Medium & Large Business Health Plans

What’s New for 2025*

Reminder! Vitalize^℠
Introduced in 2024, Vitalize is a digital home base dedicated to engaging teams in health and wellbeing. Virgin Pulse will be transitioning to the Personify Health^TM name and brand over the coming months. Members will continue to use and engage with Virgin Pulse solutions throughout 2024. Our partnership with Virgin Pulse gives employees the tools to make small, everyday changes to their wellbeing that are focused on the areas they want to improve the most. They’ll build healthy habits, have fun with friends, and experience the lifelong rewards of better health and wellbeing. Vitalize is embedded in all Fully Insured plans and available as a buy-up for Self-Funded and Minimum Premium plans. Our suite of rewards programs is designed to provide your employees with helpful incentives for getting and staying healthy. Depending on the incentives you are looking to offer, we have several different reward options available to be purchased.
Foodsmart Nutritional Program
Foodsmart is a nutrition offering embedded in the Virgin Pulse platform, where members can take the “NutriQuiz” for personalized health insights, browse a comprehensive recipe library, set dietary preferences, and save recipe ingredients to an exportable grocery list.
Mom's Meals^®
In partnership with Mom's Meals, we're making nutritious home-delivered meals available to members after a hospital stay. The availability of healthy food options after discharge has been shown to lower the chances a member will be readmitted. To support recovery following an observation, inpatient acute or skilled nursing facility stay, members can receive up to two free home-delivered meals per day for 7 days. Mom’s Meals is available as a buy-up for all PPO plans.
Vision Plan Options
We're introducing two new vision plan options: Vision Platinum and Vision Platinum Plus. The Platinum plan will have a $0 copay and an increased allowance from $150 to $175. The Platinum Plus plan will offer all the benefits in the Platinum plan, plus coverage of safety glasses. All six vision plans include low-cost eye exams plus benefits for fully covered and low-cost corrective eyewear, in addition to other great discounts. Through a partnership with Davis Vision, members will have access to a large local and national network.
Eliminating Diabetic Insulin Copays
According to the American Diabetes Association, people with diabetes have medical expenses that are 2.6 times higher than people who do not have diabetes. To improve accessibility and affordability, we support the NYS mandate to eliminate the cost share – including the deductible – for diabetic insulin.
Cardiac and Pulmonary Rehab
We’re committed to lowering the total cost and other barriers to care for our members. Beginning in 2025, cardiac and pulmonary rehab health services will be covered in full (subject to deductible, when applicable) for Fully Insured plans.

* Subject to DFS approval.
Virgin Pulse is an independent company and offers a digital wellbeing service on behalf of Univera Healthcare.
Davis Vision is an independent company providing vision benefit management services and access to their network.
Mom’s Meals is an independent company that provides home delivered meals and nutritional services to Univera Healthcare members.

Medical Plans

With multiple plan types and options, we have coverage that’s right for every group and every member. Our network gives you access to more of the best doctors, specialists, and hospitals in your neighborhood and around the globe than any other. We’ve also negotiated great rates with these providers, which means everyone pays less for a higher quality of care.

Local 39-County Network: 100% of hospitals and 99% of doctors in our area accept our plans
National Network: In-network benefits with more than 1.4 million practitioners and 5,600 hospitals throughout the United States through the PHCS/Multiplan system

Also, we know that going to the doctor’s office isn’t always an option, so our plans allow employees to access care and support right from home through MDLIVE^® telemedicine, Vori Health, and the Wellframe^® app. Learn more about these convenient tools in Tools & Resources.

Medicare Solutions

We can also help you with Medicare Advantage, Part D, and Supplement Plans for retirees and employees working past age 65. View Group Medicare Options.

MDLIVE is an independent company, offering telehealth services in the Univera Healthcare service area.
Vori Health is an independent company that offers virtual musculoskeletal (back, neck and joint) health care and physical therapy services to Univera Healthcare members.
Wellframe is an independent company that provides a health and wellness support mobile app to Univera Healthcare members.

Member Health Management

When your team is healthier, your business runs more smoothly. That’s why our comprehensive approach to Member Health Management is essential. With our system of clinical programs, reminders, and education, we surround your employees with the help they need to stay on track with their health goals, live better, and work harder.

Whether someone on your team is dealing with a chronic or complex condition, or just needs a reminder to go to the doctor once in a while, you can feel confident knowing someone is looking out for them—at no additional cost^*.

Some highlights of our comprehensive roster of Member Health Management services include:

Utilization management
Care management
Disease management
Behavioral health management
Wellbeing and incentive programs

^*Included for Fully Insured. Buy-up for Self-Funded.

Tools & Resources

We’re dedicated to making health care more convenient for greater employee engagement. That’s why we offer free self-service support tools that make it easier than ever to get care.

Vitalize^SM: A digital home base for health and wellbeing. By partnering with Virgin Pulse, we help members make small everyday changes to their wellbeing that are focused on the areas they want to improve the most. Members will build healthy habits, have fun with friends, and experience the lifelong rewards of better health and wellbeing.
Online Member Accounts: From viewing their member card and benefits to viewing claims, tracking their deductible and out-of-pocket spending, and more, members have more visibility into their plan than ever before.
Telemedicine: For non-emergency conditions and emotional wellbeing needs, telemedicine gives members convenient access to medical and behavioral health care 24/7/365 from the comfort of their home. In-network telemedicine services provided by a member’s physician or our partner, MDLIVE^®, are covered in full (subject to deductible where applicable).
Wellframe^® App: Wellframe is a convenient way for members to receive confidential, text-based, one-on-one outreach from our care managers using a smartphone or tablet. Members can receive guidance, support, and tips to help achieve their health care goals and reduce costs.
24/7 Nurse Call Line: Members can contact a nurse by phone anytime—24 hours a day, seven days a week—with general health questions. If ongoing support is needed, members may be referred to a member care manager so they’ll have the support that best fits their needs.
Find a Doctor & Estimate Medical Costs Tool: Members are more in control of their care with the ability to quickly and easily find their most affordable local and national care options with our online tools.

Voluntary Benefits Services

When you integrate services like dental, administrative services and stop loss with medical benefits, Univera Healthcare can support employees with a more complete view of their health. Leading to more proactive support to help keep employees healthy and costs of care down.

Dental

Large Group Dental Packages (more than 50 eligible employees)

With Univera Dental Select, groups get comprehensive dental coverage with the flexibility of choosing from a variety of coinsurance, deductible, and annual maximum options. With an emphasis on preventive care, Univera Dental Select helps employees maintain their complete oral health, reducing the need for more costly dental care in the future.

With Univera Healthcare, members get:

One-stop shop for comprehensive medical and dental coverage
Flexible benefit options at competitive rates
Easy access to a broad network of providers
Rewarded for regular dental care through Dental Rewards, a program offering monetary incentives for getting dental exams and cleanings
100% employee-paid options available

Dental Annual Maximum Rollover: Regular dental visits can greatly reduce the occurrence of major oral health issues, saving money for both employers and employees. The Dental Annual Maximum Rollover incentivizes preventive care by rewarding employees with funds they can roll over to use as needed in the future.

Groups new to enrolling in our dental plan will be able to keep any accrued rollover account funds from another plan when they enroll in a dental plan that includes the annual maximum rollover benefit. We will match the funding members have with a competitor up to the Rollover Account Maximum.

Dental Preferred Packaging: To help make selecting the right plan easier, we’ve created four preferred package options. They are a great place to start for groups that are new to dental or need help navigating through some of our popular levels of coverage. The new packages vary, with coverage options that range from a focus on preventive care to more comprehensive coverage featuring orthodontia, and generous annual maximums.

Vision Plans

When you help employees take care of their eye health, they can enjoy a better quality of life, lower costs, and peace of mind in knowing they’re taking care of their whole health. That’s why group vision plans with low out-of-pocket costs are now available from Univera Healthcare.

All vision plans include:

Low-cost eye exams
Fully covered and low-cost on-trend frame options through the Exclusive Collection
Competitively priced plan options and multiple contribution options
Access to great discounts on lens add-ons, additional pairs of eyeglasses, LASIK services and other great extras*

Through our partner, Davis Vision, employees have access to a large network that includes 350 provider locations in the 8-county Western New York region and 152,000+ points of access nationwide, including independent eye care professionals, 4 of the top 5 eyewear retailers and online retailers.

*Not all providers participate in Davis Vision discounts, including the fixed lens option pricing. Members should contact their provider prior to scheduling an appointment to confirm if discount and fixed lens options are offered.

Davis Vision is an independent company providing vision benefit management services and access to their network.

Pharmacy Management

We oversee every aspect of pharmacy care on a member-by-member basis to keep costs low and keep businesses and their employees safe. Plus, we regularly connect with local physicians to stay current on new medications that can lower costs even further.

With integrated benefits from Univera Healthcare, you get the complete package:

One member card
Zero claims integration fees, hidden costs for utilization management, or reporting fees
Local, dedicated pharmacy, sales, and customer service team for more responsive service
Real-time formulary management to identify the most effective drugs at the lowest cost —based on real member data (not national statistics)
4-6% reduction in overall medical costs*

*Health Plan Data

Stop Loss Insurance

We’re in the business of protecting local businesses from catastrophic claims, We treat stop loss as an important part of our business, not a commodity. So you get the timely support and payments you need, when you need them most.

An Integrated Approach to Care: By rolling stop loss in with medical and pharmacy coverage, we can use real-time member data to help prevent catastrophic events. The result: pricing consistently below the industry’s average stop loss trend.
Reimbursements When They Matter Most: With wire transfer availability, we can make deposits directly into health plan accounts — with funds immediately available. We can also provide credit to claim billing for extraordinary, large reimbursements.
Administration Without the Frustration: One point of contact for billing and customer service. Direct access to underwriters. And one consolidated bill for ASO administrative fees and stop loss payments when you also have medical through us — with no need to verify enrollment between carriers.

Administrative Services

Health insurance administration is complicated. We can help connect you with workplace management solutions to help ensure regulatory compliance while improving efficiencies and bottom lines. Meaning your business can save more by focusing on other business priorities.

You can get administrative support for things like: