PPO

Choose a health care partner that will do more for you

We understand your needs as well as the local players, and treat every client as our most important. Our comprehensive health plan management includes:

Robust network

More than 225 hospitals and 130,000 doctors in New York, New Jersey, and Connecticut – where you members live and work. When your members travel to another state, they’re covered by a national network of top-notch health care professionals in more than 550,000 locations.

Claims adjudication

Our medical clinicians review every claim to determine whether the billed service level is appropriate for the diagnosis or procedure codes, and decide whether to approve, deny, or reduce the claim.

Medical management

Case management, population health management, utilization review, and more by our clinically expert Medical Management team ensure your members’ health and wellness, and that they get the most appropriate care at the most affordable price.

Advanced technology platform

Simplified administration, easy claim review, and much more save you time and effort. Our mobile app gives your members anywhere, anytime access at their fingertips.

Superior customer service 

Knowledgeable customer service reps treat every member and client as our most important. You and your members receive a superior level of service. Dedicated account managers go above and beyond for you.

Control prescription drug costs

MagnaCare Rx pharmacy benefits manager (PBM) manages your prescription drug benefits and controls the ever-rising cost of medications. Your members benefit from:

  • Comprehensive, national network of 61,000+ retail pharmacies, including the major chains
  • Complete mail order and speciality services
  • Flexible plan designs
  • Online portal to view benefit details, claim history and status, wellness information, and drug formulary
  • Quality clinical programs

Our TPA services help you control costs while delivering the appropriate care to your employees with ease.

Claims Administration
Claims Repricing
Eligibility Management
Employee Enrollment
Customer Support
Provider Support