Still have questions?
We have answers. The healthcare experts at Imagine360 have compiled the most frequently asked questions — about self-funded insurance, reference-based pricing and our full-service health plan solution — and put them all in one place. Explore the FAQs below to learn more.
Frequently asked questions
My company has fewer than 500 employees. Are we a good fit for Imagine360?
Yes. Imagine360 works for companies with 100 employees or more. Since our plans are completely customizable, we can build a money-saving health plan solution around your employee population, health plan goals and budget.
If I currently have a self-funded health plan, how can Imagine360 help me?
You’re in luck, because Imagine360 solutions are designed for self-funded companies.
With Imagine360, you have options. You can choose our full-service health plan solution with expert plan administration, 360-degree member support, reference-based pricing and direct contracts built in. That’s the most complete plan we offer for self-funded employers.
You can also add our standalone products to your existing self-funded plan, including reference-based pricing or our direct contracts with quality providers and health systems. For more information on all of these options, please visit our solutions page.
What if my business isn’t currently self-funded?
While there are many advantages to moving to a self-funded health plan, there are also many factors to consider. Imagine360 provides a total health plan solution that helps fully insured businesses migrate to a self-funded plan. We’ll work with you and your broker — providing our 50+ years of expertise in healthcare — to ensure a seamless transition.
If I’m currently with a large insurance carrier, can I switch to Imagine360?
Yes. Every day, we get clients that switch from big-box insurance plans to an Imagine360 solution. We make it easy to switch with a solution that offers significant savings, plus an elevated member experience. Check out our case studies page to see examples of companies that have made the switch.
We also work with companies that would like to provide their employees with a dual option, in which employees can choose between a PPO and a plan with the cost savings of reference-based pricing built in. This gives employees freedom of choice while still delivering savings for the company.
Is there support for the HR team?
Absolutely. The plan administration team at Imagine360 has 50+ years of experience providing support to HR — from plan design and open enrollment to onboarding and year-round employee education and benefits administration. Plus, we offer a robust MiBenefits portal that offers around-the-clock support for both HR and plan members.
Does Imagine360 provide member education?
Members are at the center of the Imagine360 experience. An account manager will assist with onboarding, open enrollment, employee education and ongoing support. From that point on, members will have access to ongoing healthcare guidance, billing support, the MiBenefits online portal that provides instant access to essential healthcare data and one number to call for all their healthcare questions.
If I have offices in multiple cities, can I still use Imagine360?
Yes, our health plan solutions include coverage from coast to coast, with the price protection from reference-based pricing included wherever you receive care. Plus, we offer direct contracts with quality providers nationwide, prominent health systems in 14 U.S. markets and 6,500 Quest Diagnostic Centers.
What if I have remote employees?
Our health plan solutions include built-in price protection from RBP that applies wherever your employees are located. Plus, we offer concierge-level service through our member support platform. With Imagine360, your remote employees always have someone on their side to help them with questions wherever they are on their healthcare journey.
What solutions does Imagine360 offer?
Imagine360 is a different kind of healthcare company offering an innovative portfolio of health plan solutions. Our core product is Your Health Plan — a full-service health plan solution with expert plan administration and 360-degree member support built in. Your Health Plan also includes the financial savings of reference-based pricing, plus direct contracts with high-quality providers and health systems. It’s our most complete health plan solution, proven to lower healthcare costs by 15-30% — and it’s ready to customize today.
Reference-based pricing and direct contracts with provider partners are offered as standalone solutions. We work with TPAs nationwide so you can easily add one or both of those components to your existing self-funded plan. With Imagine360, the choice is yours.
Not sure what product is the best fit for your company? One of our health plan experts can recommend a solution that’s right for your business. Call 866-485-5205 or complete our contact form to get started.
How does Imagine360 differ from a traditional PPO plan?
A PPO health plan is built around a “preferred provider” network that offers a discounted rate to members that use the healthcare services of their contracted providers. The problem is that the PPO discount that is included in the plan is typically applied to a highly inflated rate.
Take a CT scan, for example. The average price for a hospital CT scan in the U.S. is $3,821. A typical PPO plan provides a 60% discount, which lowers the price to $1,528. That sounds like a good deal until you realize the actual cost of the CT scan, as reported by the facility, is only $100. That’s a 3,800% markup!
With an Imagine360 plan, we take a different approach to pricing claims. In the CT scan example, our members get the CT scan at the same hospital. But instead of paying the full amount, Imagine360 reviews and reprices the claim, using the actual cost of care ($100) and what Medicare pays ($125) as a guide. It then resubmits the claim with payment. So instead of paying $1,528, an Imagine360 member pays just $150. That’s significant savings compared to a traditional PPO plan. Same procedure. Same hospital. Dramatically lower cost.
And if the provider ever has a question about payment, you have a team of member advocates on your side to help resolve any billing issues and further maximize those healthcare savings. That’s the advantage of an Imagine360 health plan solution versus a PPO.
Will I need a third-party administrator (TPA)?
With Imagine360, plan administration is included in our core offering, Your Health Plan. We act as your third-party administrator and manage your plan just like any other health plan provider. Plus, our plans include concierge member support that surrounds your employees throughout their healthcare journey — from finding a provider to helping with a bill and everything in between.
But we also understand that some clients want to build their own plan using their preferred TPA. That’s why we offer reference-based pricing and direct contracts as standalone products. This way you can still realize the benefits of Imagine360, even if you want to use your own TPA.
How can I learn more about Imagine360 without a hard sales push?
You can explore our case studies pages to see the Imagine360 solution at work. As you’ll see, most companies save anywhere from 15-30% on average while also improving the healthcare experience for their employees.
Imagine360 also offers virtual events, where you can learn about our health plan solutions first-hand. Check out our events page for details.
How does reference-based pricing (RBP) work?
Reference-based pricing (RBP) is a cost-containment strategy that uses an established benchmark, like Medicare, to determine what is paid for healthcare services. Self-insured businesses can add a reference-based pricing solution to their health plan and reduce annual costs by up to 30%. RBP providers review and audit medical bills, reprice them based on Medicare or some other benchmark like the actual cost reported by the hospital, and pay a fair markup on those charges. As a result, employers and employees can save money on their healthcare.
Think of reference-based pricing as a bottom-up approach, starting at the bottom with a reference metric — often the actual cost or Medicare — then adding a fair profit margin to determine provider payment.
Visit our RBP page to learn more.
How do provider contracts work?
Rather than including a wide range of unvetted providers within a region, Imagine360 uses independent data to identify only high-performing physicians, health systems and hospitals. We then establish direct contracts with those providers. We currently have contracts with more than 25,000 quality healthcare providers and more than 550 medical facilities in 14 U.S. markets – and adding more all the time. In addition, members have nationwide access to CVS Minute Clinics and Quest Diagnostics centers. Click here to learn more.
How can I find out whether Imagine360 is a good fit for my company?
Imagine360 delivers solutions for employers looking to escape the escalating costs and inflexibility of traditional employer-sponsored healthcare. The best-in-class offerings of Imagine360 make it a leading choice for businesses looking to achieve cost savings, while giving their members personalized support to navigate their healthcare journey and achieve their health goals.
The best way to see if Imagine360 is a good fit for your organization is to talk to an Imagine360 representative. We’ll listen to your needs, asses your healthcare challenges and recommend a health plan solution that is custom designed for your employees and your budget. Schedule a free consultation with an Imagine360 representative by calling 866-485-5205 or completing our contact form.
How do I get started?
Once you’re done exploring our case studies and learning more about our solutions, the next step is to connect with an Imagine360 representative by calling 866-485-5205 or filling out our contact form.