Large Group Health Insurance Plans that Work for You
Our Self-Funded Health Benefit Solutions Provide Members with Concierge Level Care
Our Self-Funded Health and Welfare Benefits Solution Replaces an Outdated PPO Insurance Model
In our role as health care advisor, we believe control over your plan design and how your money is spent should be yours, the plan sponsor. Our smarter data-driven, member advocate approach ensures quality care, faster and better health outcomes, with a tremendous ROI on your health care investment.
Self Insured Plans vs Fully Insured Plans
The real difference between self-insured plans and fully-insured plans, comes down to this. The BUCAH’s (Blue Cross/Shield, United Healthcare, Cigna, Aetna, and Humana) control your fully-insured plan 100%; administration, claims payments, etc. They are huge publicly traded companies that answer to Wall Street and/or shareholders. Their interests are not aligned with yours. The large health insurance brokerage houses rely on overrides and bonuses from them for much of their income, in addition to commissions. When the BUCAH’s raise your rates, their commission goes up, because it’s based on a percentage of total premium. Why ruin a good thing?! There is little to no transparency, whether you have a good year or a bad year they keep 100% of your premium. And no one in this equation has any incentive to change things. These things are true regardless of their online and print advertising.
Self-Insured Plans
Self-funding is just that, you control the plan design to accommodate your people and your enterprise, by law, the plan runs the way you decide it runs, you control member care, and get to decide how claims are paid. You’re in control!
Fully-Insured Plans
When you have a BUCAH PPO they decide what they want to charge for their network, and plan administration, whether or not to pay a claim, and member care isn’t the top priority.
Tribal Nations Health Has 40 Years of Combined Experience and Understands What Works and What Doesn’t. Our Stop-Loss and Reinsurance Healthcare Markets are A+ Rated. We Leave Nothing to Chance
The Best Third Party Administrators Work Smarter, and Keep Their Promises
Tribal Nations Health services go beyond the traditional TPA role. Member engagement happens early in their care journey, while optimizing your healthcare investment for an outstanding ROI
Plan Design
(Risk management, financial performance, quality of care)
Care Management
(Target the right care before services rendered, preventive care, Remote monitoring)
Optimized Decisions
Leverage data to optimize
Member Engagement
(Guide members into better experiences, outcomes)
Claims & Payments
Deeper monitoring and vetting, easier admin
Transforming Health Benefits Administration
Tribal Nations Health is bold enough to suggest constant price increases and a lack of quality care doesn’t have to be the fate of your employer health plan.
Plan Design
Our self-funding, reference based pricing model, and member advocacy approach is transforming healthcare.
Price Protection Enhanced with AI
We guide members to quality providers who work well with their health plan. We are always available to members.
Care Management
Engaging members early and often in their care journey, enables us to create better health outcomes, smarter and faster.
Claim Management
Identify and mitigate potential billing issues before they occur, to resolve claims more effectively and preserve savings.
20-30%
Average Year One Savings
8X ROI
Care Navigation & Management
200,000+
Members Served