EverydayCARE®
Everyday 1to1® Protection
for your company and employees
Everyday 1to1® Platform
Your Company’s 24/7 Medical Director
- Virtual Primary Care (24/7/365)
- In-Office Primary & Urgent Care
- Pediatric Care
- Annual Adult Physical3 & Well Child
- Chiropractic (12 free visits per year)
- X-rays
$0 copay Virtual and In-Network Office Visitwith 48 Hour Pre-Authorization
$20 copay4 Out-of-Network Office Visitwith 48 Hour Pre-Authorization
$50 copay5 In-Network or Out-of-Network Visitwithout 48 Hour Pre-Authorization
$0 copay Labs RedirectHealth.com/labswith 48 Hour Pre-Authorization
$0 copay Mental Health Tele-Counselingwith 48 Hour Pre-Authorization
Rx & Immunizations RedirectHealth.com/RxFormulary
Copays may vary depending on pharmacy location, quantity, and dosage with 48 Hour Pre-Authorization$0 copay Virtual Specialist Curbside Consult6with 48 Hour Pre-Authorization
Specialist Consults
$50 member responsibility5with 48 Hour Pre-Authorization
Advanced Imaging
$50 member responsibility5
MRI, PET, CT scans, ultrasound, mammogram and other imaging
with 48 Hour Pre-AuthorizationHospital Care - Inpatient & Outpatient Procedures7
Individual – plan year
$2,000 initial member responsibility
20% co-share | $4,000 out-of-pocket max4
Family – plan year
$4,000 initial member responsibility
20% co-share | $6,000 out-of-pocket max4
Emergency Room
$500 initial member responsibility + 20% co-share
Everyday 1to1® CareLogistics™
- Get the healthcare you need without spending more than you should
- Appointment scheduling, Referrals, Navigation
- Negotiations, Alternative funding mgmt.
Cost of Services is 100% Member Responsibility
Excluded Services8
Pre-existing conditions, organ transplants, dialysis, skilled nursing, advanced psychiatric care, and specialty and non-formulary medications
Everyday 1to1® CareLogistics™
- Get the healthcare you need without spending more than you should
- Appointment scheduling, Referrals, Navigation
- Negotiations, Alternative funding mgmt.
Cost of Services is 100% Member Responsibility
- Additional chemotherapy
$30,000 sharing limit10 - Dialysis
$10,000 sharing limit10 - Skilled nursing
$5,000 sharing limit10 - Air ambulance
$5,000 sharing limit10 - Pre-existing exclusions apply
12 month look back
MultiplanPractitioner Only Network9
(or add a doctor 48 Hours prior to visit)1 The EverydayCARE program is an Employer self-insured health plan managed by Redirect Health exclusively for members of the Modern Business Council. The captive risk pool is managed by Newpath Mutual Insurance Company (see Summary Plan Description for details). The Medical Cost Share risk pool is managed by Newpath Medical Inc., a Wyoming Health Sharing Ministry organized pursuant to Wyo. Stat. Ann. 26-1-104 (see Membership Guidelines for details). 2 Special enrollment requirements apply in order to qualify for Specific Deductible Waivers. Medical Questionnaires will be required. 3 Routine physical exam; gynecological exam; screening mammogram; PAP smear; prostate testing (PSA); routine lab and immunizations; and all other ACA required Preventive Screening with pre-authorization 4 Eligible benefits subject to initial member responsibility count toward max out-of-pocket. Excludes prescription drug benefits, excluded pre-existing conditions, and subject to program sub-limits. 5 Maximum allowable charge is 140% of Medicare allowable or as negotiated by Redirect Health but not to exceed UCR. 6 A Redirect Health medical professional will interact with specialists on the member’s behalf. 7 Pre-authorization REQUIRED for ALL NON-EMERGENCY care or no benefit will apply. 8 See Membership Guidelines and Summary Plan Description. 9 Any doctor who accepts the Redirect Health Usual, Customary and Reasonable (UCR) Agreement can be in-network. 10 Maximum sharing after Initial Member Responsibility
Everyday 1to1® Platform
Makes any Health Plan Work Better*
Affordable access to basic healthcare for every employee and their entire family. Prevention of chronic and expensive disease starts with children
Your Company’s 24/7 Medical Director
- Medical Professionals ON STAFF with licenses in all 50 states
- Complete Electronic Medical Records always at their fingertips
- 24/7 Virtual Primary Care & Virtual Urgent Care
- Virtual Specialist and Emergency Room curbside consults and opinions
- Enhanced Population Health & Prioritized Proactive Outreach
- CareLogistics™ + Care Navigation
- Work Injury Management and E-MOD Protection
- Referral Management
- Rx Management (Insurance vs. Cash)
- Physician-to-Physician Case Management
- Hospital Discharge and Follow-up Management
- Alternative Funding Management for Plan Exclusions and Limitations. Access to Impact Together™ and foundation funds
- Integrated Data Management and Decision Support (Unique combination of Clinical Data, Cost Data, Claims Data and Employer Data)
- Wellness Program with Critical illness, Accident and Hospital coverage can be added and managed for net $0 cost**
Flexible Enrollment
Enroll any date. Not tied to your health plan’s renewal or enrollment dates
When your Company’s Everyday 1to1® Platform is in place you’ll always have the foundational protection you need to give you more options and control at renewal time
*Traditional fully-insured, Traditional self-insured, Level-funded self-insured, Medical Sharing Programs, and others **Using a qualified ACA Wellness Program will result in FICA tax savings that are greater than the cost of the Everyday 1to1® Platform
What you can expect
Virtual-First Primary Care—CareLogistics™ that works for everyone
Always Use the Redirect Health Member App FIRST
Always contact us FIRST through the Member App (available 24/7) so we can schedule the quality healthcare you need quickly with the lowest out-of-pocket costs. Always the right care at the right price.
Referral & Care Navigation
Personalized expert concierge navigation through the healthcare system.
Cost Protection
Healthcare can be expensive and difficult to understand. No surprises. Special prescription discounts for members.
CareLogistics™
We do all the work, schedule and fast track appointments, prescription refills, and more.
Physician-to-Physician Case Management
Coordination with your other physicians. Ensure you get the quality and care you need.
Start with the Redirect Health Member App
- If you have a medical need simply use the Member App
- Available to answer any questions 24/7/365 in English and Spanish
- Our Care Team is made up of healthcare experts and medical providers
We Navigate and Coordinate Your Care
- We’ll help you determine what kind of care is needed – virtual, in-person, urgent, or emergency care
- Connect to a virtual medical provider at a convenient time for you
- We’ll assist with next steps, like scheduling or filling prescriptions so you don’t waste time or money
Follow-Up that Matters
- Follow-up after your visit to make sure your care plan is staying on track
- Ever have a question? The Care Team is available 24/7/365
How the Plan Works
Plan Compliance
Your company plan is set up to comply with ERISA and the Affordable Care Act (Penalty A). We also coordinate required 5500, PCORI & 1094/1095.
Plan Management
Redirect Health manages your plan with the extra care your employees need - Appointment Preparation, 24/7 concierge access, coordination, navigation and pre-negotiation.
Predictive Healthcare
Even before your plan’s effective date Redirect Health starts learning about your employees’ healthcare needs and the obstacles that may get in their way. Proactive, predictive and smart healthcare.
How You and Your Employees Access Healthcare
Contact us FIRST
Always contact Redirect Health FIRST to initiate any medical need 24/7/365 - the Member App is the best way.
Choose a doctor
A medical provider will be recommended or your employee can choose their own from a large network. Employees can even add a doctor to the network. Ask us how.
Physician-to-Physician case management
A Redirect Health clinician coordinates with your employee’s doctor to facilitate care and prevent unnecessary missed work and spending. Streamlined coordination, navigation & pre-negotiation is our goal.
Advocacy
Redirect Health will arrange and coordinate qualifying financial assistance programs, manage alternative funding options, and pre-negotiate costs of services.
Claims payment
Redirect Health assembles and reviews claims and submits them to the Plan Administrator for payment.*
How Pre-Existing Conditions are Shared
(EverydayCARE Hospital & Hospital PLUS Only)A condition is considered pre-existing for a member or dependent if symptoms or treatment have occurred within the 12 months prior to joining the Medical Cost Share. See the Membership Guidelines for detailed description of what will be considered a pre-existing condition. Controlled diabetes, hypertension, high cholesterol, seasonal allergies and intermittent asthma will not be considered pre-existing when reported prior to membership effective date.
Conditions beginning after a member’s effective date will be shared after paying a $2,000 initial member responsibility then 20% with a maximum out-of-pocket of $4,000^ per year. See the Membership Guidelines for sharing rules.
Pre-existing conditions become eligible for sharing based on members’ tenure with the plan, as indicated by the following graduated sharing schedule:
*Specialist, advanced imaging, and hospital claims must be pre-authorized and coordinated by Redirect Health to be eligible for payment. ^Subject to program sub-limits. Prescription drug benefits are not included in out-of-pocket max calculation.
EverydayCARE® Plan Pricing – Effective 10/1/26
Prices shown above include 6% broker commission
1Special Requirements to Qualify for Specific Deductible Waivers and Base Rates for Hospital Plans:
1. Minimum Employer Contribution Options:
a. 100% of the employee only EverydayCARE® Routine Care amount if all eligible employees are auto-enrolled in EverydayCARE® Routine Care (employee only tier). Any employee may buy up to another plan or opt out.
b. 50% of the employee only EverydayCARE® Hospital plan amount if all eligible employees are NOT auto-enrolled in EverydayCARE® (employee only tier). Any employee may buy up to another plan or opt out.
2. Minimum Eligible Employee Participation Options:
a. 50% of total eligible employees
b. 25-49% enrollment – Base Rates above will be increased by 20%. Carrier reserves the right to add this 20% Low Participation Risk Premium mid-year should participation drop below 50%.
3. Employer, as the Plan Sponsor and Plan Administrator agrees to adopt certain limitations and exclusions, pre-authorization requirements, and maximum allowable charges of 140% of Medicare rates (or as negotiated by the TPA*, but not to exceed Usual, Customary and Reasonable), in their self-insured Plan Documents.
4. Individual Medical Questionnaires required for groups with less than 20 eligible employees.
Enrollment Date Requirements:
a. Enrollment needs to be complete by the first business day on or after the 14th of the month prior to the Effective Date;
b. If Enrollment is not completed by the first business day on or after the 14th of the month prior to the Effective Date, Individual Medical Questionnaires are required to be submitted to Redirect Health by the 20th of the month for any employees wishing to participate in an EverydayCARE® Hospital plan;
c. If Enrollment is not complete by the 20th or Individual Medical Questionnaires not submitted by the 20th, the Effective Date will be delayed until the following month.
*Redirect Health is the Program Manager and Redirect Health Administrator is the Plan TPA.