OffPlan vs. Traditional Plans

You are paying for insurance on everything. Here is what that actually costs you — and what changes when you stop.

Dive Deeper

Comparison

Traditional Plan

Your carrier underprices year one to win the business, then hits you with 10–25% renewal increases. You negotiate. Move a deductible. Maybe shop carriers. The result is roughly the same: more money for the same coverage. The cycle never breaks because the structure never changes.

With OffPlan

80% of your spend is removed from the renewal cycle entirely.

OffPlan's care layer is a flat-rate services contract. It does not increase with carrier trend. Only the catastrophic layer is exposed to annual increases, and that layer improves every year because your claims data keeps getting better. The result: your total trend exposure is a fraction of what it was.

Traditional Plan

You pay a bundled number. You never see what a claim actually costs, what is carrier admin, and what is carrier profit. Every layer — the TPA, the PBM, the hospital system — earns spread on complexity. Nobody in the chain has a financial incentive to lower your costs.

With OffPlan

Every component is visible and priced independently.

Flat-rate care layer. Cash-pay specialist rates at 50–80% below insurance. Transparent pharmacy at direct cost. Stop-loss quoted separately. You see what every dollar buys.

Traditional Plan

$35–$60 copays. 15-minute visits. A doctor managing 2,500 patients who is reading your chart for the first time. 3-week wait for an appointment. Every visit generates a claim with admin overhead. This is the care your employees use most — and it is the worst experience in the system.

With OffPlan

$0 copay. 45-minute visits. Same-day access. 24/7 availability.

Physician-owned practices with 500–600 patient panels. Your doctor knows your name, your history, your family. No claim filed. No prior authorization. No insurance involvement at all.

Traditional Plan

Routed through PPO at 250–350% of Medicare. A knee MRI that Medicare reimburses at $442 costs your plan $1,200–$3,000. Facility fees added. Surprise bills possible. Every referral generates a claim with deductible and coinsurance exposure for the employee.

With OffPlan

Curated cash-pay providers at pre-negotiated transparent rates.

MRI: $350. Ortho visit: $150. Colonoscopy: under $1,500 vs. $4,000+. No facility fees. No surprise bills. Paid with employer-funded benefit card. No claim filed. $0 to the employee.

Traditional Plan

An ER visit costs $3,000–$8,000. A minor surgery runs $10,000–$20,000. These fall below your stop-loss attachment point, so the plan pays in full through the claims system. Every one of those dollars counts against your renewal. There is no middle layer to absorb the hit.

With OffPlan

Hospital indemnity + accident insurance bridges the gap.

Fixed cash payouts for ER visits, hospital admissions, and accident-related care. Available as a voluntary benefit. HSA-compatible. Employees get cash to cover the out-of-pocket costs that fall between Tier 2 and your stop-loss attachment point.

Traditional Plan

Your PBM pockets the spread between what your plan pays and what the pharmacy receives. They steer to expensive drugs. Rebate revenue flows to them, not your plan. The formulary is designed around their margins, not your members' health. You never see the actual numbers.

With OffPlan

NADAC-based pricing. 100% rebate pass-through. No spread.

Generic medications dispensed in-office by your OffPlan physician at direct cost. Brand and specialty drugs sourced through transparent channels. You see what every prescription actually costs.

Traditional Plan

Your carrier's nurse line is a call center. Nobody there knows your employees. Nobody is proactively managing chronic conditions, steering referrals to lower-cost providers, or preventing the ER visit that could have been a same-day office visit.

With OffPlan

Your OffPlan physician is the care navigator.

They know each patient. They coordinate every specialist referral, route imaging to curated providers, manage chronic conditions proactively, and handle urgent needs same-day before they become ER visits.

Traditional Plan

Carriers profit from a percentage of premium. Higher healthcare costs = higher premiums = higher carrier revenue. The carrier has no structural incentive to lower your costs. That is not a conspiracy. It is their business model.

With OffPlan

OffPlan earns a flat rate. When your costs go down, your costs go down.

We do not earn more when claims go up. We do not profit from complexity. Physicians are incentivized by outcomes, not visit volume.

Traditional Plan

You get a renewal summary once a year. Maybe a claims report with aggregate data. No risk stratification. No predictive analytics. No visibility into which conditions are driving cost until after the claims hit. You are always reacting.

With OffPlan

Population health analytics, risk stratification, and claims avoidance tracking.

OffPlan surfaces which employees are trending toward high-cost events and intervenes before they get there. The data feeds directly into stop-loss evidence packages that earn better renewal pricing. A dedicated account manager runs quarterly business reviews with your team.

Summary

Side-by-side

Dimension	Traditional Plan	OffPlan
Can you see your costs?	No. Bundled premium with hidden margins.	Yes. Every component priced independently.
$0 claims for primary care?	$35–$60 copay. Claim filed every visit.	$0. No claim. No copay. No deductible.
Cost transparency	Carrier decides. You see the bill.	Every dollar visible. Cash-pay rates published.
Employer control	Carrier controls plan design.	Employer selects TPA, stop-loss, pharmacy independently.
Pharmacy	PBM spread + hidden rebates.	NADAC pricing. 100% rebate pass-through.
Primary care	$35–$60 copay. 12-min visits. 2,500 patients.	$0. 45-min visits. 500–600 patients. Same-day.
Specialist pricing	250–350% of Medicare through PPO.	Cash-pay at 120–150% of Medicare. $0 to employee.
Gap protection	No middle layer. ER and minor surgery hit the plan in full.	Hospital indemnity + accident insurance. HSA-compatible. Voluntary.
Care navigation	Carrier call center. Nobody knows you.	Your physician coordinates everything.
Employer analytics	Annual renewal summary. Aggregate claims data.	Population health dashboard. Risk stratification. Claims avoidance tracking.
Risk identification	Reactive. You find out after the claim hits.	Predictive. Platform surfaces rising-risk members before they become high-cost.
Account management	800 number. Carrier service rep.	Named account manager. Quarterly business reviews. Advisor coordination.
Stop-loss positioning	Carrier submits standard renewal data.	OffPlan compiles actuarial evidence package proving improved risk profile.
Carrier incentive	Profit tied to premium volume. Costs up = revenue up.	Flat rate. No profit from claims volume. Physicians incentivized by outcomes, not visits.

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