Pre-sale questionnaire: network & plan design

Consists of select doctors or hospitals within a network that have a strong track record of providing high-quality care for specific conditions or procedures—like joint replacements or bariatric surgery. Plans may require members to use these providers for certain services to improve results and manage costs.
Example: Aetna may require all transplant services to be done at a facility it designates as an “Institute of Excellence.”

When an employer partners directly with a hospital or health system (instead of going through an insurance company) to better control costs and ensure quality care.
Example: Employees can access a specific health system in addition to the regular in-network providers through the employer’s direct agreement.

Smaller, carefully selected networks made up of providers who meet strict standards for quality and cost. They’re usually offered in certain locations and aim to deliver consistent, affordable care.

These programs offer members rewards—often financial—for choosing certain high-quality, in-network providers. It’s a way to encourage smart healthcare choices and improve patient outcomes.
Example: Members get a cash reward when they see a provider in a preferred health system or tier.

The name of the group of doctors and hospitals included in a health plan. You’ll see it listed in benefit materials like the Summary of Benefits and Coverage (SBC), on the insurer’s website, or in the “Find a Doctor” tool.
Examples: Blue Card PPO, Aetna Choice Plus, Cigna Open Access.

Instead of using the rates insurance companies negotiate with doctors, this method pays providers based on a set pricing standard—often Medicare rates. It’s another way to manage healthcare costs.

Some plans group in-network providers into tiers based on quality, cost, or other factors. Providers in a top tier typically offer better value and members may pay less when they use them.
Example: Cigna’s “Care Designation” includes providers who meet specific quality and cost standards.

These are extra provider options made available when members can’t find in-network care nearby or for certain specialties. They help expand access when needed.
Example: BlueCard PPO networks can be used when someone needs care outside their home state.

Care Finder Standard includes up to 5 preferred point solutions (listed below):

Care Finder Custom includes up to 10 point solutions, which can be a combination of preferred or non-preferred.

An optional add-on that enables the display of up to 10 additional member benefits—such as telehealth or behavioral health services—directly within the Care Finder experience. These benefits are shown on the landing page and in relevant search results. Members can view descriptions and learn more, but single sign-on (SSO) access is not included.

A similar optional add-on that also promotes up to 10 member benefits, but with integrated single sign-on (SSO) access. This allows members to seamlessly view and access these services from the Care Finder landing page and search results.

Includes a virtual assistant tool powered by Embold. This AI-enabled chat experience helps guide members to high-performing providers and lower-cost care options. It also supports the promotion of point solutions and incorporates member cost visibility. The tool is fully configurable based on client-specific preferences, networks, and benefit priorities.

An optional program that encourages members to choose high-quality, cost-effective providers by offering incentives such as gift cards or direct payments. This rewards program is tailored to each client’s goals and can be tracked either through self-reported member attestation (included) or claims-based verification (available at an additional cost). It is designed to drive member engagement and help reduce overall healthcare spend.