Health Plans

Discover affordable health plans, customized to your unique needs and focused on giving your employees a pathway to a healthy lifestyle.

Open Access Plan

Under our Open Access Plan, members coordinate their own care and do not have to choose a primary care physician or provide referrals. More of the member's costs are covered when they go to in-network providers, but they also have the choice to go outside the network. For certain services, members will be asked to provide a pre-authorization.

HMO Network

Under QualCare's Health Maintenance Organization (HMO) network model, members choose a Primary Care Physician (PCP) to help coordinate all their health care needs and are required to provide referrals for specialty care. The traditional HMO model allows members to receive plan coverage when seeking services with in-network providers.

Point of Service Network (POS)

Under QualCare's Point of Service (POS) network model, members are encouraged to coordinate care through a Primary Care Physician. Members can lower their out of pocket costs when using in-network providers, yet coverage is also available for services with out-of-network providers.

Preferred Provider Organization (PPO)

With our Preferred Provider Organization (PPO), members pay less for care when they use in-network doctors, hospitals and ancillary healthcare providers. Under this plan, members can choose to go outside the network but will pay higher co-payments, deductibles and co-insurance costs. Referrals are not required nor is there a need to choose a primary care physician (PCP). For certain services, members will be asked to get a pre-authorization.

QualCare offers a broad suite of services to assist with the administration of the health plan including:

  • Claims Administration & Cost Containment
  • Customer Service (Multiple Channels)
  • Care Management (including Population Health Management & Wellness)
  • Plan Reporting & Analytics
  • Flexible Spending Accounts & Consumer Directed Health Plans

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Copyright © 2016 QualCare, Inc. (dba QANI Administrators), A Cigna Company. Some content provided under license.