Elevating
Care.
Reducing
Cost.
A comprehensive proposal for Swiderski Equipment, Inc.
Executive Summary
Swiderski Equipment Inc. has the opportunity to transition from a fragmented, high-deductible plan structure to a unified Health365+ model with a proposed effective date of August 1, 2025. Our approach eliminates unnecessary employee costs while delivering richer benefits and a simplified structure. Crucially, under this model, 100% of unused claim funds are returned to you, whereas the insurer currently keeps all surplus. In year one, the group stands to realize significant hard premium savings, retained surplus, and additional savings via our integrated Rx and chronic condition management programs, with a projected five-year cumulative opportunity exceeding $1.95 million.
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.
Care Coordination System
1. AI-Powered Pre-Certification
Our pre-auth service, powered by an AI engine and reviewed by clinicians, dramatically accelerates approvals. This eliminates frustrating delays and creates critical data for our care team.
2. Proactive Clinical Outreach
The moment a procedure is approved, the data alerts the member's dedicated health coach. They don't wait for a call; they reach out immediately to begin care coordination.
3. High-Value Care Guidance
The coach guides the member to the best in-network providers, schedules appointments, and arranges follow-up care. This ensures a better experience, improved outcomes, and lower costs for the plan.
This isn't just about speed; it's about intelligence. Every administrative step is transformed into a proactive care opportunity, ensuring better care, a better 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. There's no central "quarterback" to manage their care. 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.
Calls multiple doctor's offices to find an in-network provider and schedule.
Is responsible for coordinating between PCP, specialist, lab, and pharmacy.
Spends hours on hold with the insurance carrier to understand bills and coverage.
Health365+ Coordinated Journey
Unified, proactive, and simple.
Member contacts their dedicated Health365+ Care Team.
Care Team finds the right in-network provider and schedules the appointment.
Care Team coordinates pre-authorizations, specialist referrals, and prescriptions.
Member has one point of contact for all questions, resulting in a simple, stress-free experience.
Core Plan Services
The integrated flow is powered by these foundational services, designed to provide comprehensive support across all aspects of care.
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 care team for acute issues, chronic condition management, wellness visits, and prescription renewals.
Proactive Chronic & Whole-Health Management
Using data from across the ecosystem, we identify at-risk members and engage them with a health coach and no-cost remote monitoring devices. This program is proven to save over $2,000 per engaged member annually.
A Conflict-Free Pharmacy Model
We fundamentally redesign pharmacy benefits to eliminate conflicts of interest. For high-cost specialty medications, our TPA, Marpai Health, will work with members to utilize Manufacturer/Patient Assistance Programs. Any remaining claim funds at the end of the year 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
We provide your employees with direct access to our team of salaried, licensed benefit coaches. During open enrollment, our coaches can walk each employee through their options and complete their benefit elections over the phone or via a co-browsing session. This hands-on approach limits costly enrollment errors, gives valuable time back to your HR department, and dramatically increases employee understanding of how to select and use the right plan for their family.
BenefitBites: On-Demand Education
We make complex benefits simple with our library of short, interactive "BenefitBites" courses. These communications are sent directly to employees via SMS or email both pre- and post-enrollment to teach them how to use their plan effectively. Each course is custom-built for your benefits package, ensuring your team gets the specific information they need, when they need it.
Voices of Our Members
Here’s what employees have to say about their experience with the Health365+ model.
"With my old B**** C**** plan, I felt like a number. I'd spend hours on hold trying to get answers. The first time I called Health365+, I spoke to a real person who knew my name and actually 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, Emily, 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, Maria, 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."
Recommended Plan Options
With Health365+, you gain unprecedented rights and control over your plan. The options below are built on this philosophy, replacing your current HMO and POS plans with a unified, superior structure.
From Passive Payer to Empowered Owner
| Aspect of Your Plan | Typical Fully Insured Plan | The Health365+ Model |
|---|---|---|
| Access to Claims Data | A "black box" where data is owned and hidden by the insurer. | Full Transparency. Access your plan's data to see exactly where your dollars are going. |
| Unused Claim Dollars | Forfeited. The insurance carrier keeps all unused premium dollars as profit. | 100% Retained. You keep every dollar in your claims fund that isn't spent on care. |
| Plan Design & Flexibility | "One-size-fits-all" menu of off-the-shelf designs. | Designed by you, for you, with the flexibility to meet your workforce's specific needs. |
| Financial Control & ROI | Unpredictable annual increases with no real control over costs. | Strategic Cost Management. Finally manage the root cause of costs: member health. |
Current vs. Proposed: A Clearer Choice
| Feature | Your Current Aspirus Plans | Our Proposed Health365+ Plans |
|---|---|---|
| Network Access | Restricted local HMO & confusing tiered POS networks. | Single, broad National PPO network for all members. |
| Balance Billing Risk | High Risk for POS members needing care outside the core network. | No Risk when using in-network providers. |
| Deductible Exposure | High deductibles on HDHP plans, creating significant financial barriers to care. | GAP plan wraps the deductible, dramatically lowering or eliminating it for major medical events. |
| True Out-of-Pocket Max | Can be as high as $7,000+ per person, plus the risk of uncapped balance bills. | Predictable and capped at $700 (Copay Plan) or $2,650 (HSA Plan). |
| Unused Claim Fund (Surplus) | Kept by Insurer. You receive no financial return for a healthy year. | 100% Returned to You. Your investment in health pays you back. |
| Member Support | Standard call center experience, leaving members to navigate care alone. | Dedicated, proactive health coach and care team for every member. |
Proposed Monthly Rates
| Plan Name | EE | EE+SP | EE+CH | FAM |
|---|---|---|---|---|
| eDIYBS Bronze H405 + GAP | $609.84 | $1,236.47 | $1,123.08 | $1,661.35 |
| eDIYBS Bronze H404 + GAP (HSA) | $585.52 | $1,162.31 | $1,057.93 | $1,553.39 |
Rates are based on the census provided with 49 EEs, 23 ESs, 13 ECs, and 24 EFs.
Recommended Plan Benefit Comparison
| Feature | Replaces HMO Copay: eDIYBS Bronze H405 + $8k GAP |
Replaces HDHPs: eDIYBS Bronze H404 + $6k GAP (HSA) |
|---|---|---|
| Deductible (Ind/Fam) | $8,000 / $16,000 Wrapped to $0 by GAP |
$6,000 / $12,000 Member pays first $1,650/$3,300 |
| True OOP Max (Ind/Fam) | $700 / $1,400 Remaining coinsurance exposure after GAP. |
$2,650 / $5,300 IRS min ($1,650) + coinsurance ($1,000). |
| Plan Type | Co-pay | HSA-Compatible |
| Primary / Specialist / Urgent Care | $50 / $120 / $100 | 30% After Deductible |
| In-Patient Hospitalization | 30% After Deductible Covered by GAP |
30% After Deductible Covered by GAP after member portion |
| Prescription Drugs (Tier 1 / 2 / 3) | $10 / $35 / $75 | 0% / 25% / 45% After Deductible |
A Simpler, More Secure Network
Your current benefit structure creates a confusing and unequal experience for employees. Those on the HMO plans are restricted to the local Aspirus Signature Network. POS members have a confusing tiered Freedom Network, where they face a higher deductible, 20% coinsurance, and the significant financial risk of being balance billed if they need care from providers outside the core Signature network. Health365+ resolves this by moving all employees to the single, broad HPN National PPO Network, ensuring everyone has simple, predictable, and protected access to care.
Network Access Comparison
Marshfield Medical Center
Major Regional System
Aspirus HMO
❌
Out-of-Network
Aspirus POS
⚠️
Tier 2: 20% after $7k Ded. + Balance Bill Risk
Health365+
✓
PPO Access
Aspirus Wausau Hospital
Primary Local System
Aspirus HMO
✓
In-Network
Aspirus POS
✓
Tier 1 Access
Health365+
✓
PPO Access
ThedaCare Regional (Appleton)
Regional System
Aspirus HMO
✓
In-Network
Aspirus POS
✓
Tier 1 Access
Health365+
✓
PPO Access
North Central Health Care
Behavioral Health Center
Aspirus HMO
❌
Out-of-Network
Aspirus POS
⚠️
Tier 2: 20% after $7k Ded. + Balance Bill Risk
Health365+
✓
PPO Access
Aspirus Riverview Hospital
WI Rapids
Aspirus HMO
❌
Out-of-Network
Aspirus POS
⚠️
Tier 2: 20% after $7k Ded. + Balance Bill Risk
Health365+
✓
PPO Access
Aspirus Merrill Hospital
Local Community Hospital
Aspirus HMO
✓
In-Network
Aspirus POS
✓
Tier 1 Access
Health365+
✓
PPO Access
Aspirus Stevens Point
Local Community Hospital
Aspirus HMO
✓
In-Network
Aspirus POS
✓
Tier 1 Access
Health365+
✓
PPO Access
Aurora BayCare (Green Bay)
Regional System
Aspirus HMO
✓
In-Network
Aspirus POS
✓
Tier 1 Access
Health365+
✓
PPO Access
Aspirus Rhinelander
Local Community Hospital
Aspirus HMO
✓
In-Network
Aspirus POS
✓
Tier 1 Access
Health365+
✓
PPO Access
GAP Strategy: Financial Protection
The recommended Bronze plans become powerful when paired with a GAP solution. This supplemental benefit "wraps" the deductible, creating two distinct strategies to protect your employees from high out-of-pocket costs.
For Copay Plan Members (H405)
A full first-dollar wrap with an $8,000 GAP benefit. This reimburses all member cost-sharing for major medical events from the very first dollar, effectively eliminating the deductible for those services.
For HDHP Members (H404)
An HSA-compliant wrap with a $6,000 GAP benefit. The member first pays their IRS-mandated minimum deductible ($1,650 Ind / $3,300 Fam). The GAP benefit then kicks in to cover costs above that amount.
How the GAP Works: Real-World Examples
Scenario: Inpatient Stay
Plan: Bronze H405 + $8,000 GAP
The GAP plan provides a full first-dollar wrap, covering the entire deductible for major medical events.
Scenario: Outpatient Surgery
Plan: Bronze H404 + $6,000 GAP (HSA)
The GAP plan covers the deductible after the member meets the IRS minimum, preserving HSA eligibility.
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. You will have direct access to our Chief People Officer to ensure our program is meeting the evolving needs of your organization.
Our Pledge to You, the Employer
- We pledge absolute transparency. You will have the access to the data you need to make informed decisions.
- We pledge a proactive partnership. We will bring you data-driven insights and strategic recommendations to continually improve the health of your population and the value of your investment.
- We pledge to deliver a measurable return. We are committed to improving health outcomes that result in lower costs and a more productive workforce.
Our Pledge to Your Employees
- We pledge to always be a compassionate, human-first point of contact. You will be treated with dignity and respect by a care team that knows your name.
- We pledge to be your trusted health advocate. We will help you navigate the complexities of the healthcare system, coordinating care between your providers.
- We pledge to empower you. We will provide the tools, information, and on-demand coaching support you need to achieve your personal health goals.
Jeremy Spreitzer
Chief Executive Officer
Joshua Parise
Chief Innovation Officer
Accept the Proposal
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