Elite Health was developed by local health care systems to provide the highest quality care at the lowest available cost. Its purpose is simple: Collaborate to improve the health of the community by bringing a unique health solution to create better care for business.
What is Elite Health?
An employer sponsored, major medical solution designed to be an alternative to current options available in the Northern Kentucky and Greater Cincinnati marketplace.
Is the network limited?
No. Employees have access to tier one providers such as St. Elizabeth Healthcare, TriHealth, Cincinnati Children’s Hospital, numerous local independent specialty practices, and a national wrap network, First Health, allowing plan participants to seek care at provider of choice.
Who is the Pharmacy Benefit Manager (PBM)?
The PBM is CVS/Caremark™.
Who is the Third Party Administrator (TPA)?
The TPA will be Key Benefit Administrators.
What type of funding arrangements are available?
Elite Health can be purchased as a partially self-funded/level funded (similar to fully-insured) or self-funded plan.
Are plan designs flexible?
Yes. Plan designs have been pre-determined but employers have over 30 options including traditional PPO plans, HDHPs with HSAs, and a copay only plan with no deductibles. All of the available plan designs have tiered benefit structures with maximum out-of-pocket limits including out-of-network benefits.
Is there a wellness component and/or requirement?
No requirement is in place today, however, employers will be encouraged and have the opportunity to purchase additional services from pre-selected providers at discounted prices.
Why is it different?
Case Management (CM) and/or Chronic Disease Management (CDM)
The CM & CDM will be done by American Health Data Institute (AHDI). As a result of the CDM protocols of AHDI any service rendered by a network provider pertaining to an included chronic disease will be covered at 100%.
Access to Claims Information
All participating employers will have access to claims reporting and analytics including healthcare risk management reports and EZ ViewSM technology.
Special Contract Provisions
For example, if you are admitted to a St. Elizabeth facility and are re-admitted for the same diagnosis within 30 days any fee connected to the second admission will be waived.
Discounted Non-medical Benefits
Fully-insured dental and vision plans will be available with bundled discount pricing.
To learn more about Elite Health, please contact