OffPlan as the Primary Care Layer
Standards OffPlan requires of advisor-selected partners:
TPA criteria:
- Administrative-first scope: claims and stop-loss coordination only, no care delivery ambitions.
- Transparent fee structure: flat PEPM strongly preferred, with no hidden spread or rebate retention on the care layer.
- Stop-loss carrier flexibility: not captive to a single carrier.
- Data transparency: claims reporting, utilization data, and eligibility file access.
- Hospital admission and high-cost claimant notification capability.
- No competition with OffPlan for the employer relationship or clinical function.
PBM criteria:
- Pass-through pricing model: no spread between plan cost and pharmacy cost.
- Full rebate pass-through to the plan.
- Formulary transparency.
If your partners meet this bar, we will evaluate fit and structure the engagement accordingly. OffPlan does not require you to replace vendors that are performing. We require that whatever sits alongside OffPlan meets the same transparency and alignment standards we hold our own program to.
Best for: Advisors working with larger or more complex employer groups where existing vendor relationships need to be preserved. This path requires a longer design conversation and is evaluated case by case.