Brokers
At Pinnacle Health Plans, we don’t just build level-funded and self-funded solutions, we build partnerships designed to help brokers like you stand out and succeed. When you bring us data on a mid-size or large group, we go all in acting as your behind-the-scenes team to design, price, and present a plan that wins the case. No more being at the mercy of traditional carriers. With Pinnacle, your clients get complete control over their plan design and you gain more influence, insight, and flexibility than ever before.
Let's Breakdown Our Approach
Pass-Through Pharmacy & Prescription Sourcing
The U.S. prescription model is broken. Our plans only work with Pharmacy Benefit Managers with fixed administration cost, so we know members aren't pushed toward a high profit drug through a faulty formulary. For any prescription we can source alternatively, we are savings the client 30%-100% of the prescription cost and providing that prescription to the employee free.
Direct Contracting
Our nationwide direct contract network layers with our PPO Network and allows our plans to pay for outpatient surgery and imaging 20%-80% less than the average PPO Discount Rate. To incentive members to utilize this direct contract network, we wipe all out of pocket costs for the member to $0.
Egregious Claim Strategy
Emergency claims are one of the most difficult claims to manage for any carrier. With our proprietary contract with our national PPO Networks, our plans are able to carve out the 4% of claims that makeup on average 50% of the cost and pay these on average 1/3 the rate of the PPO Network.
Claims Surplus
These level funded plans allow the employer to own the portion of the premium set aside to pay for claims. 100% of the claims surplus is returned to the employer regardless if they stay with the plan or move to another carrier. No gimmicks.