Introducing Simplica: A variable copay health insurance plan based on clarity and cost control
Traditional health insurance isn’t always transparent. When what’s driving your costs isn’t clear, and your employees aren’t sure where they can go or what they’ll end up paying, it’s easy to question whether you or your staff are getting the most value from your plan.
That’s why we’re excited to share Simplica, a more modern approach to health insurance.
Simplica does things differently: It’s a copay-only plan with no deductible and no coinsurance for in-network care, so members can see what they’ll pay ahead of time for every service. There’s no complicated math, just a simple, clear, flat price for everything. It’s a smarter health insurance plan that puts predictability and value first.
Simplica’s difference is its design: Simplicity meets sophistication
For employers, Simplica delivers:
- Better cost control – For any given service, copays are lower at locations that offer proven higher-quality care, not just places that charge less. This design – informed by decades of data, our trusted
total cost of care model and nationally respected quality benchmarks – incentivizes members to pick providers that manage their health better for the long run. That means more predictable claims costs, reduced inefficiency and a boost in the return on your benefits investment. - Improved employee health and satisfaction – Simplica is built around our proprietary Find Care tool, an AI-enhanced end-to-end digital platform that not only simplifies health care shopping but also helps members do it more judiciously. In Find Care, members are guided toward higher-quality options for whatever care they’re looking for. The result is a more personal, more tailored health insurance experience, where employee benefits actually fit employee needs.
- Fewer administrative headaches – Simplica is easy for members to understand: Pick a service, pick a provider and the price you see is exactly what you pay. That radical clarity translates to smoother claims experiences, fewer demands on your HR team to sort out issues and more time for your staff to focus on growing your business.
For employees, Simplica offers:
- Unprecedented control over care – By empowering members with clear copay-only price information up front, Simplica takes the uncertainty and frustration out of health care, so it’s easier to choose care based on need and budget. That means more informed, confident and affordable choices (protected, of course, by an out-of-pocket maximum).
- Easier ways to find quality care providers – Since higher-quality providers just cost less, Simplica helps take the guesswork out of finding a good doctor. Provider ratings combine real-world clinical performance data, safety indicators, quantitative and qualitative care outcomes, and more. Plus, no choice is a bad choice: We don’t contract with any providers who don’t meet our baseline standards.
- Nationwide flexibility backed by local support –Simplica is paired with our broadest
Open Access network , meaning copay-only pricing is available for providers in all 50 states. So no matter where members are, their plan works the way it was meant to. And no matter what questions they have, award-winning Midwest-based support is only a single call or message away.
Compare Simplica to other variable copay plans
We’ve listened to what employers, brokers and consumers told us they really wanted out of the next generation of health insurance. Then we built a plan that meets their needs today and anticipates their needs tomorrow.
| Plan features | Other variable copay plans | Simplica |
|---|---|---|
| Network | Limited selection of providers; vague tiers based on dubious criteria | Nationwide provider network; copays tied to real-world performance data |
| Experience | Impersonal third-party “bolt on” tools that increase employee friction with using their plan | Fully integrated first-party platforms based on decades of personalization data and expertise (achieving 50% higher member engagement versus the industry norm)¹ |
| Copay pricing | Confusing charge bundling; ambiguity over which parts of a visit are covered by your copay | Clear, plain-language guidance on what’s included with your copay, and what’s not |
| Impact | Not designed to change how employees and members engage with their benefits and care | Intentionally designed to help educate employees and members by steering them toward higher-quality, lower-cost care |
“We developed Simplica in response to the growing demand for more predictable benefits. This plan gives members the cost clarity and ease they expect from their health plan and guides them in making informed decisions about where to get the care they need.”
“Simplica delivers one seamless experience that makes it easier for members and employers to understand and manage costs. This plan ties copays to provider value, guides members in real time and delivers the digital-first convenience today’s workforce expects.”
Notes
1HealthPartners 2023 personalization campaign results