Quoting in 2027
One plan. Two paths. You choose, visit by visit.
There’s no network to pick at enrollment and nothing to lock in for the year. Each time you need care, you decide how to get it, and the plan pays for either.
The two paths
Same plan, same card. Two ways to use it.
Coordinated
Through your care team
$0 deductible. $0 copays.
Text or call your care team: your doctor, your nurse and your care concierge.
They book what you need, the specialist, the scan or the lab, and send your records ahead.
The plan pays in full. No prior auth to chase. The care team is the authorization.
Self-directed
See anyone you like
Covered, with a deductible.
Book any doctor or hospital yourself. There’s no list of approved names.
Everyday visits keep a flat copay with no deductible, so a checkup never costs a surprise.
Bigger care goes to your deductible, then coinsurance, at fair prices set by reference to Medicare. One out-of-pocket maximum caps the year.
Choosing one path this time doesn’t lock you in next time. Your care team is there either way.
The two schedules, in plain words
What you’d pay, side by side.
Planned for 2027. Final terms come with your quote.
| Benefit | Coordinated | Self-directed |
|---|---|---|
| Deductible | $0 | $5,000 per person, $10,000 per family |
| Out-of-pocket maximum | $7,000 per person, $14,000 per family | $7,000 per person, $14,000 per family |
| Preventive care | $0 | $0 |
| Primary care, virtual included | $0, unlimited visits | $50, no deductible |
| Labs and X-rays | $0 | $30, no deductible |
| Specialists | $0 | $100 for your first two visits a year, then deductible and 25% |
| Mental health visits | $0, no visit limit | $40, no deductible |
| Urgent care | $0 at the places your team names | $75 |
| Emergency room | $350, waived if you’re admitted | $350, waived if you’re admitted |
| MRI, CT and other advanced scans | $0 at the place your team books | Deductible, then 25%. Needs approval first. |
| Outpatient surgery | $0 | Deductible, then 25%. Needs approval first. |
| Hospital stays | $0 | Deductible, then 30%. Needs approval first. |
| Having a baby, start to finish | $0 | Deductible, then 30% |
| Physical, occupational and speech therapy | $0, up to 30 visits each | $50, up to 30 visits each |
| Medical equipment, home health and skilled nursing | $0 when the plan arranges it | Deductible, then 25%. Needs approval first. |
| Prescriptions | After your first visit and medication review: $0 generic, $25 preferred, $50 other brands, $100 specialty | Before that review: $10, $50 and $100. Specialty drugs through the plan’s specialty pharmacy. |
| Your first 90 days | Nothing extra to do | New members get a 90-day grace on everyday visits while they have their first visit |
Adult dental and hearing can be added. Not HSA-compatible, by design. Specialist copays count toward the deductible. An emergency costs the same on both paths.
When care counts as coordinated
Your care team’s referral covers the whole episode.
When your care team refers you, the visit pays on the $0 path. The referral rides with the whole episode, so what that specialist orders along the way is covered the same way.
Planned for 2027. Final terms come with your quote.
A referral from your care team.
It covers the specialist and what they order: 90 days for visits, a hospital stay through 30 days after you go home, a full course of therapy or infusions. A second specialist needs its own referral, and your team writes it within a day.
A place your team books.
Surgery, scans and infusions at a place your care team books for that episode cost you $0. The plan pays them the same day.
Any real emergency.
Anywhere, automatically. $350 on both paths, waived if you’re admitted.
Went on your own? Ask within 30 days.
If you booked care yourself, ask your care team to review it within 30 days. If it’s the care they would have sent you to, they can mark it coordinated after the fact. If they say no, you keep the plan’s normal appeal rights. You can see which path every episode took, in the app.
One episode, two prices
Susan finds a mole that started bleeding.
Tuesday, 8:10 am
She texts her care team a photo.
1:30 pm
Her doctor looks. It should be seen by a dermatologist.
2:00 pm
Her nurse books an independent dermatologist nearby, six days out, and sends her records ahead.
Six days later
Visit and biopsy, done. Susan pays nothing. There’s no claim to chase.
$1,100
The same visit and biopsy at a hospital-based dermatologist. The default path today.
$130
At the independent dermatologist her care team picked. Susan pays $0.
Allowed amounts for a new-patient dermatology visit and punch biopsy (99203 + 11104), pathology excluded, in-network rate files for a large DMV plan, June 2026. The hospital figure includes facility fees.
Had she booked the hospital practice herself, she’d still be covered. The visit would count toward her deductible, and her care team would still help if the bill came back wrong.
Before you ask
Three things people ask first.
Not HSA-compatible.
An HSA only pairs with a plan where you pay the deductible before the plan pays. The coordinated path pays from the first dollar, so the plan can’t pair with one. We chose $0 care over a tax account.
Open network. See anyone.
There’s no list of approved doctors. Any licensed doctor or hospital in the country is covered on the self-directed path. Your care team simply knows where the care is good.
Pharmacy built in.
Prescriptions are part of the same plan, on the same card. After a first visit and a medication review with your care team, your copays drop, whichever path you use.
Quotes open in spring 2027.
Get on the list and we’ll tell you when your company can see a quote.