Quoting in 2027
What’s inside
Six parts, chosen and wired together.
A health plan is a handful of parts. Most employers rent them from one carrier as a sealed box. We chose each part for your people and connected them, so the care, the prices and the paperwork work as one.
The parts
What your people get, and what runs underneath.
01
Primary care: Whole Care
Your people’s own doctor, nurse and care concierge. Same-day answers, unhurried visits, and one team that books the specialist, sends the records and sorts out the bill. Care that runs through this team costs your people nothing: $0 deductible, $0 copays.
02
A fair-price open network
There’s no network gate. Your people can see any doctor or hospital, and they’re covered. The plan pays prices set by reference to Medicare, with a standard price for each kind of care and a documented ceiling above it. We also sign direct deals with independent imaging centers, surgery centers and specialists, and pay them the same day.
03
Pharmacy, built in
Prescriptions live inside the same plan and the same care team. A first visit and a medication review with the care team, renewed each year, lowers what your people pay. Specialty drugs go to the place that prices them fairly, and your people always pay the stated copay.
04
Care management, handled by the care team
Through the care team, there are no referral chains and no approvals to chase. The care team is the approval. When your people go their own way, a clinical review applies to a short list of big-ticket care, like a hospital stay, and we handle it with the doctor.
05
Stop-loss protection
Insurance for the plan itself. If one person’s care turns expensive, or the whole year runs high, stop-loss pays above a set line. That’s what lets you fund to a known maximum that can never go higher. We shop it across a panel of specialist carriers for every group.
06
Plan administration
Claims paid, ID cards printed, a member line that answers, and the filings a plan sponsor owes each year, done for you. One even monthly payment covers it.
Why wire them together
Wired together, the plan can say yes.
The care team sets the path.
The doctors and the plan belong to one company. So a visit through your care team pays at $0, and the plan never second-guesses a doctor it already works with.
Prices stay fair everywhere.
When your people go their own way, the plan still pays a fair price set by reference to Medicare, and everyday visits keep flat copays. Nobody is punished for choosing.
Savings stay in your plan.
When care costs less, the money stays in your plan’s claims fund. What the year doesn’t spend comes back to you at settlement.
How the plan pays for care
Three ways to pay a doctor, in order.
First
A card, at the visit.
When your care team sends someone somewhere, the plan pays that doctor the same day on a card, at a price agreed ahead. No claim, no coding, no bill in the mail. We use it as often as we can.
Next
Direct deals, close to home.
Imaging centers, surgery centers, infusion sites and independent specialists in the DMV, priced ahead and paid the same day. Every deal we sign moves more care onto known prices for good.
Last
Fair prices, as the backstop.
When care arrives as an ordinary claim, the plan pays a fair price set by reference to Medicare, with a documented ceiling for each kind of care, and help with any bill that comes back.
Every visit that moves up this list means less paperwork, fewer disputes and nobody taking a cut in the middle. More of it moves up every year.
How the plan prices care
A standard price and a ceiling, written down.
Every claim is priced by reference to Medicare, by kind of care. The ceiling is the most the plan will agree to in a case-by-case negotiation, and it’s written into the plan.
Doctors and clinicians
About 120% of Medicare
Ceiling: 160%
Visits, specialists, procedures in the office.
Outpatient care
About 150% of Medicare
Ceiling: 220%
Hospital outpatient, surgery centers, imaging.
Hospital stays
About 180% of Medicare
Ceiling: 250%
Admissions and inpatient care.
Planned for 2027. Final terms come with your quote.
Never alone with a bill
Nobody in your plan faces a bill alone.
Prevent
Most bills never happen.
Going through the care team means most people never see a bill that could come back to them.
Defend
Surprise bills get fought.
When a bill comes in above the fair price, the plan’s claims team runs the federal surprise-billing appeal for you.
Screen
Hospital help gets found.
We check whether a hospital’s financial help applies. Far more people qualify than expect to.
Resolve
Hard cases get a person.
For the rare hard case, advocates step in case by case, backed by a fund set aside for it.
Dialysis, transplants, air ambulance and gene therapy each have a plan of their own, written before anyone needs it.
Pharmacy, in plain terms
Medicines at their real cost.
Planned for 2027. Final terms come with your quote.
No hidden markup.
The plan pays what a medicine actually costs. Nobody keeps a spread in the middle, and there are no rebate games.
Your copay, set by one visit.
After a first visit and a medication review, renewed each year: generics $0, preferred brands $25, other brands $50, specialty $100. Before that: $10, $50 and $100. The review changes what you pay, never what you can get.
Specialty drugs, handled.
Specialty prescriptions are routed within 48 to 72 hours to a pharmacy that prices them fairly. Infusions go to an independent infusion site, where they can cost a third to a fifth of the hospital price.
Quoting in spring 2027
See the plan before your renewal.
Get on the list and we’ll reach out when quoting opens. Want to start now? Whole Care works alongside your current carrier today.