With Memberly, what you don’t spend comes back. Smarter self-funded health plans for employers.
Memberly delivers strategic solutions through top-tier partners—optimizing costs while elevating the benefits experience.
Empowering Employers with Self-Funded Plans
Memberly Guides You Through the Self-Funded Health Plan Process
Transparency
A clear breakdown of where every dollar goes in a self-funded health plan.
Claims Funding
Stop-Loss Cost
Network Cost
Admin Cost
Cost Controls
Identifying inefficiencies and opportunities to optimize the self-funded plan.
Direct Contracts
Rx Rebates
J-Code Controls
Network Tiering
Data-Driven Decisions
Helping employers make strategic choices to balance costs and coverage.
Fixed Cost Ratio
Risk Review
Margin Forecast
Rate Analysis
Improved Performance
Maximizing the value of
every healthcare dollar
spent.
Richer Benefits
Lower Rates
Branded PPOs
Better Support
Health Share Options for Employers and Consumers
With Plans Starting at $82/Month, Health Share Makes a Compelling Case
Employer Plans
A cost effective option for employees when health insurance is out of reach.
Up to 90% Savings
No Network Limits
Flexible Plan Options
No Min Participation
Paired Benefits
Integrate with other benefits to fortify health share
offering:
Critical Illness
Hospital Indemnity
Cancer Insurance
Accident Insurance
Consumer Plans
For individuals and families when unexpected medical events occur.
Hospitalization
Doctors Visits
Urgent Care
Labs and Imaging
Sample Rates
Health Share Plan – $5,000 Unsharable, Oldest Member Age 45.
Individual: $222/mo.
Ind - Child: $421/mo.
Married: $421/mo.
Family: $548/mo.
Traditional Health Insurance Coverage
From the nation’s largest carriers – Aetna, United Healthcare, Cigna, and Blue Cross Blue Shield
Simplicity
A straightforward approach making healthcare coverage simple and hassle-free.
Fixed Monthly Premium
Preset Plan Designs
Carrier Administrated
National Coverage
No Risk
Premiums cover all costs, eliminating unexpected financial risk.
Carrier Assumes Risk
Best for High Utilization
Community Rated
Simple Renewal
Compliance
The carrier ensures full compliance with healthcare regulations including:
ACA Compliant
COBRA Aministration
RxDC reporting
No Network Limits
Analysis
Memberly conducts periodic reviews to ensure employers are getting the best value.
Self-Funded Comparison
Compare Coverage
Compare Plan Designs
Market Arbitrage
Northwell - Anthem 2-Tier Health Plan
Direct Contract with Northwell Health Reduces Costs by Up to 40%
Rate Reduction
Utilizing directly contracted hospitals and providers to reduce health plan rates.
40% below similar plans
Pre-Priced for 2025
No and Low Deductible
3 Plan Options
Easy Enrollment
Simplified enrollment process for small and large
employers.
Join any time of year
1 - 100s of Employees
No Contracts
No min participation
Northwell Health
The largest healthcare system in New York plus partnered hospitals providers.
60+ Hospitals
31,000 Doctors
9,000 PCPs
167 Urgent Care Centers
Blue Cross Blue Shield
Anthem’s Blue Cross Blue
Shield provides national
coverage.
96% of all US Hospitals
1.7 Million Providers
106 Million Members
95% of all US Doctors
Self-Funded Plan Types
Memberly Offers a Range of Self-Funded Plan Options
Self-funded health plans can take various forms, including PPO, Reference-Based Pricing (RBP), and Minimum Essential Coverage (MEC). Memberly helps employers understand the differences, navigate plan structures, and determine the best fit for their workforce. We provide expert guidance on how each plan works, as well as the pros and cons of each option, ensuring employers make informed decisions that align with their financial goals and employee healthcare needs.
PPO
SELF-FUNDED
Preferred Provider Organization
Hospitals Network: Aetna, Cigna, United Healthcare, or BCBS
Physician Network: Aetna, Cigna, United Healthcare, or BCBS
Stop-Loss: Individual and Aggregate
Administration: Managed by TPA
Hospitalization: Covered subject to plan terms.
Pricing: Potential savings of 20-40% less than fully insured plans.
RBP
SELF-FUNDED
Reference-Based Pricing
Hospital Network: No hospital network. RBP is used to reprice bills.
Physician Network: Multiplan PHCS Physician-only network or no network.
Stop-Loss: Individual and Aggregate
Administration: Managed by TPA
Hospitalization: Covered subject to plan terms.
Pricing: Potential savings of 40-60% less than fully insured plans.
MEC
SELF-FUNDED
Minimum Essential Coverage
Hospital Network: No hospital network. MEC plans do not cover hospitalization.
Physician Network: Multiplan PHCS Physician-only network or no network.
Stop-Loss: No stop-loss
Administration: Managed by TPA
Hospitalization: Not covered in basic MEC plans.
Pricing: $50 pepm plus claims. Same rate for EE, EC, ES, and Family.
Join the Memberly Multi-Employer Group Plan
Affordable, Flexible Coverage for Teams of Any Size — From Solo Operators to 100+ Employees
Whether you’re a solo entrepreneur or a company with hundreds of employees, Memberly makes it easy to offer high-quality health coverage. One person or one hundred — all can join through our flexible, multi-employer group plan.
Rates Set for 2025
Our 2025 plan rates are up to 40% lower than comparable fully insured plans in the NY metro area — with no compromise on quality. Transparent pricing allows for easy comparisons in both cost and benefits.
Powered by Premium Networks
- Directly contracted with Northwell Health — including its hospitals and provider network for superior regional access.
- National coverage through Blue Cross Blue Shield — ensuring coast-to-coast care and peace of mind for your employees wherever they go.
TIER 1
62 Regional & Community Hospitals
9,000 Primary Care Physicians
31,000 Physicians and Specialists
167 GoHealth Urgent Care Centers
TIER 2
96% of U.S. Hospitals
106 Million Members
95% of U.S. Doctors
1.7 Million Providers
Linking Employers to National Carrier Networks
Strategic PPO Health Plans
Memberly leverages PPO (Preferred Provider Organization) networks to strategically design self-funded health plans that offer flexibility and affordability for employers and individuals. By partnering with national and regional PPO networks, Memberly ensures members have access to a wide range of healthcare providers at discounted rates. This approach allows members to receive care from preferred doctors and specialists without the restrictions of narrow network plans.
Memberly’s use of PPO networks also helps reduce out-of-pocket costs by negotiating competitive pricing for medical services. Through this strategy, Memberly creates tailored healthcare solutions that balance cost savings with high-quality care.
Our Telemedicine Program
Physician-First Virtual Care within 60 Seconds
Businesses and health plans can access CirrusMD virtual care through Memberly, offering a 48-hour startup with no contracts, implementation fees, or minimum enrollment requirements.
24/7 Access
Licensed in-state physicians are available 24/7 within 60 seconds.
Text, audio, or video
Members start with a text and can move to audio or video.
No claims
Other than the monthly subscription, there are no additional costs to use the program.
Health Share Programs
Savings for employers and families
Healthcare is more expensive than ever, causing many Americans to go without coverage. That’s why Memberly has taken the lead in helping employers and individuals find a health share program that provides them with a reliable safety net.
It’s important to understand the ins and outs of health share programs, as they often have waiting periods for preexisting conditions and other limitations.
Our Expertise in Action
CASE STUDIES
Hundreds of thousands saved. Benefits improved or maintained.
These are just a few self-funded success stories showcasing how diverse businesses have benefited from Memberly’s strategic expertise and execution. In every case, benefits were maintained or enhanced while achieving significant cost savings. There are multiple ways to optimize healthcare plans and control costs, but it takes deep industry experience to do it effectively—the kind of experience Memberly brings to every client.
Staffing Agency
A staffing agency with a self-funded health plan faced a 38% renewal increase driven by higher stop-loss premiums and aggregate factors.
Memberly re-marketed the stop-loss coverage and negotiated a reduction in administrative and network fees from $127 to $46 PEPM. These strategic cost-saving measures successfully lowered the renewal increase to just 8%, resulting in savings of over $1 million.
SELF-FUNDED PPO
Aerospace Manufacturer
A New England-based aerospace manufacturer faced another 15% premium increase on their Tufts Pilgrim health plan. Memberly moved them to a self-funded RBP plan, unlocking significant savings.
Year 1: Received a $55,000 refund from unused claims funds.
Year 2: Received a $50,000 refund, bringing total savings to $105,000.
Result: 30% net reduction in health plan costs over two years.
LEVEL FUNDED RBP
Labor Union
A union faced rising healthcare costs due to escalating stop-loss premiums. Memberly leveraged its expertise to drive significant savings through:
Stop-Loss Negotiation – Successfully reduced stop-loss costs by $430,000, securing more favorable terms.
Direct Hospital Contracting – Partnered with a large hospital system to establish a direct contract, lowering claims costs and improving provider access.
LEVEL FUNDED PPO
Who We Help
Tailored Healthcare Solutions for Diverse Industries & Strategic Partners
At Memberly, we understand that every industry and business structure has unique healthcare challenges. Whether you’re a large multi-state employer, labor union, franchise chain, or a business under common ownership, we provide customized self-funded health plans and healthcare programs designed to meet your specific needs.
