Northwell +
Blue Cross
Blue Shield
A smarter Health Plan built on
2 best-in-class networks
For 1 to 1,000 Employees
Two NETWORKS are better than one
Lowering costs for employers and employees
Northwell-Anthem is a 2-Tier health plan designed to deliver high quality care anywhere in the US through the Blue Cross Blue Shield network while leveraging directly contracted Northwell hospitals and physicians. By direct contracting with Northwell Health members pay less in the form of lower copays and deductibles when visiting Northwell hospitals, urgent care, labs, surgical centers, and physicians. Since direct contracting also lowers costs for employers, it helps to reduce premiums even for members who don’t use Northwell – a win-win for everyone.
More Networks and Care Choices
Regional, National, and Out-Of-Network Coverage
Blue Cross Blue Shield
National PPO Coverage
The Northwell-Anthem health plan is carefully designed to provide national coverage anywhere in the US. Anthem features one of the broadest networks in the nation. Members have access to a network that includes 95% of doctors and 96% of hospitals in the U.S. One in three Americans carries a BCBS card — over 106 million members (bcbs.com).
Northwell Health
31,000 high-quality providers
With the cost and complexity of care on the rise, contracting directly with the Northwell hospital system delivers additional benefits. Northwell Direct offers members access to 31,000 high-quality providers and facilities in metro NY and NJ. The savings for members comes in the form of lower copays and deductibles when accessing the Northwell network.
Out-Of-Network
Flexibility to go to any doctor
Sometimes, our members may choose to visit a doctor outside the Blue Cross Blue Shield or Northwell network. In these situations, they can rest assured that their plan still provides coverage. However, out-of-pocket costs are typically higher when receiving out-of-network care.
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High-Quality Care
Northwell Health’s award-winning facilities and highly skilled medical professionals are known for delivering exceptional care.
Cost Savings
With lower co-pays, deductibles, and out-of-pocket expenses, Tier 1 ensures affordable access to premier healthcare services.
Convenience
An extensive network spans the New York metro area, so you’re never far from a trusted Northwell Health provider.
Three PRE-PRICED plans to choose from
- Ultra Plan
- 3 K Plan
- 6 K Plan
EMPLOYEE
NORTHWELL DEDUCTIBLE
$0
ANTHEM BCBS DEDUCTIBLE
$500
OUT-OF-NETWORK DEDUCTIBLE
$1,000
EMPLOYEE & SPOUSE
NORTHWELL DEDUCTIBLE
$0
ANTHEM BCBS DEDUCTIBLE
$2,000
OUT-OF-NETWORK DEDUCTIBLE
$2,000
Employee & CHILD
NORTHWELL DEDUCTIBLE
$0
ANTHEM BCBS DEDUCTIBLE
$2,000
OUT-OF-NETWORK DEDUCTIBLE
$2,000
FAMILY
NORTHWELL DEDUCTIBLE
$0
ANTHEM BCBS DEDUCTIBLE
$2,000
$2,000
EMPLOYEE
NORTHWELL DEDUCTIBLE
$2,000
ANTHEM BCBS DEDUCTIBLE
$3,000
OUT-OF-NETWORK DEDUCTIBLE
$6,000
EMPLOYEE & SPOUSE
NORTHWELL DEDUCTIBLE
$4,000
ANTHEM BCBS DEDUCTIBLE
$6,000
$12,000
Employee & CHILD
NORTHWELL DEDUCTIBLE
$4,000
ANTHEM BCBS DEDUCTIBLE
$6,000
$12,000
FAMILY
NORTHWELL DEDUCTIBLE
$4,000
ANTHEM BCBS DEDUCTIBLE
$6,000
$12,000
EMPLOYEE
NORTHWELL DEDUCTIBLE
$5,000
ANTHEM BCBS DEDUCTIBLE
$6,000
OUT-OF-NETWORK DEDUCTIBLE
$9,200
EMPLOYEE & SPOUSE
NORTHWELL DEDUCTIBLE
$10,000
ANTHEM BCBS DEDUCTIBLE
$12,000
$18,200
Employee & CHILD
NORTHWELL DEDUCTIBLE
$10,000
ANTHEM BCBS DEDUCTIBLE
$12,000
$18,200
FAMILY
NORTHWELL DEDUCTIBLE
$1000
ANTHEM BCBS DEDUCTIBLE
$12,000
$18,200
Integrated Medical Benefits
Integrated medical networks are designed to work seamlessly together so physicians and facilities can deliver the right care, in the right setting, at the right time.
Pharmacy Benefits Management
2-Tier plans are powered by CarelonRx, providing tailored pharmacy benefits that support doctors and pharmacists at every stage, from prescribing to prior authorization.
Small groups can save big
Up to 50% less than comparable health plans
With the Northwell-Anthem 2-tier plan designed by Memberly, businesses of any size can finally get relief from health plan costs. That’s because Northwell-Anthem is serving over 100,000 lives in the New York metro area under a tier 1 direct contract which reduces premiums for every employer and employee regardless of whether they are in the Northwell footprint.
Joining the Northwell-Anthem plan is easy as the rates are set for 2025 giving businesses the opportunity to compare costs and designs with the current plan. Employers can join the plan anytime of year. The no and low deductible plan options minimize the financial impact of changing plans off cycle.
Large group specialists
50 to 1,000's of employees
Large groups can establish a Northwell-Anthem plan tailored to their workforce while reducing costs and improving access to care. Using a self-funded or level-funded plan design, a standalone Northwell-Anthem plan will have the potential to return unused claims funds to the employer. This is one of the key benefits of using a self-funded plan and why nearly 70% of employer plans in the US operate under a self-funded structure.
In New York, an employer must have 100 employees or FTEs to qualify for a self-funding. Connecticut and New Jersey have lower group size requirements staring at 50 employees.
Memberly specializes in self-funded groups anywhere in the US and can advise on the optimal plan structure based on group size, history and location.
Case Management
You don’t have to go it alone
Northwell ensures that patients receive timely interventions and appropriate resources to support their health journey.
When you want to get better the last thing you need is more work. In addition to the Northwell Direct network, the 2-tier plan is contracted with Northwell to provide case management for members located anywhere in the US. Case management focuses on delivering patient-centered, coordinated care across its extensive network or the Blue Cross Blue Shield network. Case management emphasizes individualized care plans, seamless transitions between care settings, and communication among healthcare providers, patients, and their families.