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Achievable Savings with Paradigm Health Plans®

Brokers who partner with Paradigm Health Plans® can help their Clients achieve savings and rate stability by:

  • Projecting premium costs accurately—with an unprecedented average renewal rate of 3.5%
  • Offering our exclusive max rate cap for 3 Renewal cycles—with 75% participation in our Lifestyle-for-Life® Health Management Program
  • Sharing our flexible plan solutions for Self-Funded, Level-Funded and ASO groups
  • Providing Fixed-Cost Funding, Claim Funding and Expected Funding
  • Including organ and transplant insurance
  • Accessing ancillary coverage, including Dental, Vision, and Short- and Long-Term Disability
  • Taking advantage of dedicated Account Management partners
  • Leveraging Lifestyle-for-Life, our exclusive health management program that helps Members make lasting, impactful changes, resulting in a healthier workforce and reduced claims spend
  • Changing the way Plan Members utilize and maximize their plan benefits with reduction or elimination of Member out-of-pocket costs with our Member 360 Program
  • Controlling increasing Client costs in five key areas, including:
    • Claim Savings of over three years of 27-32%
    • Complex imaging costs—reductions as much as $450 per scan
    • Average Reduction of Pharmacy costs of more than 18-22%
    • Lab cost savings as much as $179 per study (for participants in the Lifestyle-for-Life Health Management Program)
    • Lifestyle-for-Life® Health Management Program, resulting in actuarial savings of 9.8% the employer claims attachment point

Paradigm Health Plans provides total solutions for managing workforce populations, including:

TPA Processing for claims adjudication and payment

TPA Processing for claims adjudication and payment

Pharmacy Benefit Management

Pharmacy Benefit Management

Disease and Maternity Management

Disease and Maternity Management

Telehealth solutions through our partnership with 1.800MD

Telehealth solutions through our partnership with 1.800MD

Unparalleled Provider Access

  • Major PPO Networks with thousands of high-quality access points, comprised of physicians, specialists, hospitals and ancillary facilities
  • Multiple Networks for the same Employer, guaranteeing provider access regardless of geographic location
  • Access to more than 200 Networks!
  • On average, less than 3% disruption and seamless transition during change of benefit platforms

Member 360 Program

We help “Map the Gap” in Members’ expectations about their healthcare coverage and change the way Employers offer Plan benefits in their workforce. Paradigm Health Plans’ Members who used the Member 360 Program experienced:

  • Unparalleled Member out-of-pocket cost containment with reduction or elimination of out-pocket-costs
  • Transparency of network quality and cost options for imaging, planned and elective hospital admissions and more!
  • Removal of Facility charges and outpatient hospital excess claims costs
  • Member education about plan benefits before the plan starts and throughout plan enrollment

Plans Made Easy

Inspire PPO

Paradigm Health Plans’ Inspire PPO offers 4 flexible plan options:

Inspire Platinum

100% Coverage & Coinsurance

Inspire Preferred

90% Coverage & Coinsurance

Inspire Select

80% Coverage & Coinsurance

Inspire Value

70% Coverage & Coinsurance

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Acclaim PPO

Paradigm Health Plans’ Acclaim PPO offers 4 flexible plan options:

Acclaim Platinum 

90% Coverage & Coinsurance

Acclaim Preferred
 
80% Coverage & Coinsurance

Acclaim Select
 
70% Coverage & Coinsurance

Acclaim Value
 
60% Coverage & Coinsurance

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Achieve

Paradigm Health Plans’ Achieve offers 5 flexible plan options:
Achieve More 

Unlimited office visits/Non-Hospital services (Rider available for buy-up coverage for hospitalization)

  • 100% Coverage & Coinsurance

  • 70% Coverage & Coinsurance

Achieve Preferred

Achieve Select

Achieve Value

Acheive Elect

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