Tiered-Network Plans

Smarter, Not Smaller

Tiered-network plans are a smart option for employers who wish to lower health care costs without compromising choice or quality of care. Why? Because they empower employees to become active participants in health care decisions and reward provider efficiency.

How Tiered-Network Plans Guide Decision-Making to Lower Costs

At first glance tiered-network plans might seem complicated, but in reality, they’re quite simple. What’s better: they work.

With tiered-network plans, providers are grouped into “tiers” based on the value of care they provide, encompassing both cost and quality.

At Tufts Health Freedom Plan, providers that offer high quality care at the lowest cost are placed in Tier 1, the “preferred” tier. Members are then incentivized to visit providers in Tier 1 through reduced out-ofpocket costs—for example, a lower copayment.

In contrast to full-network plans, in which employees may make arbitrary decisions when it comes to choosing a provider, tiered-network plans naturally guide employees to the most efficient providers that offer the highest quality care. In this way, tiered networks support members in being active, informed decision makers, and employers benefit from cost savings thanks to the prioritization of efficiency and quality.

A Common Misconception

A common misconception regarding tiered-network plans is that they operate on a smaller, more restricted network.

In reality, tiered networks offer the same access to employees as a full network plan. The difference is that in a tiered network, employee deductibles and out-of-pocket costs reflect the true value of care. So, while employees are encouraged to visit providers that offer the highest quality care at the lowest cost, they retain access to all providers, and have the freedom to visit a provider outside of Tier 1 based on personal preference. So while costs may shrink, members’ choices are still preserved.

Making the Switch to a Tiered-Network Plan

In the face of steadily rising health care costs, tiered-network plans are a good solution for employers who want to save while maintaining access to the best possible care.

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