edHEALTH offers brokers the opportunity to provide a cost-effective solution to rising healthcare costs. By recommending edHEALTH, you will bend your educational clients’ healthcare cost trend, improving your reputation and advancing your advisory role.

There is not a significant disruption to plan design, coverage, and access to current healthcare providers. Our members have experienced seamless conversions with little or no disruption to coverage or doctors/hospitals. edHEALTH has an active Plan Design Committee made up of representatives from each member institution. The Committee works with the Third Party Administrators (TPAs) to determine plan designs customized to meet the needs of edHEALTH members.

edHEALTH has a range of plan designs that are customized to meet the needs of edHEALTH members. Representatives from each member institution (typically benefits administrators) meet monthly to determine plan year design options. The Plan Design Committee’s collaboration with the Third Party Administrators (TPAs) helps to ensure the optimal suite of choices.

edHEALTH is available throughout the United States.

edHEALTH has two regional healthcare TPAs – Harvard Pilgrim Health Care and Tufts Health Plan. Our national TPA is Trustmark Health Benefits, a national employee benefits company. OptumRx is our prescription drug carve out administrator.

Here are the tasks and deadlines for joining January 1; the timeline is similar for other times of the year:

• School submits letter of authorization, claims data, and working rate fee by August 31
• School determines its plan designs by August 31
• School reviews rates, makes plan design adjustments, and determines choice of carrier by September 15
• General Counsel executes contractual agreements by October 1
• Fiscal Department provides financial and banking information by October 15
• Open Enrollment takes place late October – early November
• Estimated premium and stop loss invoices due for January by December 15
• Adjusted final enrollment premium and stop loss invoices due for January by February 1

After an initial three-year commitment, a Member may elect to leave edHEALTH. There are no costs to leave, but the school must send a signed letter from its President on the institution’s letterhead to edHEALTH's President and CEO notifying us of the school's wish to leave at least four months prior to their departure.

edHEALTH charges prospective members a $5,000 fee for a working rate quote. This fee represents the cost our actuary charges to calculate the working rate that includes a breakdown of all expected costs for the plan year. Because we are a member-owned non-profit organization, we don’t ask current members to pay for working rate quotes for prospective members.

No. There are no fees to join edHEALTH. When a school joins edHEALTH, it must pay a $50,000 paid-in surplus and three months of stop loss premium to edHEALTH’s Captive, as required by the Vermont regulators. The $50,000 is a Member capital asset and should a Member elect to leave edHEALTH, the money is returned to them.

Each member selects its own Third Party Administrator (TPA) and plan design from our suite of healthcare options. The program is individually underwritten by the TPA and the institution selects its self-insured retention attachment points. A licensed Vermont Reciprocal Captive owned by the members and administered by a captive manager covers any gaps between expected claims and actual results. Additionally, our purchasing power helps us negotiate low TPA fees.