Frequently asked questions

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How is Imagine Health different from a PPO plan?

Unlike a traditional PPO that offers broad coverage typically including 95% of healthcare providers, Imagine Health takes a different approach. Rather than including most providers within a region, we select only high-performing hospitals and physicians and then establish direct contracts with those providers. This allows self-funded employers and their employees to get quality care from high-performing providers at low costs. Read our blog post to learn more.

How does Imagine Health choose its quality providers?

We have developed a methodology for calculating provider quality. The methodology uses independent data to identify the best-performing physicians, health systems and hospitals in local markets. We’re able to filter out the low-performing ones. This becomes the foundation of Imagine Health coverage. In our core markets, we’ve established direct contracts with many high-performing providers, which enables our members to access quality care at a low cost. Read our blog post for a deeper dive into quality methodology.

What happens if a member receives care at a provider that’s not an Imagine Health partner?

Going to an Imagine Health partner provider is the best way to make sure you receive quality care at a fair price. But we understand that sometimes you need to seek care at a non-partner provider. That’s why, as part of every health plan, we offer built-in price protection that protects members from overcharges — regardless of where they receive care. Using a model called reference-based pricing, we’re able to identity a fair, reasonable cost for care and then use that reference point to determine reimbursements for non-partner providers. If a member receives a balance bill after a visit, the Imagine Health team will take over and work on behalf of the member to resolve the bill.

Is Imagine Health available in 12 key markets?

Imagine Health offers health plan coverage in 12 key markets across the United States. The Imagine Health model is quickly gaining traction and we have plans to expand to new markets soon. Click here to view a map of our current markets.

How does Imagine Health help introduce its plans to employees?

Imagine Health offers a range of support services for both HR and employees — from plan design and rollout strategy to employee launch and engagement campaigns. To learn more, visit the Empowering HR page.

How does Imagine Health help with balance bills?

Due to our established contracts, members should not experience balance bills when visiting any of our provider partners. If a member chooses another provider, the plan offers built-in price protection and member advocacy services in the event of a balance bill. We stand shoulder to shoulder with members throughout the process, answering any billing questions and managing all ongoing communications.

Does a broker need to be certified to sell Imagine Health?

Any licensed health insurance broker can sell Imagine Health. There’s no extra certification needed. But brokers who complete our broker certified program have access to additional training and resources, making them the best equipped to sell Imagine Health to their clients. Are you a broker interested in becoming certified? Visit our broker certification page to learn more.



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