2-TIER PLAN​
Northwell Direct 2-Tier Health Plan: Direct Contracts for Lower Costs & Personalized Care
Designed to provide high-quality healthcare access nationwide while leveraging directly contracted Northwell hospitals and physicians for enhanced regional access and cost savings.
A Smarter Health Plan for Businesses - Accessible Anywhere, Anytime
The Northwell Direct 2-Tier Health Plan provides access to high-quality care through two distinct tiers. Tier 1 provides enhanced savings through direct contracts with Northwell Health, while the National Tier 2 PPO provides broad healthcare access across the country. Members benefit from lower copays and deductibles when using Northwell hospitals, urgent care centers, labs, surgical centers, and physicians, while retaining the flexibility to access providers nationwide through the National Tier 2 PPO.
By leveraging direct contracting, employers benefit from lower overall costs, helping keep plan rates more affordable while providing members with both regional value and nationwide access.
TIER 1
New York Tri-State
Up to 30% Less Than Comparable Health Plans
Memberly customizes health plans to achieve the right balance between affordability, benefits, and access to care. Proven cost-containment strategies can help make coverage more affordable for both employers and employees without simply shifting additional costs to members. For employers that want to make comprehensive healthcare coverage accessible to more of their workforce, Memberly can recommend proven strategies designed to achieve savings of up to 30%, depending on plan design and utilization.
Effortless Enrollment with Flexible Plan Options
Joining is simple. Employers can easily compare costs and plan designs against their current coverage to determine which option best meets their needs. Enrollment is available throughout the year, with a range of plan designs and deductible options that provide flexibility and help minimize financial disruption when transitioning from existing coverage.
Three Cost-Effective Memberly Model Plans
Memberly offers three cost-effective model plan designs that incorporate practical cost-control strategies to help make comprehensive health coverage more affordable for employers and accessible to more employees. The Ultra, 3K, and 6K Model Plans provide different deductible and benefit levels, allowing employers to select the right balance of cost, benefits, and access to quality healthcare for their workforce.
EMPLOYEE
NORTHWELL DEDUCTIBLE
$0
NATIONAL PPO DEDUCTIBLE
$500
OUT-OF-NETWORK DEDUCTIBLE
$1,000
EMPLOYEE & SPOUSE
NORTHWELL DEDUCTIBLE
$0
NATIONAL PPO DEDUCTIBLE
$2,000
OUT-OF-NETWORK DEDUCTIBLE
$2,000
Employee & CHILD
NORTHWELL DEDUCTIBLE
$0
NATIONAL PPO DEDUCTIBLE
$2,000
OUT-OF-NETWORK DEDUCTIBLE
$2,000
FAMILY
NORTHWELL DEDUCTIBLE
$0
NATIONAL PPO DEDUCTIBLE
$2,000
$2,000
EMPLOYEE
NORTHWELL DEDUCTIBLE
$2,000
NATIONAL PPO DEDUCTIBLE
$3,000
OUT-OF-NETWORK DEDUCTIBLE
$6,000
EMPLOYEE & SPOUSE
NORTHWELL DEDUCTIBLE
$4,000
NATIONAL PPO DEDUCTIBLE
$6,000
$12,000
Employee & CHILD
NORTHWELL DEDUCTIBLE
$4,000
NATIONAL PPO DEDUCTIBLE
$6,000
$12,000
FAMILY
NORTHWELL DEDUCTIBLE
$4,000
NATIONAL PPO DEDUCTIBLE
$6,000
$12,000
EMPLOYEE
NORTHWELL DEDUCTIBLE
$5,000
NATIONAL PPO DEDUCTIBLE
$6,000
OUT-OF-NETWORK DEDUCTIBLE
$9,200
EMPLOYEE & SPOUSE
NORTHWELL DEDUCTIBLE
$10,000
NATIONAL PPO DEDUCTIBLE
$12,000
$18,200
Employee & CHILD
NORTHWELL DEDUCTIBLE
$10,000
NATIONAL PPO DEDUCTIBLE
$12,000
$18,200
FAMILY
NORTHWELL DEDUCTIBLE
$1000
NATIONAL PPO DEDUCTIBLE
$12,000
$18,200
Your Gateway to the 2-Tier Plan
Easy Access Through Memberly
The Northwell Direct 2-Tier Health Plan is available to eligible employers through Memberly, the General Agent for the program. Memberly assists employers and brokers throughout the application and enrollment process and provides ongoing account support.
The plan combines Tier 1 access to directly contracted Northwell Health providers with a National Tier 2 PPO, giving members the flexibility to access healthcare both within the New York Tri-State area and nationwide.
Employers can take advantage of a pre-priced major medical health plan designed to combine competitive rates, enhanced Tier 1 benefits, and nationwide provider access.
Customized Northwell 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 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 Direct 2-Tier Plan is best suited for employers in the New York Tri-State area that want to leverage Northwell Health’s directly contracted provider network for cost savings and enhanced access to care. The plan combines Northwell Direct as Tier 1 with a National Tier 2 PPO for broader access outside the Northwell network. Memberly works with the stop-loss carrier, third-party administrator (TPA), network partners, and other service providers to structure and coordinate the plan for the employer. This approach allows employers to establish a customized self-funded health plan while leveraging Northwell’s direct contracts and a National Tier 2 PPO for nationwide access.
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 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 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
National Tier 2 PPO
Broad Nationwide Provider Access
The National Tier 2 PPO complements Northwell Direct by providing members with broad access to healthcare providers throughout the United States. When members are outside the Northwell service area—or simply choose to receive care outside Tier 1—they can access participating physicians, specialists, hospitals, and other healthcare facilities nationwide through the Tier 2 PPO network.
The two-tier structure combines the cost advantages of directly contracted Northwell providers with the flexibility and convenience of nationwide PPO access.
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.
Three Cost-Effective Memberly Model Plans
Memberly offers three cost-effective model plan designs that incorporate practical cost-control strategies to help make comprehensive health coverage more affordable for employers and accessible to more employees. The Ultra, 3K, and 6K Model Plans provide different deductible and benefit levels, allowing employers to select the right balance of cost, benefits, and access to quality healthcare for their workforce.
Getting Started with the 2-Tier Plan
Employers can get started through Memberly’s streamlined enrollment process. To evaluate available plan options and prepare a comparison, employers provide their most recent health plan invoice, renewal notice, Summary of Benefits and Coverage (SBC), and an employee census that includes date of birth, ZIP code, and coverage tier. Memberly will review the information and help identify the plan design that best meets the employer’s needs.
Recent Carrier Invoice
Renewal Notice
Employee Census
Plan SBCs
Establish a Standalone 2-Tier Plan: Employers Starting at 100 Employees
Employers starting at 100 employees can establish a standalone Northwell Direct 2-Tier Plan through Memberly, combining directly contracted Northwell Health providers for Tier 1 with broad nationwide access through a National Tier 2 PPO. Memberly works with the stop-loss carrier, TPA, network partners, and other service providers to structure and coordinate the plan based on the employer’s workforce, current benefits, and claims profile. To obtain a proposal, employers typically provide their most recent health plan invoice, renewal notice, Summary of Benefits and Coverage (SBC), employee census including date of birth, ZIP code and coverage tier, and current plan renewal date.
Recent Carrier Invoice
Renewal Notice
Employee Census
Plan SBCs
Common Questions
Learn More About 2-Tier Plans
General Information
The Northwell Direct 2-Tier Health Plan is a healthcare plan that provides two levels of in-network coverage:
- Tier 1: Local in-network providers within the Northwell Health network, offering the lowest out-of-pocket costs.
- Tier 2: A National Tier 2 PPO, giving members access to participating providers across the country, typically at a higher cost than Tier 1.
This structure provides flexibility in choosing healthcare providers while maximizing savings when members use Northwell's directly contracted network.
The National Tier 2 PPO includes participating healthcare facilities and specialists across the country. Members can access Tier 2 care when traveling or when specialized services are needed outside the Northwell network. Copays, deductibles, and coinsurance are typically higher in Tier 2 than in Tier 1.
The Northwell Direct 2-Tier Plan covers a wide range of medical services, including:
- Preventive care, such as screenings and vaccines
- Doctor visits
- Emergency care
- Hospital stays
- Surgical procedures
- Prescription medications
Coverage specifics may vary, so members should review the applicable plan documents for detailed benefits.
The plan provides access across three levels:
- Tier 1 - Northwell in-network providers: Lowest out-of-pocket costs with reduced copays, deductibles, and coinsurance.
- Tier 2 - National Tier 2 PPO: Covered at a higher cost than Tier 1 while remaining in-network.
- Out-of-network providers: Covered subject to the applicable plan terms, generally with the highest member cost sharing and lower reimbursement levels.
Members are encouraged to use Tier 1 or Tier 2 participating providers when possible.
The plan may be well suited for employers and members who:
- Want the cost advantages of using Northwell providers while maintaining nationwide provider access
- Need flexibility for travel, specialized care, or family members in different regions
- Prefer a tiered structure that combines lower-cost Tier 1 care with broader national access through Tier 2
Costs and Deductibles
Cross accumulators allow qualifying medical expenses from Tier 1, Tier 2, and out-of-network providers to count toward applicable annual deductibles and out-of-pocket maximums. This allows qualifying expenses across the tiers to contribute toward the plan's financial limits for the year.
- Tier 1: Lowest copays for covered services within the Northwell network
- Tier 2: Higher copays for covered services through the National Tier 2 PPO
- Out-of-network: Generally the highest member cost sharing, subject to the plan's reimbursement provisions
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 provider choice.
The out-of-pocket maximum is the most a member pays in a plan year for covered services that count toward the applicable maximum. Under the tiered structure, the applicable member cost sharing is lowest in Tier 1, higher in Tier 2, and highest for out-of-network services. Qualifying expenses accumulate according to the terms of the plan.
After meeting the applicable deductible, coinsurance is the percentage of the allowed cost a member pays for covered services:
- Tier 1: Lower coinsurance
- Tier 2: Higher coinsurance
- Out-of-network: Highest coinsurance and member responsibility, subject to the plan's reimbursement provisions
Enrollment Options
Yes. Eligible employees or members can enroll year-round if their group or organization allows rolling enrollment. This provides flexibility for onboarding new participants without waiting for a traditional open enrollment period.
Yes. If you join through the multi-employer plan, rates are locked in through December 31, 2025. This helps employers and employees maintain predictable costs for the remainder of the plan year.
Yes. Employers can establish a standalone version of the 2-Tier Plan tailored to their needs. Memberly works with the stop-loss carrier, TPA, network partners, and other service providers to structure and coordinate the plan for the employer.
- Multi-employer plan: Provides streamlined enrollment, pre-priced rates, and quicker onboarding.
- Standalone plan: Offers greater customization and control over plan features, contributions, eligibility, and plan structure.
Memberly can explain the available structures based on the employer's needs and eligibility.
Lower Rates & Cost Advantages
The 2-Tier Plan may be up to 40% less expensive than comparable traditional health plan options with similar deductibles and benefits. Savings are driven by direct provider contracting and the plan's tiered structure. Actual savings vary by employer, plan design, geography, and current coverage.
The plan leverages direct contracts with the Northwell Health System and affiliated providers, helping control medical costs while encouraging members to use cost-effective Tier 1 care.
The plan's direct-contracting structure and claims data can be considered by stop-loss carriers during underwriting. Stop-loss pricing and terms are determined by the applicable carrier based on the employer's risk profile, plan design, claims experience, and other underwriting factors.
By participating in the multi-employer plan, participating employers are part of a larger health plan structure. The larger membership base can help spread claim volatility and support more predictable plan costs over time.
Stop-loss coverage is incorporated into the applicable self-funded plan structure. Availability, terms, pricing, and underwriting are determined by the stop-loss carrier and governing plan arrangements.
