HOT TOPIC: Tiered Benefit Design

Empower members to choose preferred providers

Tiering divides groups of healthcare providers into levels, or tiers, based on the value (cost and quality) of the care they provide. High-quality, low-cost providers who are designated as Tier 1, preferred providers.

Creative benefit design drives savings through smarter usage of benefits. Lowering or eliminating copays and other coinsurance for Tier 1 providers encourages members to use these preferred providers. Members still have the choice of visiting any provider in the network, but they will pay more out-of-pocket if they go to Tier 2 providers. Finally, a way to bring more transparent pricing and good consumerism to healthcare.

Another objective of tiered networks is that they help payers negotiate lower fees with providers, since higher cost providers will lose patient volume.

Tiering can save the plan up to 20% depending on geography, member utilization, and plan design. We will work with you and your client to determine the providers for each tier.

Read about tiered benefit design and other ways we drive down costs by directing members to preferred providers.