Frequently
Asked Questions

Answers about our product, our partners, and how we work with our clients

Product

What does Collective Health do?

Collective Health is an integrated third-party administration (TPA) plus navigation solution. We support self-funded employers and their populations nationwide. The core pieces of our offering include:

Integrated third party administrator: Administration of your medical, pharmacy, dental, and vision plans, medical claims adjudication, and the networks and digital health programs that fit your needs.
Elevated member experience: Complex care management, compassionate personal support, and convenient digital tools to make understanding, navigating, and paying for care easier.
Smart employer tools: Streamlined operations, billing and payments support, and analytics to help you and your consultant partner make the most out of your benefits investment.

Visit Our solution page to learn more.

Of the health benefits vendors I work with today, who do you replace?

We take over plan administration and member support for your self-funded health benefits. That means we replace the administration services provided by your current medical carrier and other redundant member support services like third party mobile, online, or telephonic solutions. You can think of Collective Health as one solution for plan administration, claims adjudication, member engagement and advocacy, partner ecosystem, and integrated analytics.

Visit Our solution page for more information.

Do you support Centers of Excellence (COEs), Accountable Care Organizations (ACOs), and/or other innovative care delivery models?

Yes, our platform is built to blend traditional PPO networks and new delivery options like COEs, ACOs, and other direct contracting arrangements into one seamless member and employer experience.

Visit our Partner ecosystem page to learn more.

Do you offer high-quality member services?

Yes, we are laser focused on creating an exceptional experience for our members. Our Member Advocates and Care Navigation team provide empathetic and supportive member engagement. In fact, we believe our support model is more effective than third party concierge providers because our service team is built directly into the health plan. This integrated approach enables stronger, more impactful member relationships that simply can’t be achieved with a third party program. How do we know it’s working? We have a customer net promoter score average of 70 (the industry average is 9) and we see a 50% reduction in healthcare cost trend over 5-year period (view the Impact Study).

Care Navigation, our complex care management program, received NCQA accreditation in 2022 in recognition for meeting rigorous service and quality standards for case management.

Visit our Employee experience page to learn more.

Can you help drive engagement in our other health and wellness programs?

Yes, our platform is designed to create a seamless experience across your entire health benefits ecosystem, from your medical, pharmacy, dental, and vision plans, to your health and wellness programs and spending accounts. This means that our integrated online portals, mobile app, and Member Advocates help connect the right members to the right programs at the right times through a personalized approach. And—with our Care Navigation program—we are able to deeply guide members through complex health needs.

Partners

What networks do you work with?

We partner with some of the nation’s leading medical, pharmacy, dental, and vision networks, so our clients and members can access broad, nationwide networks with strong discounts.

We’re happy to set up some time to talk to you about the options available to your organization. Visit our Network partners page to learn more.

What third party health and wellness programs do you work with?

The Collective Health Platform is designed to support whatever third party health and wellness programs you prefer. Today, we integrate with a wide variety health and wellness programs from telemedicine and maternity to disease management and behavioral health. With our platform, we’re able to streamline the day-to-day management of your programs for your benefits and finance teams and create an all-in-one health benefits experience for your members.

Visit our Network partners page to learn more.

Clients

What size companies do you work with?

We generally work with clients who have 1000 to 50,000 benefits eligible employees.

Do you work with fully-insured or self-insured companies?

We’re focused on serving companies who are already self-insured or are looking to transition from fully-insured to self-insured.

Can you support companies who have employees across the U.S.?

Yes, our clients access provider networks nationwide. That means our members benefit from great provider networks, with great discounts, no matter where they live. We serve members in all 50 states.

Pricing and Procurement

How much does Collective Health cost?

Our pricing structure mirrors the integrated pieces of our solution. Clients pay a medical plan administration fee, network access fees, and have the option of adding additional platform modules.

Would you be included in a typical carrier RFP process?

Yes, include Collective Health in medical carrier RFPs. We think it’s helpful to be able to talk to companies and their consultants prior to the RFP to quickly explain how Collective Health is both similar to and different from traditional health plan options.

How long does it take to implement Collective Health?

We can fully implement our solution in as little as 90 days. However, most of our clients begin the implementation process early so that Collective Health’s printed materials, digital tools, and Member Advocates can play a key role in helping members understand and navigate their choices during Open Enrollment.

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Frequently Asked Questions