What Defines a Preferred Provider?

A Preferred Provider with Self Fund Health is a provider who agrees to deliver care at a fair, transparent price. Specifically, these providers are paid at rates that average 200% of Medicare or less.

Why 200% of Medicare?

Keeping Preferred Provider rates at or below this level is essential for two reasons:

1. Employer Affordability – It ensures members and employers avoid the inflated costs typical of hospital systems. This allows us to offer many Preferred Provider services at $0 cost to members.
2. Stop Loss Underwriting – To secure favorable stop loss insurance rates for employers, we must demonstrate to underwriters that members are consistently steered to care that is significantly less expensive than the hospital market norm. Preferred Providers priced at 200% of Medicare or less make that possible.

Key takeaway: Preferred Providers are defined not just by their price point, but by their role in proving to underwriters—and delivering to employers—that Self Fund Health members are accessing high-quality care at sustainable costs.