For self-funded employers

You bought the programs. Utilization is a separate question.

A self-funded employer of any size runs a stack of benefits programs. But having the programs doesn't mean members know which one to use.

Each purchase was defensible

Together they assume the member knows which one applies and remembers it under stress.

A member mid-claim facing separate cards for TPA, network, stop-loss, PBM and point solutions, each with its own portal and numberA member mid-claim facing separate cards for TPA, network, stop-loss, PBM and point solutions, each with its own portal and number
Care entry is the decision point; the claim is the record of spending that followsCare entry is the decision point; the claim is the record of spending that follows

Govern specialty-care entry before cost is committed

Care-entry decisions shape which pathway is used. HealCo evaluates whether an approved entry rule can be applied before care proceeds.

Book + Qualification

What changes and what does not

The plan approves a rule for a defined category. HealCo applies it when an eligible member enters, routes them to the approved pathway, keeps the existing network available as fallback, and records the decision.

Explore Pathways
What changes
HealCo governs care entry
Plan-approved rule
You define the rules for the relevant category.
01
Pathway routing
HealCo applies the rule when care enters the plan.
02
Decision record
Documented for governance and transparency.
03
What does not change
Your infrastructure stays in place
TPA administration
Your TPA still administers and adjudicates claims.
Unchanged
Existing network
Stays in place, including its fallback role.
Unchanged
Broker or consultant of record
Your relationship remains the same.
Unchanged
Stop-loss relationship
Existing stop-loss coverage remains part of the plan’s risk-financing structure. HealCo does not underwrite risk or replace the stop-loss relationship.
Existing point solutions
Existing point solutions can be incorporated as approved destinations within a governed pathway where the required access, supply and workflow are available.

Fiduciary and disclosure context

Private self-funded plan sponsors operate within ERISA and other applicable plan-governance and disclosure requirements. HealCo documents the governance process it executes; questions about legal obligations remain with the plan and its counsel.

Explore the evidence

Important distinction

HealCo does not provide legal advice and does not satisfy a fiduciary obligation for any sponsor. What a particular plan's obligations require is a question for the plan's counsel.

What qualifies

A potential fit requires:

01

Self-funded plan

Your organization pays claims directly and carries the risk.

02

Authority to adopt a pathway

Someone on your side can approve a change to how care enters the plan.

03

Shareable contracts

Relevant contracts can be shared for evaluation.

04

Usable claims or workflow data

Claims or workflow data is available in a usable format.

05

A live decision or renewal window

A contract, renewal or pathway decision creating a practical window for action.

Explore Control Tower
About 5 minutes. No contracts needed yet.
Where the line is
Not a fit

Fully insured plans.

The carrier holds the data and the authority, so there is nothing for us to change.

Case by case

Level-funded plans.

Evaluated one at a time and do not qualify automatically. It comes down to whether the plan holds the data rights and the authority to change how care enters.