Elevating
Care.
Reducing
Cost.
A comprehensive proposal for G.M. Casting House, Inc.
Executive Summary
For years, G.M. Casting House, Inc. has provided employees with generous benefits through a traditional, fully-insured/level-funded plan with BlueCross BlueShield of Illinois. However, this model has led to a familiar cycle: significant premium growth that outpaces your actual claims experience. Health365+ offers a fundamentally better model that provides immediate savings while controlling long-term costs, paving the way for lower stop-loss renewals and significant long-term value.
A Journey Reimagined
Health365+ is built on a different idea: real support should feel personal, accessible, and proactive. We're on a mission to transform health coverage from a frustrating maze into an experience that is guided, transparent, and genuinely helpful for everyone.
Our Philosophy: A Fundamentally Better Approach
A True Concierge Experience
We provide a dedicated, human-first point of contact for every member, moving beyond call centers to build real relationships and provide expert guidance.
Improving Health to Reduce Costs
Our model is designed to address the root cause of claims. By proactively engaging members to manage and improve their health, we deliver better outcomes and generate sustainable, long-term savings for your plan.
Human-Centric Technology
We leverage powerful, integrated digital tools not to replace human interaction, but to enhance it. Our apps and platforms free our care teams to focus on what matters most: your people.
Our Integrated Care Model
This is how we deliver better care and lower costs. Our model isn't a set of disconnected services; it's one intelligent system that connects technology, data, and human expertise to proactively guide members at every turn.
1. Intelligent Pre-Certification
Our pre-authorization service, powered by an advanced AI engine and reviewed by clinicians, dramatically accelerates approvals. This eliminates frustrating delays and creates critical early data for our care team.
2. Proactive Clinical Outreach
The moment a procedure is approved, that data triggers an immediate outreach from the member’s dedicated health coach. They don’t wait for a call; they reach out proactively to begin coordinating care and support.
3. High-Value Care Guidance
Our health coaches use our proprietary care guidance platform to direct members to the best in-network providers, schedule appointments, and arrange follow-up care. This ensures a better experience, improved outcomes, and lower costs for the plan.
By converting routine processes into trigger points for outreach and guidance, we ensure better care, a better member experience, and lower costs.
The Coordinated Care Difference
In traditional healthcare, members are often left alone to navigate a web of disconnected providers, labs, and pharmacies. We solve this problem by acting as the single, reliable hub for all of a member's health needs.
Typical Member Journey
Fragmented, confusing, and stressful.
Member feels unwell and is unsure where to go.
Searches for an in-network provider, calling multiple offices to find and schedule an appointment.
Must coordinate between the primary care doctor, specialists, labs, and pharmacies on their own.
Spends hours on hold with the insurance carrier to understand bills and coverage issues.
Health365+ Coordinated Journey
Unified, proactive, and simple.
Member contacts their dedicated Health365+ Care Team (one call, 24/7 support).
Care Team promptly finds the right in-network provider and schedules the appointment.
Care Team handles pre-authorizations, specialist referrals, and prescription coordination behind the scenes.
Member has one point of contact for all questions. The process is simple and stress-free, with a knowledgeable advocate guiding them at every step.
Core Plan Services
The integrated care journey is powered by several core services that provide comprehensive support across all aspects of health.
Virtual Direct Primary Care (DPC)
The digital front door to our system. For a $0 copay, members get unlimited, on-demand access to a dedicated primary care team for acute issues, chronic condition management, wellness visits, and prescription renewals.
Proactive Chronic & Whole-Health Management
Using data from across the healthcare ecosystem, we identify at-risk members and engage them with a personal health coach, and a free remote monitoring device (as needed). This program is proven to save over $2,000 per engaged member per year by preventing complications and improving health behaviors.
Conflict-Free Pharmacy Model
We fundamentally redesign pharmacy benefits to eliminate conflicts of interest. For high-cost specialty medications, our TPA works with members to leverage Manufacturer and Patient Assistance Programs. This strategy generates an average savings of 35% on your total pharmacy spend. Any claim fund dollars remaining at year-end are returned to you.
The Health365+ Digital Hub
We empower members and administrators with a unified, intuitive technology platform that simplifies benefits and enhances the human-powered support our care teams provide.
Your Central Hub for Digital Support
Our platform provides a single point of access for all plan-related information and tools, eliminating the confusion of multiple logins and disconnected systems. It's the central hub for a member's entire health journey.
"We believe technology should simplify the healthcare journey, not complicate it. Our platform provides the clarity for transparent decisions while always keeping the member at the heart of a human-centric experience."— Joshua Parise, Chief Innovation Officer
A Better Benefits Experience
We believe that a health plan is only as good as an employee's ability to understand and use it. We lift the burden of benefits education from your HR team by providing direct, expert support to your employees.
Guided Enrollment with Licensed Coaches
During open enrollment, Health365+ provides your employees with direct access to salaried, licensed benefit coaches to walk them through their options and complete enrollment.
“BenefitBites” On-Demand Education
We make complex benefits simple with our library of short, interactive micro-learning courses sent directly to employees to teach them how to use their health plan effectively.
Voices of Our Members
Here’s what employees have to say about their experience with the Health365+ model.
"With my old plan, I felt like just a number… The first time I called Health365+, I spoke to a real person who knew my name and solved my issue in minutes. The difference is night and day."
"Managing my diabetes used to be a constant struggle. With Health365+, they sent me a free glucometer that syncs with their app, and my health coach checks in regularly. I feel more in control of my health than ever before."
"I was so stressed when my daughter got sick, but our Health Coach was incredible. She helped us find a top-rated pediatrician in our network and even scheduled the appointment for us. It was a huge weight off my shoulders."
Strategic Direct Comparison
To provide the clearest possible financial picture, we have analyzed each of your current plans separately. This approach allows you to see the precise financial and benefit trade-offs for each employee population.
Comparison for BCBSIL MIBCO2015 Enrollees (Current Plan is Platinum PPO)
| Benefit | Current: MIBCO2015 | Strategy 1: Better Alt. (Plat H102) | Strategy 2: Max Savings (Bronze H405 + GAP) |
|---|---|---|---|
| Deductible (Indv/Fam) | $750 / $2,250 | $0 / $0 | $8,000 / $16,000 (Member pays $0 after GAP) |
| OOP Max (Indv/Fam) | $750 / $2,250 | $1,250 / $2,500 | $8,700 / $17,400 (Max exposure $700/$1,400 after GAP) |
| PCP / Specialist Copay | $25 / $50 | $25 / $45 | $50 / $120 |
Comparison for BCBSIL MIESA2122 Enrollees (Current Plan is Gold HSA)
| Benefit | Current: MIESA2122 | Strategy 1: Comparable (Silver H303) | Strategy 2: Max Savings (Bronze H404 + GAP) |
|---|---|---|---|
| Deductible (Indv/Fam) | $2,500 / $5,000 | $3,300 / $6,600 | $6,000 / $12,000 (Member pays first $1.65k/$3.3k) |
| OOP Max (Indv/Fam) | $2,500 / $5,000 | $6,400 / $12,800 | $6,000 / $12,000 (Max exposure $1.65k/$3.3k) |
Comparison for BCBSIL MIBPP2000 Enrollees (Current Plan is Platinum PPO)
| Benefit | Current: MIBPP2000 | Strategy 1: Comparable (Plat H102) | Strategy 2: Max Savings (Bronze H405 + GAP) |
|---|---|---|---|
| Deductible (Indv/Fam) | $0 / $0 | $0 / $0 | $8,000 / $16,000 (Member pays $0 after GAP) |
| OOP Max (Indv/Fam) | $1,000 / $3,000 | $1,250 / $2,500 | $8,700 / $17,400 (Max exposure $700/$1,400 after GAP) |
| PCP / Specialist Copay | $20 / $40 | $25 / $45 | $50 / $120 |
Comparison for BCBSIL MIEEA2020 Enrollees (Current Plan is Gold HSA)
| Benefit | Current: MIEEA2020 | Strategy 1: Comparable (Gold H201) | Strategy 2: Max Savings (Bronze H404 + GAP) |
|---|---|---|---|
| Deductible (Indv/Fam) | $2,500 / $5,000 | $3,300 / $6,600 | $6,000 / $12,000 (Member pays first $1.65k/$3.3k) |
| OOP Max (Indv/Fam) | $5,000 / $7,350 | $3,300 / $6,600 | $6,000 / $12,000 (Max exposure $1.65k/$3.3k) |
Detailed Rate Comparison & Savings
The following tables provide a granular look at the costs and savings for each employee group, comparing the renewal against the proposed strategic alternatives.
Analysis for MIBCO2015 Enrollees
| Coverage Tier | # of EEs | Renewal Rate | Strategy 1 Rate | Strategy 2 Rate |
|---|---|---|---|---|
| Single | 3 | $1,012.74 | $838.74 | $724.63 |
| Total Monthly Cost | $3,038.22 | $2,516.22 | $2,173.89 | |
| Total Annual Cost | $36,458.64 | $30,194.64 | $26,086.68 | |
| % Change vs. Renewal | -17.2% | -28.4% |
Analysis for MIESA2122 Enrollees
| Coverage Tier | # of EEs | Renewal Rate | Strategy 1 Rate | Strategy 2 Rate |
|---|---|---|---|---|
| Single | 9 | $738.42 | $724.19 | $722.35 |
| Employee + Spouse | 1 | $1,428.60 | $1,375.02 | $1,256.05 |
| Family | 2 | $2,208.23 | $1,815.89 | $1,640.86 |
| Total Monthly Cost | $12,490.84 | $12,142.81 | $11,039.80 | |
| Total Annual Cost | $149,890.08 | $145,713.72 | $132,477.60 | |
| % Change vs. Renewal | -2.8% | -11.6% |
Analysis for MIBPP2000 Enrollees
| Coverage Tier | # of EEs | Renewal Rate | Strategy 1 Rate | Strategy 2 Rate |
|---|---|---|---|---|
| Single | 6 | $1,135.28 | $838.74 | $724.63 |
| Employee + Child(ren) | 2 | $2,333.93 | $1,551.81 | $1,194.25 |
| Total Monthly Cost | $11,479.54 | $8,136.06 | $6,736.28 | |
| Total Annual Cost | $137,754.48 | $97,632.72 | $80,835.36 | |
| % Change vs. Renewal | -29.1% | -41.3% |
Analysis for MIEEA2020 Enrollees
| Coverage Tier | # of EEs | Renewal Rate | Strategy 1 Rate | Strategy 2 Rate |
|---|---|---|---|---|
| Single | 3 | $948.88 | $770.59 | $722.35 |
| Employee + Spouse | 2 | $1,835.77 | $1,508.21 | $1,256.05 |
| Family | 2 | $2,837.61 | $2,007.87 | $1,640.86 |
| Total Monthly Cost | $12,193.40 | $10,480.01 | $9,861.87 | |
| Total Annual Cost | $146,320.80 | $125,760.12 | $118,342.44 | |
| % Change vs. Renewal | -14.0% | -19.1% |
Overall Group Savings Summary
| Strategy | Total Renewal Annual Cost | Proposed Annual Cost | Total Annual Savings | Overall % Savings |
|---|---|---|---|---|
| "Comparable Match" Strategy | $470,424.00 | $399,291.20 | $71,132.80 | -15.1% |
| "Max Savings" GAP Strategy | $470,424.00 | $393,466.80 | $76,957.20 | -16.4% |
A 5-Year Financial Outlook
The projection below provides a transparent, year-by-year outlook on the total financial value of partnering with Health365+. Our model assumes a standard 10% annual trend for your current plan’s fixed premiums, compared to a managed trend of 2.5% for the Health365+ plan. Consistently lowering the claims baseline through proactive management is the key to long-term cost control.
| Year | Trended Current Cost | Trended H365+ Cost | Annual Premium Savings | Projected Program Savings | Total Annual Value |
|---|---|---|---|---|---|
| 1 | $470,424 | $393,467 | $76,957 | $100,800 | $177,757 |
| 2 | $517,466 | $403,303 | $114,163 | $103,320 | $217,483 |
| 3 | $569,213 | $413,386 | $155,827 | $105,903 | $261,730 |
| 4 | $626,134 | $423,721 | $202,414 | $108,551 | $310,965 |
| 5 | $688,748 | $434,314 | $254,434 | $111,264 | $365,698 |
| Total | $803,795 | $529,838 | $1,333,633 |
A Stronger, Smarter Network
A significant advantage of the Health365+ model is the move away from the restrictive networks associated with your current BCBSIL plans, like the confusing Blue Choice Options tiered network and the limited Blue Choice PPO. Health365+ simplifies this by providing a single, broad, national PPO network, wrapped with the PHCS network to ensure all major local hospital systems are in-network, giving your team superior access and peace of mind.
Local Hospital System Access Comparison
| Hospital System | Found in Current BCBSIL Network? | Found in Proposed Health365+ Network? |
|---|---|---|
| Northwestern Medicine | Yes | ✓ Yes |
| Rush University System for Health | Yes | ✓ Yes |
| University of Chicago Medicine | Yes | ✓ Yes |
| Advocate Health Care | Yes | ✓ Yes |
| NorthShore University HealthSystem | Yes | ✓ Yes (via PHCS Network Wrap) |
| Loyola Medicine | Yes | ✓ Yes |
GAP Strategy: Financial Protection
Pairing a high-deductible plan with a GAP supplement is a powerful strategy. The GAP plan "wraps around" the primary plan's deductible, shielding employees from high out-of-pocket expenses for major medical events. This dramatically lowers premium costs while still providing excellent coverage.
Scenario: HSA Plan with GAP
Plan: Bronze HSA ($6,000 deductible) + HSA GAP
The HSA GAP plan is designed to comply with federal regulations. It only begins to pay after a member has personally met the federal minimum required deductible. For 2025, that minimum is $1,650 for an individual and $3,300 for a family.
Scenario: PPO Plan with GAP
Plan: Bronze PPO ($8,000 deductible) + PPO GAP
The PPO GAP plan provides a first-dollar wrap, covering the deductible and coinsurance for major medical events from the very beginning, effectively eliminating out-of-pocket costs for those services.
Our Partnership Pledge
Choosing Health365+ is the first step in transforming your healthcare into a strategic benefit. We are not a vendor; we are an extension of your team, and our success is measured by your success.
Our Pledge to You, the Employer
- We pledge absolute transparency. You will have full access to all data and insights needed to make informed decisions.
- We pledge a proactive partnership. We will continuously analyze your population health data and bring you data-driven recommendations.
- We pledge to deliver a measurable return. By improving health and optimizing care, we are committed to lowering costs.
Our Pledge to Your Employees
- We pledge to always be a compassionate, human-first point of contact.
- We pledge to be your employees’ trusted health advocate.
- We pledge to empower every member with the tools and information they need.
Jeremy Spreitzer
Chief Executive Officer
Joshua Parise
Chief Innovation Officer
Next Steps: Select Your Strategy
Please review the strategic paths presented. You can choose to apply one strategy across the board, or mix-and-match based on the needs of your different employee groups. To move forward, please click the button below to generate a pre-filled email notifying us of your decision.
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