2-TIER PLAN
Northwell-Anthem Health Plan: Direct Contracts for Lower Costs & Personalized Care
Designed by Memberly to deliver high quality care anywhere in the US through the Blue Cross Blue Shield network while leveraging directly contracted Northwell hospitals and physicians.
A Pre-Priced Health Plan for Businesses - Accessible Anywhere, Anytime
The Northwell-Anthem 2-Tier Health Plan offers access to high-quality care nationwide through the Blue Cross Blue Shield network, while providing enhanced savings through direct contracts with Northwell Health. Members enjoy lower copays and deductibles when using Northwell hospitals, urgent care centers, labs, surgical centers, and physicians, making care more affordable.
By leveraging direct contracting, employers benefit from lower overall costs, which helps keep premiums more affordable for all members—whether they choose Northwell providers or not.
TIER 1
New York Tri-State
Up to 40% Less Than Comparable Health Plans
With the Northwell-Anthem 2-Tier Plan, designed by Memberly, businesses of any size can finally gain relief from rising healthcare costs. Serving over 100,000 lives in the New York metro area, this plan leverages Tier 1 direct contracts with Northwell Health, reducing premiums for all employers and employees—even those outside the Northwell footprint.
Effortless Enrollment with Locked-In 2025 Rates
Joining is simple. Rates are locked in for 2025, allowing businesses to easily compare costs and plan designs against their current coverage. Plus, employers can enroll at any time of year, with no- and low-deductible plan options that help minimize financial disruptions when switching off-cycle.
Three PRE-PRICED plans to choose from
The Northwell-Anthem 2-Tier Plan offers three pre-priced plan options, giving employers flexibility to choose the best fit for their workforce. Each plan is designed to provide predictable costs and competitive benefits, making it easy to compare against existing coverage. With pre-set rates, businesses can confidently select a plan that balances affordability and quality care without the hassle of complex pricing negotiations.
EMPLOYEE
NORTHWELL DEDUCTIBLE
$0
ANTHEM BCBS DEDUCTIBLE
$500
OUT-OF-NETWORK DEDUCTIBLE
$1,000
EMPLOYEE & SPOUSE
NORTHWELL DEDUCTIBLE
$0
ANTHEM BCBS DEDUCTIBLE
$2,000
OUT-OF-NETWORK DEDUCTIBLE
$2,000
Employee & CHILD
NORTHWELL DEDUCTIBLE
$0
ANTHEM BCBS DEDUCTIBLE
$2,000
OUT-OF-NETWORK DEDUCTIBLE
$2,000
FAMILY
NORTHWELL DEDUCTIBLE
$0
ANTHEM BCBS DEDUCTIBLE
$2,000
$2,000
EMPLOYEE
NORTHWELL DEDUCTIBLE
$2,000
ANTHEM BCBS DEDUCTIBLE
$3,000
OUT-OF-NETWORK DEDUCTIBLE
$6,000
EMPLOYEE & SPOUSE
NORTHWELL DEDUCTIBLE
$4,000
ANTHEM BCBS DEDUCTIBLE
$6,000
$12,000
Employee & CHILD
NORTHWELL DEDUCTIBLE
$4,000
ANTHEM BCBS DEDUCTIBLE
$6,000
$12,000
FAMILY
NORTHWELL DEDUCTIBLE
$4,000
ANTHEM BCBS DEDUCTIBLE
$6,000
$12,000
EMPLOYEE
NORTHWELL DEDUCTIBLE
$5,000
ANTHEM BCBS DEDUCTIBLE
$6,000
OUT-OF-NETWORK DEDUCTIBLE
$9,200
EMPLOYEE & SPOUSE
NORTHWELL DEDUCTIBLE
$10,000
ANTHEM BCBS DEDUCTIBLE
$12,000
$18,200
Employee & CHILD
NORTHWELL DEDUCTIBLE
$10,000
ANTHEM BCBS DEDUCTIBLE
$12,000
$18,200
FAMILY
NORTHWELL DEDUCTIBLE
$1000
ANTHEM BCBS DEDUCTIBLE
$12,000
$18,200
Your Gateway to the 2-Tier Plan
Easy Access Through Memberly
The 2-Tier Northwell-Anthem health plan is accessible to employer groups of any size through Memberly, which serves as the agent for enrollment and administration. Memberly streamlines the process, ensuring seamless access to Northwell’s directly contracted providers alongside Anthem’s extensive Blue Cross Blue Shield network.
Whether as part of a multi-employer group or a standalone plan, employers can leverage this cost-effective solution to provide high-quality healthcare for their workforce.
Customized Northwell-Anthem 2-Tier Plans for Large Employers
Leverage Layered Networks on Your Own Terms
With the assistance of Memberly, large employers can establish a self-funded Northwell-Anthem 2-Tier Plan tailored to their workforce. This model enables full control over healthcare strategy, allowing businesses to customize provider networks, reduce costs, and improve access to care. By leveraging direct contracting and layered networks, employers can optimize plan design, manage expenses, and retain unused claims funds for long-term financial benefits.
A standalone Northwell-Anthem 2-Tier Plan is best suited for employers in the tristate area to leverage Northwell’s care network for cost savings and enhanced access. Since the plan uses Anthem for access to the Blue Cross Blue Shield network, Memberly will establish it through Anthem, which holds the necessary licenses for New York and Connecticut.
New York
100 FTES
In New York, employers must have at least 100 employees or full-time equivalents (FTEs) to qualify for self-funding and establish a standalone Northwell-Anthem 2-Tier Plan.
Connecticut
30 FTES
In Connecticut, employers must have at least 30 employees or full-time equivalents (FTEs) to establish a standalone Northwell-Anthem 2-Tier Plan.
New Jersey
30 FTES
Since Anthem does not service New Jersey, employers must have at least 30 full-time equivalents (FTEs) and an office in New York or Connecticut to join the Northwell-Anthem 2-Tier Plan.
The criteria outlined apply to establishing a standalone Northwell-Anthem plan. Employers with at least one eligible employee anywhere in the U.S. can also join an existing multi-employer 2-Tier plan, with Memberly serving as the agent of record.
Expanding Access with Northwell Direct
Northwell Health Plus Partners
Northwell Direct consists of Northwell Health, the largest health system in New York state, plus a diverse, high-performing network of partner providers, hospitals and health systems in the tri-state region. By directly contracting with Northwell and its partner network, the plan offers a full spectrum of employer health services at a cost that’s sustainable. More importantly, employers get quality care for the employees from the largest health system in New York..
TIER 1
62 Regional & Community Hospitals
9,000 Primary Care Physicians
31,000 Physicians and Specialists
167 GoHealth Urgent Care Centers
Expanding Access with Northwell Direct
Northwell Health Plus Partners
Northwell Direct consists of Northwell Health, the largest health system in New York state, plus a diverse, high-performing network of partner providers, hospitals and health systems in the tri-state region. By directly contracting with Northwell and its partner network, the plan offers a full spectrum of employer health services at a cost that’s sustainable. More importantly, employers get quality care for the employees from the largest health system in New York..
Northwell Health
Northwell Health is the largest healthcare provider in New York, offering a comprehensive network of hospitals, physicians, and specialty services to deliver high-quality care across the region.
Partnered Hospitals and Providers
Northwell Direct collaborates with partnered hospitals and physicians to deliver high-quality care at lower costs through direct contracting, expanding the directly contracted healthcare options available within the 2-Tier Plan.
Northwell Health Plus Partners
62
Hospitals
9,000
Primary Care Physicians
33,000
Healthcare Providers
167
Urgent Care Sites
- Search Northwell Direct Providers
96% of U.S. Hospitals
106 Million Members
95% of U.S. Doctors
1.7 Million Providers
Blue Cross Blue Shield Network
Contracted through Anthem
The 2-Tier plan is built on the expansive Anthem Blue Cross Blue Shield network, covering 95% of doctors and 96% of hospitals nationwide. As the exclusive BCBS provider for select regions in New York and Connecticut, Anthem ensures seamless access to care for members and their dependents.
With over 106 million BCBS members nationwide, 2-Tier plan participants receive an Anthem BCBS ID card for doctor visits and hospital care, along with access to the Anthem portal for easy account management.
Blue Cross Blue Shield Network
Contracted through Anthem
The 2-Tier plan is built on the expansive Anthem Blue Cross Blue Shield network, covering 95% of doctors and 96% of hospitals nationwide. As the exclusive BCBS provider for select regions in New York and Connecticut, Anthem ensures seamless access to care for members and their dependents.
With over 106 million BCBS members nationwide, 2-Tier plan participants receive an Anthem BCBS ID card for doctor visits and hospital care, along with access to the Anthem portal for easy account management.
Blue Cross Blue Shield Network
96%
of U. S Hospitals
106
Million Members
95%
of U.S. Doctors
1.7
Million Providers
Integrated Networks for Streamlined Healthcare Access
Medical and Pharmacy Integration
The 2-Tier Plan seamlessly integrates Northwell’s direct contracts with the expansive Blue Cross Blue Shield network, ensuring employees have broad access to high-quality care. With a single ID card, members can easily visit Northwell providers and any Blue Cross Blue Shield-participating doctors and hospitals nationwide without navigating multiple networks.
Additionally, pharmacy benefits are fully integrated, allowing employees to fill prescriptions effortlessly while maximizing cost savings.
Integrated Medical Benefits
Integrated medical networks are designed to work seamlessly together so physicians and facilities can deliver the right care, in the right setting, at the right time.
Pharmacy Benefits Management
2-Tier plans are powered by CarelonRx, providing tailored pharmacy benefits that support doctors and pharmacists at every stage, from prescribing to prior authorization.
2-Tier Plan Enrollment with Memberly
Memberly manages enrollment for both the multi-employer group plan, available to employers of any size, and the standalone 2-Tier Northwell-Anthem plan for employers that meet the minimum FTE requirement.
Join the Current Plan: Any Size Employer Starting at One Employee
Employers of any size, in any U.S. location, can enroll in the 2-Tier plan through Memberly’s streamlined onboarding process. The plan offers set rates, simplified administration, and cost savings driven by a larger risk pool. To receive a cost comparison, employers provide their most recent health plan invoice, renewal notice, summary of benefits (SBC), and an employee census that includes date of birth, ZIP code, and coverage tier.
Recent Carrier Invoice
Renewal Notice
Employee Census
Plan SBCs
Establish a Standalone 2-Tier Plan: Large Employers Starting at 30 FTEs
Employers with a workforce in the tristate area can establish a standalone Northwell-Anthem 2-Tier Plan through Memberly. This self-funded plan structure enables businesses to leverage direct Northwell contracts for Tier 1 savings while maintaining access to the Blue Cross Blue Shield network for nationwide coverage. To get started, employers provide their most recent health plan invoice, renewal notice, summary of benefits (SBC), an employee census including date of birth, ZIP code, and coverage tier, as well as the current plan’s renewal date.
Recent Carrier Invoice
Renewal Notice
Employee Census
Plan SBCs
Common Questions
Learn More About 2-Tier Plans
General Information
The Northwell - Anthem 2-Tier Health Plan is a healthcare plan that provides two levels of coverage:
- Tier 1: Local in-network providers within the Northwell Health network, offering the lowest out-of-pocket costs.
- Tier 2: A national network (such as Anthem/Blue Cross Blue Shield), giving members access to providers across the country, typically at a higher cost.
This structure allows flexibility in choosing healthcare providers while maximizing savings when using Northwell’s network.
The national network includes healthcare facilities and specialists nationwide through Anthem/BCBS. Members can access care when traveling or when specialized services are needed outside the Northwell network. Costs such as copays, deductibles, and coinsurance are typically higher in Tier 2 compared to Tier 1.
The Northwell - Anthem 2-Tier Plan covers a wide range of medical services, including:
- Preventive care (e.g., screenings, vaccines)
- Doctor visits
- Emergency care
- Hospital stays
- Surgical procedures
- Prescription medications
Coverage specifics may vary, so it’s important to review your plan documents for detailed benefits.
Yes, you can choose providers across three tiers:
- Tier 1 (Northwell in-network providers): Lowest out-of-pocket costs with reduced copays, deductibles, and coinsurance.
- Tier 2 (Anthem/BCBS national network): Covered at a higher cost than Tier 1 but still in-network.
- Out-of-network providers: Covered, but with the highest copays, deductibles, and lower reimbursement levels. Members are encouraged to use Tier 1 or Tier 2 providers when possible.
This plan is ideal for individuals who:
- Want the cost savings of using Northwell providers while maintaining national access through Anthem/BCBS
- Need flexibility for travel, specialized care, or family members in different regions
- Prefer a comprehensive network that allows them to choose between lower-cost in-network care and broader national access—even out-of-network options when necessary
Costs and Deductibles
Cross accumulators allow medical expenses from Tier 1, Tier 2, and out-of-network providers to count toward your annual deductible and out-of-pocket maximum. This ensures that all qualifying care contributes to your financial limits for the year.
- Tier 1: Lowest copays for services within the Northwell network
- Tier 2: Higher copays for services through the national Anthem/BCBS network
- Out-of-network: Highest copays, often with reduced reimbursement and increased member responsibility
No.
- Tier 1: Lower deductible
- Tier 2: Higher deductible
- Out-of-network: Highest deductible
This tiered approach encourages members to seek cost-effective care while maintaining choice.
Your out-of-pocket maximum is the most you’ll pay in a year for covered medical services. It is:
- Lowest for Tier 1
- Higher for Tier 2
- Highest for out-of-network services
All tiered expenses count toward your annual maximum through cross accumulation.
After meeting your deductible, coinsurance is the percentage of the cost you pay for covered services:
- Tier 1: Lower coinsurance (e.g., 20%)
- Tier 2: Higher coinsurance (e.g., 30–40%)
- Out-of-network: Highest coinsurance, based on the provider and reimbursement levels
Enrollment Options
Yes. Eligible employees or members can enroll year-round if their group or organization allows rolling enrollment. This allows flexibility in onboarding new participants without waiting for a traditional open enrollment period.
Yes. If you join through the multi-employer plan, your rates are locked in through December 31, 2025. This helps employers and employees maintain predictable, stable costs.
Yes. Employers can choose to implement a standalone version of the 2-Tier Plan tailored to their needs. Memberly will assist with plan design, eligibility rules, and contribution strategy.
- Multi-employer plan: Provides streamlined enrollment, group-negotiated rates, and quicker onboarding
- Standalone plan: Offers more customization and control over plan features, contributions, and eligibility
Memberly will help you determine the best fit based on your organization's goals.
Lower Rates & Cost Advantages
The Northwell - Anthem 2-Tier Plan is typically 40% less expensive than a comparable Blue Cross Blue Shield plan with similar deductibles and benefits. This significant savings is driven by direct provider contracts and efficient plan design.
The plan leverages direct hospital contracts with the Northwell Health System and affiliated providers, reducing third-party administrative costs and helping to control overall medical spend.
The plan provides transparent, data-backed savings that stop-loss carriers can use in underwriting. This often results in lower stop-loss premiums due to predictable claim costs and established provider rates.
By participating in the multi-employer plan, your group shares risk with thousands of other members. This spreads the cost of high claims, reduces volatility, and promotes long-term rate stability.
Yes. Stop-loss coverage is purchased as part of a group with over 80,000 covered lives. This scale increases negotiating power and spreads risk. Many stop-loss carriers are already familiar with the plan, which supports faster approvals and more competitive pricing.
