Centivo Level Funding Overview.pdf
Savings, predictability and control with Centivo level funding
Centivo level funding offers the predictable monthly billing of a traditional insured health plan with the control and benefits of a self-funded arrangement. Together with Centivo's proprietary network and an optional broad national network, we deliver the affordable, quality healthcare everyone deserves.
100% of unused claims funds returned
Benefits of Centivo level funding
- Fixed, predictable monthly bills
- Bundled, transparent PBM with pass-through savings
- State premium tax exemptions
- Built-in individual and aggregate stop-loss protection
Claims: Your maximum annual claims divided into 12 equal payments. You won't be responsible for more than the original estimate and, if claims fall below that level, you'll get back any surplus.
Centivo level funding provides a low, monthly payment consisting of:
- Fully insured
Ready to rethink your health plan?
At Centivo, we believe a health plan should solve the problem. Not be the problem. So we've upended the costly status quo by building a value-based, high-quality health plan that employers can afford to offer and employees can afford to use.
Centivo's flagship Partnership Plan delivers:
- Affordable plan design with free primary care, no deductibles and predictable copays
- High-performance network of curated providers that meet strict price and quality standards
- Unparalleled member experience that ensures members feel confident engaging with their plan
- PCP-centered model that guides members to appropriate care at the right time
Maintain flexibility and choice.
Centivo can administer our Partnership Plan alongside traditional network options, for a seamless benefits experience with more employee choices.
| Partnership Plan | Traditional PPO Plan | Traditional HDHP | |
|---|---|---|---|
| Typical Actuarial Value | 85-95% | 75-85% | 65-75% |
| Plan Administrator | CENTIVO. | CENTIVO. | CENTIVO. |
| Network | CENTIVO. | Cigna healthcare | Cigna healthcare |
| Primary care referrals to specialists required | Yes (except for OB/GYN, behavioral health and certain other services) | No | No |
| Deductible (individual/family) | None | $1,500/$3,000 | $3,000/$6,000 |
| Out-of-pocket maximum | $3,000/$6,000 | $4,000/$8,000 | $6,000/$12,000 |
| PCP visits | FREE | Ded.+20% coins. | Ded.+30% coins. |
| Specialists | $30 | Ded.+20% coins. | Ded.+30% coins. |
| Basic labs/imaging | $10/$200 | Ded.+20% coins. | Ded.+30% coins. |
| Outpatient surgery | $350 | Ded.+20% coins. | Ded.+30% coins. |
| Inpatient hospital | $700 | Ded.+20% coins. | Ded.+30% coins. |
| Urgent care | $100 | Ded.+20% coins. | Ded.+30% coins. |
| Emergency room | $200 | Ded.+20% coins. | Ded.+30% coins. |
| Rx | $10/$35/$70/30% | Ded.+$10/$35/$70/30% | Ded.+$10/$35/$70/30% |
Ready to rethink your plan?
How our Partnership Plan works:
Contact your benefits advisor or Centivo at info@centivo.com.
- Members choose a Primary Care Provider (PCP)
- Specialist referrals are guided by the PCP
- Members get access to good care at an affordable price
Cigna is an independent company and not affiliated with Centivo. Access to the Cigna PPO Network is available through Cigna's contractual relationship with Centivo. All Cigna products are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc.
The Centivo Partnership Plan Network is currently available in multiple markets across the country including portions of: CA, CT, CO, FL, IA, NC, NY, NJ, PA, TX and WI. NC is a non-referral market.