Quoting in 2027
FAQ
Questions, answered plainly.
About the Mainstay Health Plan, which starts quoting in spring 2027. Grouped by who’s asking.
Planned for 2027. Final terms come with your quote.
For employers
What employers ask first.
Is it available now?
Not yet. We start quoting in spring 2027, and the first plans start in July 2027, each on its renewal date. Get on the list and we’ll tell you when your quote can start. Whole Care, our primary care, is available today alongside your current carrier.
Who is it for?
Employers in D.C., Maryland and Virginia with 50 to 500 people.
What does it cost?
It’s quoted on your census, the list of people on your plan today. You get two numbers: the most you could ever pay for the year, and what we expect you to pay. We don’t publish prices, because every group is different.
What happens if claims run high?
Stop-loss protection pays above a set line, for one person or for the whole group. Your cost for the year has a known maximum, and it can never go higher.
Do we get money back?
Yes, when the year runs well. What the year doesn’t spend is surplus, and it comes back to you at settlement. Part of our own fee sits behind it and is paid first out of surplus, so we’re paid in full only when the plan works.
Is this insurance?
It’s a self-funded health plan: your company pays its own claims, with stop-loss insurance above them. We package it as one even monthly payment, so you get the control of self-funding without the swings.
Can we start smaller?
Yes. Whole Care, the care team on its own, works beside your current plan today. See it at mainstaycare.com. It becomes the base of this plan when you’re ready, and nothing commits you to the full plan on day one.
What if someone already has a doctor they like?
They keep them. Nobody has to switch. The self-directed path covers any doctor, and everyday visits keep flat copays.
What happens when someone needs a hospital?
Through the care team, they go to a hospital or surgery center the team books, and it costs them $0. On their own, the plan pays a fair price set by reference to Medicare, and the deductible applies. An emergency is covered as coordinated, anywhere.
Will my people get balance-billed?
Rarely, and never alone. Care through the team seldom produces a bill like that. When one comes, the plan’s claims team runs the federal surprise-billing process, we check for hospital financial help, and a fund backs the hardest cases.
Why $350 for the ER?
At a lower price, the ER was the cheapest door in the plan for things urgent care handles better. At $350, waived if you’re admitted, a true emergency is held harmless and urgent care stays the easy choice.
What if our people don’t use the care team?
We commit to how many of your people get started with their care team, and we report it every quarter. The plan works either way. What moves is your surplus.
What about employees outside the DMV?
They get virtual care and the same nurse. The self-directed path works anywhere in the country.
For brokers
What brokers ask first.
How do I get a quote?
Send one census template. Quotes come back in 5 to 10 days, with stop-loss shopped across a panel of specialist carriers. Quoting opens in spring 2027.
How am I paid?
Clean pay, disclosed up front and named on its own line in the quote. Nothing hidden in the rate.
What can I sell before 2027?
Whole Care, today, beside any carrier. Groups that start with Whole Care move to the plan at renewal with their care team already in place.
For employees
What your people will ask.
Can I see any doctor?
Yes. There’s no network gate. Go through your care team and your care costs $0, with no deductible and no copays. Go your own way and you’re still covered: a deductible and coinsurance apply, everyday care keeps flat copays, and one out-of-pocket maximum caps your year.
Do I pick a path when I enroll?
No. You choose visit by visit. Each time you need care, you decide whether to go through your care team or on your own.
Is it HSA-compatible?
No. Federal rules only let a health savings account sit beside a plan with a high deductible that you pay before the plan does. This plan pays from the first dollar when you go through your care team. We chose first-dollar care.
Can I keep my doctor?
Yes. Nobody has to switch. The self-directed path covers any doctor, anywhere in the country, and everyday visits keep flat copays.
What about emergencies?
An emergency is covered anywhere, automatically, as if your care team sent you. The ER is $350 on both paths, waived if you’re admitted.
What about prescriptions?
Pharmacy is built into the plan. After a first visit and a medication review with your care team, renewed each year, generics are $0, preferred brands $25, other brands $50 and specialty drugs $100.
Still have a question?
Ask a person. We’ll answer.
Write to hello@mainstay.health, or get on the list and we’ll reach out before your renewal.