of up to $50 if you were a California resident as of March 17, 2015, and you received a Notice from Premera that your information could have been accessed in the Security Incident, as compensation under the California Confidentiality of Medical Information Act (“California Settlement Payment”)

The free Credit Monitoring & Insurance Services will be the Individual Total Plan provided by Identity Guard, valued at $19.99 per month. If you already subscribed to the Individual Total Plan with Identity Guard, two additional years will be added to your current plan for free. If you already have a similar service from another provider, you can request that this service start after your other service expires.

To claim Credit Monitoring & Insurance Services, you need only provide your email address and the Unique Identification Number provided to you in the notice that you received by mail. Each individual requesting Credit Monitoring & Insurance Services must provide a unique email address. Two or more individuals may not request Credit Monitoring & Insurance Services using the same email address.

Cash payments amounts may be adjusted pro rata depending how many people submit such Claims. Additional payments may also be sent. Complete information about the Settlement and its benefits are available on this site.

This Claim Form may be submitted online or completed and mailed via the directions below and must be completed no later than March 30, 2020.


Documentation:

Documentation must be provided to support your documented Out-of-Pocket Losses Claim. Valid documentation includes receipts, voided checks, bank statements, or other documents showing the amount of your losses and/or a detailed narrative description. Documents should be clear, readable copies, as anything you submit will not be returned to you.

If you are filing online, ensure your files are less than 20MB each and in the following formats: jpg, jpeg, gif, tif, tiff, doc, docx, xls, xlsx, pdf, zip, txt, mht, rtf, msg, or eml. Have these documents ready before you start to file, as your Claim Form will not be saved if you have to come back and finish at a later time.

If you are unable to electronically upload a copy of your documents as part of the online Claim Form, you will need to mail a printed Claim Form along with your documentation to the Settlement Administrator.


File Online:

After clicking the button below, you will be required to provide the Unique Identification Number, "Unique ID", you received with your Notice. If you did not receive a Notice or have lost yours, please contact the Settlement Administrator to obtain your Unique ID. In this Claim Form, you will be asked to provide your contact information, detailed information about the losses you incurred, and any documentation you wish to provide to prove those losses. Please have all your documentation ready, as your Claim Form will not be saved if you have to come back and finish at a later time.


Start Your Claim Form
File by Mail:

If you wish to submit a claim for a settlement payment via standard mail, you may download a copy of the form here. You will need to provide all of the information requested on the Claim Form, attach any documentation, sign it, and date it. Then mail it to the following address:

Premera Settlement Administrator
P.O. Box 3607
Portland, OR 97208-3607

Please fill out the form completely. Failure to do so may result in a denied claim.


Remember, all Claim Forms must be submitted online or postmarked no later March 30, 2020.