Employer Portal

The portal provides Employers and Employees with online access to your personal healthcare information.

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Employer Resources

You’ll have access to forms, tools,  and any outside resources that  you might need.

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Request a Proposal

If you would like to submit an RFP click here.

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Why Employers Choose Paradigm Health Plans®

By offering flexible benefit plans designed to improve Employee health, Paradigm Health Plans® empowers Employers and Employees to become active partners in managing health and healthcare costs. We provide:

Employer financial protection without sacrificing quality of care
A benefits team that helps yours, with our Member 360 Program and Account Management Teams!
Flexible plan designs to meet all Affordable Care Act mandates, including:
- Acclaim and Inspire EPO and PPO Plans
- Ancillary Coverage for Dental, Vision and Long- and Short-Term Disability and Life Insurance

Aggregate Member health status updates and periodic care-cost reports
Over 200 networks to choose from, with network disruption averages of less than 3%!
Specific and aggregate reinsurance
Fixed-cost funding, claim funding and expected funding experience

Paradigm Health Plans® Partners in Superior Delivery

Paradigm Health Plan’s TPA services boast an average of 97% claims accuracy and specializes in self-funded, level-funded, fully-insured and ASO services.

Our Lifestyle-for-Life® Health Management Program helps make positive changes in health behaviors in workforces nationally, resulting in healthier workforces and reduced claims costs. Don’t forget to ask us about our 3-year rate cap for Employers who participate in our Lifestyle-for-Life® Health Management Program!Learn More „

1.800MD provides groups and individuals with email, video and telephone consultation and convenient access to high-quality medical care 24 hours a day, 7 days a week for 365 days a year throughout the United States.

Pharmacy Management—Serve You enables each Member to access a national retail pharmacy network comprised of more than 61,600 pharmacies as well as mail-order programs.

Disease Management—Our Disease Management program is URAC-accredited through American Health and targets nine prevalent conditions, including Chronic Kidney disease, chronic pain, congestive heart failure, diabetes, chronic obstructive pulmonary disease, hyperlipidemia, hypertension and coronary artery disease, for which evidenced-based guidelines are established to impact health and measure improvements.

Maternity Management—Paradigm Health Plans’ Maternity Management program provides education and support to expectant mothers to reduce instances of complications and subsequent high-dollar claims.

Organ Transplant and Liability Insurance

Online tools to manage your employer plan and more!

Accurately Project Costs... And Save!

Our health plans’ coverage provides access to high-quality care! Paradigm Health Plans’ options include:

Flexible, customized plans for Administrative Services Only, Self-Funded and Level-Funded health plan groups
Assurance on healthcare costs over a one- to three-year period, with our exclusive Rate Cap

Average premium renewal of 3.5%, significantly less than the national industry average of 7% to 14% for groups of over 50
Control of escalating healthcare costs through accurate and efficient projection of multi-year budgets

Self-Funded, Level-Funded, Fully-Insured and ASO Advantages

Choice gives you control over your healthcare costs… and saves you and your Employees money! Choose the option that works best for you.

Self-Funded

With a self-funded plan, Employers (rather than a contracted insurance carrier):

Assume the risk and responsibility of paying medical claims
Set premium rates based on your company’s claims history
Experience lower administration costs
Enjoy more flexible plan designs
Have a more fluid business cash flow

Level-Funded

Employers seeking more predictable claims costs each month may choose to add level-funded to their self-funded plan, where you can:

Make 12 monthly payments, and you owe nothing more!
Pay a set amount to a carrier each month for plan administration, expected claims for the month and stop-loss insurance for protection against extremely high, unpredictable claims
Have Employee claims paid throughout the year
At year’s end, if your payments exceed claims, receive a refund; and if the claims exceeded what you paid into the program, stop-loss insurance usually covers the overage

Administrative Services Only (ASO)

Employers who want to assume their own risk sometimes find that ASO plans offer distinct advantages compared to fully-insured plans. Paradigm Health Plans® third-party administrative services can provide administrative services for all employer plan functions which include:

Claims Adjudication
Claims Payment
Assumption of full-risk
Costs tied to actual claims experience

Member 360 Program

Exceeding Employer Expectations About Healthcare!

We created the Member 360 Program to provide unparalleled service exceeding members expectations regarding their health care. The more your Employees understand, the more likely they will use important covered preventative services, avoiding future health problems that could become serious and expensive to treat. Embedded in all Paradigm Health Plans®, our Member 360 Program provides Members easy access to preventative health services and changes the way in which Members utilize and maximize their health plan benefits. This investment in prevention also provides Members with a personal Member 360 Program Team Member who:

Helps them understand how to use their benefits to obtain high-quality healthcare

Assists with reducing or eliminating their out-of-pocket costs

Provides benefits education prior to enrollment and throughout plan duration

Provides transparency in network quality and cost options

Advocates for resolution of any billing issues

Guides them in selecting in-network providers who match their clinical needs

Assists with pharmacy-mail order programs

Member 360 Program Cost Savings

74^%

74% of members reduced or eliminated out-of-pocket costs when using the Member 360 Program

22^%

18-22% reduction of prescription drug costs

^$ 260

$260 reduction of lab and diagnostic testing costs per study

^$ 450

$450 reduction of complex imaging costs per exam

27^%

27% of average savings on Claims beginning Year 1 through Year 3

Already a Paradigm Health Plans’ Client? 

Find Your Forms & Tools here

The Paradigm Health Plans’ Portal is a password-protected website for both Employers and Employees, providing Employers a clear path to access the following:

Add | Change | Delete Form

New Business Submission Checklist

Employer Group Applications (for Preventative Plans)

Employer Group Application (for all other Plans)

Employer Online Health Portal Guide , where you can:

Add an enrollee
Make changes to enrollment
Add a spouse or dependent
Receive Member Summaries and Reports
Access Report Scheduler and Claims Ledger Report

Become a Paradigm Health Plans’ Client Now!

Lifestyle-For-Life®: Everything Works When You Do!

Empower your employees to live their best and healthiest lifestyle for life with our Lifestyle-for-Life® Health Management Program. Our dedicated clinical team builds a specific approach to addressing unique clinical challenges in your workplace, sharing responsibility for ensured success. Plus, our entire Member 360 Program Team does all the work for you, so your HR department can focus on what they do best.

Focusing on long-term lifestyle changes for complete health benefits, Lifestyle-for-Life® provides the following:

Health Evaluation and diagnostic blood draw of up to 38 panels
All Members have access to health coaches and we tailor programs specific to each Member depending on their health status
A detailed report is reviewed with Employer by the Lifestyle-for-Life manager who will provide program recommendation to better impact their workplace culture
Identification of existing moderate- and high-risk conditions that could lead to higher claims costs
Support, information and incentives for Members to make necessary lifestyle changes for long-term health success

Learn More