Most health insurance solutions focus on trying to manage expenses through plan design. But no matter how a plan is structured, employees still have to navigate health care decisions in the moment. And when choices aren’t clear, those decisions become inconsistent and uncertain, increasing employee frustration, HR demand and employer costs.
Simplica does things differently: a copay-only plan with no deductible and no coinsurance for in-network care, where members can always see what they’ll pay ahead of time for every service. It’s health insurance rooted in behavior change, focused on how employees understand and use care so they can make better choices, use their insurance more consistently and support employer goals of stable cost performance over time.
Almost everyone has asked themselves the same questions when they need health care: What do I need? Where do I go? And how much will this all cost? That confusion and ambiguity drive inconsistent, unoptimized health care experiences, creating unnecessary costs for both employees and employers.
In contrast, Simplica actively guides decision making so care options and costs are easier to understand and compare, resulting in transparent, actionable information right when it matters most. So employees confidently get the right care at the right time, and employers benefit from more predictability in their health insurance expenses.
Simplica is built around our proprietary Find Care tool, an AI-enhanced end-to-end digital platform. In Find Care, members don’t just see a list of providers; they see clinically appropriate options for whatever their needs are that help them get on the right care path from the beginning.
Find Care is rooted in the idea that employees should get helpful guidance from their plan, not just raw information that it’s their responsibility to sort out. As a result, there’s less time wasted (and less cost inflation) from repeat visits, unneeded services and delays in getting effective care.
Compared to most health insurance plans, Simplica is far easier for employees to understand. Pick a service in Find Care, pick a provider and the price you see is exactly what you pay.
Employees are clearly told ahead of time what’s included with their copay and what’s not, helping set clear expectations before their care begins so they don’t need to worry about interpreting bills and charges later. That makes it easier for employees to actually follow through and get the care they need. And it helps employers better manage costs by cutting down on the additional expenses and administrative work that come with delayed treatment and unexpected absenteeism.
With Simplica, copays vary from provider to provider, reflecting variations in value. Those variations are based on real-world clinical performance data, safety indicators, quantitative and qualitative care outcomes over time, and more.
But for employees, it’s easy: Higher-quality care simply costs less. When better care choices are easier to immediately recognize, employees naturally gravitate toward them. The result for employers is more predictable claims costs, reduced inefficiency and a boost in the return on your benefits investment.
A plan like Simplica works best when employees understand how to use it. That means clear implementation support, practical employee communications and ongoing partnership. So HR teams and employees know what to expect from day one, strong personalization technology and ready-to-go member materials help employees get the most from their plan, and continual HealthPartners-led education and reinforcement turn early understanding into consistent use.
Simplica is paired with our broadest Open Access network, meaning copay-only pricing is available for providers in all 50 states. No matter where employees 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.
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 | Simplica | Other variable copay plans |
|---|---|---|
| Network | Nationwide provider network; copays tied to real-world performance data | Limited selection of providers; vague tiers based on dubious criteria |
| Experience | Fully integrated first-party Find Care platform based on decades of personalization data and expertise | Impersonal third-party “bolt on” tools that increase employee friction with using their plan |
| Copay pricing | Clear, plain-language guidance on what’s included with your copay and what’s not | Confusing charge bundling; ambiguity over which parts of a visit are covered by your copay |
| Uptake support | Continuous; intentionally designed to help educate employees by steering them toward higher-quality, lower-cost care | Sporadic; not designed to change how employees and members engage with their benefits and 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.”
Contact your HealthPartners sales representative or broker to learn more. Or just give us a call.