Colleges, universities, and secondary schools are eligible to participate in edHEALTH. Our service area covers the United States from coast to coast.

edHEALTH’s coalition of member educational institutions provides purchasing clout that helps drive down healthcare costs. By coming together, edHEALTH member-owners realize lower costs than fully insured plans or go-it-alone self-insured options:

• Larger group = better pricing and less volatility
• Low-negotiated third-party administrator (TPA) fees
• Transparent advisor payments
• No payments of profits to TPAs on top of claims (unlike fully insured plans)
• Reduced Affordable Care Act (ACA) taxes

Healthcare costs put a significant strain on college, university, private and charter school budgets, which drives up tuition costs. Our member-owned collaborative approach gives your school, its faculty and staff access to affordable, quality healthcare. Through edHEALTH, your educational institution will play a proactive role in your institution’s healthcare, gain control over plan design, and receive valuable data insights into your trends and cost drivers.

Our member-centric approach to rising healthcare costs provides ownership, transparency, innovation, and valuable saving benefits.

• Savings – Through our purchasing clout, we consistently negotiate lower administrative fees and enjoy less healthcare cost volatility than schools can realize on their own. Our pharmacy carve-out has saved member institutions approximately $80M between 2017 and 2023. Person-centric clinical health initiatives help us improve the quality of care and reduce costs for the employees and family members who need it most. Our results show that our innovative approach is working. The ten-year average health insurance premium equivalent increase is 3.7%, well below the industry average of 7.9%. Employee satisfaction, high quality of care, and valuable savings you can pass along to students and families are all benefits of being a member-owner of edHEALTH.
• Ownership – edHEALTH is a member-owned consortium run by and for its educational institutions. As a member, you share in the savings generated by the group. To date, edHEALTH has awarded dividends of $6.7 million. Member-owners control and have a meaningful say in the decision-making process, along with direct access to plan administrators. edHEALTH provides multiple forums for member-owners to share and learn from one another. Collaboration is a key benefit of belonging to edHEALTH.
• Transparency – Health insurance works when employers have the data they need to make informed decisions. edHEALTH’s transparent approach means member educational institutions are apprised of all rate components. And our collaborative approach enables colleges and universities to compare cost, utilization, trends, and best practices with other member schools.
• Innovation – edHEALTH is the innovative healthcare solution for higher education institutions and secondary schools, along with their faculty, staff, and family members. Our self-insured healthcare offerings are tailored to meet the needs of our members. Through data analysis, advanced, person-centric programs, and decision support, we help educational institutions select programs that meet their needs while containing rising healthcare costs

Schools find minimal disruption to coverage, healthcare provider access, and plan design. Our hands-on approach allows new members to experience a seamless transition with little or no coverage or provider disruption. edHEALTH has an active Plan Design Committee made up of representatives from each member institution and their advisors who work with the third-party administrators (TPAs) to determine plan designs customized to meet the needs of edHEALTH members.

Representatives from each member institution (typically the benefits administrators) meet monthly to determine plan design options for the upcoming plan year. The Plan Design Committee’s collaboration with the third-party administrators (TPAs) helps to ensure the optimal suite of choices. edHEALTH works with new member institutions and their advisor to tailor plan designs as needed.

Yes. edHEALTH customizes its medical and pharmacy programs to meet the needs of religious institutions.

edHEALTH is available throughout the United States.

edHEALTH has both a regional and national healthcare TPA. We also use a prescription drug carve-out administrator.

edHEALTH has a partnership with a national third-party administrator that has access to over 65 different networks across the country. We use a customized approach to determine which network best meets the needs of a new member institution. We evaluate how the network and types of care align with the institution’s utilization patterns, and for financial value.

Yes. Most of our member schools work with an advisor, and we are happy to work with the advisor a school chooses. With a self-insured health plan, the broker becomes an advisor. The school pays the advisor on a fee-for-service basis instead of a commission that is built into the health insurance carrier’s rates. This arrangement improves pricing transparency as the school pays the advisor directly for their advice and representation.

No. Member schools report that the amount of work doesn’t change, but the nature of the work does. edHEALTH takes over many of the administrative and troubleshooting tasks. The member school HR departments’ role evolves as their staff take a more active role in plan design, new edHEALTH program initiatives, and wellness opportunities. Additionally, the HR staff will now have the opportunity to network and collaborate with other member schools to learn more about healthcare trends, HR best practices, and health insurance costs. Your HR team decides their level of involvement and how proactive a role they wish to take. edHEALTH member institution HR employees report high satisfaction with the collaboration and becoming a more valuable employee resource.

Yes, edHEALTH offers a person-centric clinical intervention program that improves care and reduces costs for employees and family members dealing with complex medical conditions. This program focuses on the top 5% of our members’ population, which comprises over 53% of claim costs. Clinical staff provide 24/7 care for high-risk, high-cost employees and covered dependents that improves quality and employee satisfaction. Periodic reports on the edHEALTH population risk and the Program’s return on investment gives members insight into their population to help inform decisions. Additionally, our third-party administrators offer an array of care management program options.

Here’s what to know about obtaining a working rate.

edHEALTH charges prospective members a nominal non-refundable working rate quote fee. This amount is applied to your capital contribution upon joining. The fee represents the actuarial cost to calculate the working rate, including a breakdown of all expected costs for the plan year.

Additionally, below highlights the steps taken to receive a working rate based on a January 1 effective date. Educational institutions may join edHEALTH at any time, in which case the actual dates below will change.

Once a school joins edHEALTH, we provide a more detailed timeline and work with its staff and advisor every step of the way.

While it varies by state, the minimum number that a school should have to receive a working rate quote is between 100 and 150 benefit-eligible employees.

As edHEALTH welcomes a new school, we work closely with its Finance and Human Resources staff and the school’s advisor to ensure a smooth onboarding for faculty and staff alike.

The following chart provides key onboarding dates based on a January 1 effective date. Educational institutions may join edHEALTH at any time, in which case the actual dates below will change.

Once a school joins edHEALTH, we provide a more detailed timeline and work with its staff and advisor every step of the way.

Call edHEALTH Vice President Nancy McConaghy at 1.866.692.7473 ext. 702 or send her an email.