AI TOOL PROFILE
Collective Health: Health Benefits Platform for Self-Funded Employers
- HR and Recruiting
- HR Management
- Self-funded employers
- Companies with 1,000 to 50,000 employees
- Benefits managers
- Mid-market and enterprise companies
Pricing
Pricing was not clearly available from the provided evidence. Buyers should confirm current pricing on the vendor website, as costs are based on medical plan administration fees, network access fees, and optional platform modules.
At a glance
- Best for
- Self-funded employers, Companies with 1,000 to 50,000 employees, Benefits managers, Mid-market and enterprise companies
- Key use cases
- Self-Funded Plan Administration, Claims and Payment Processing, Employee Care Navigation, Managing Digital Health Point Solutions
- Official website
- Visit collective health official website
How AI is used
Collective Health is a tech-enabled Third Party Administrator (TPA) designed for self-funded employers. It combines back-end administration, such as claims adjudication and payments, with front-end member tools including a mobile app and advocacy services.
The platform is designed for companies with 1,000 to 50,000 benefits-eligible employees. It connects employers with a partner ecosystem of over 140 program partners across various clinical categories, which helps centralize different health and wellness tools.
For the employer, the tool supports operational workflows and reporting. For employees, it provides navigation and complex care management to help them understand their care options. The platform also incorporates Collective AI (CAI) to support member navigation and operational efficiency with human oversight.
Buyers should confirm if they meet the typical company size requirements and ensure their current self-insurance structure is compatible with the TPA model.
Key Features
Plan Administration
Supports the administration of medical, pharmacy, dental, and vision plans.
Claims Adjudication
Handles the processing and adjudication of medical claims.
Member Navigation & Advocacy
Provides a member app and professional advocates to help employees navigate their care journey.
Complex Care Management
Offers guidance and support for members with complex health needs.
Reporting and Analytics
Provides employers with data and analytics to monitor their healthcare investment.
Partner Ecosystem
Supports integration with over 140 program partners across 30+ clinical categories.
Collective AI (CAI)
Uses artificial intelligence to support member navigation and plan operational workflows.
Use Cases
Self-Funded Plan Administration
Managing medical, pharmacy, dental, and vision plan administration in one place.
Claims and Payment Processing
Handling the adjudication of claims and the processing of healthcare payments.
Employee Care Navigation
Helping employees find providers and understand benefit coverage through digital tools and advocates.
Managing Digital Health Point Solutions
Integrating third-party wellness and clinical programs into a single member experience.
FAQ
What does Collective Health do?
- It is an integrated third-party administrator (TPA) and navigation solution that handles plan administration, claims adjudication, and member advocacy for self-funded employers.
What size companies is Collective Health designed for?
- The platform generally works with clients who have between 1,000 and 50,000 benefits-eligible employees.
Does Collective Health work with fully-insured companies?
- No, the platform focuses on companies that are already self-insured or those looking to transition from a fully-insured model to a self-insured one.
How long does implementation take?
- The company states that the solution can be implemented in as little as 90 days.
Source category: HR & Recruiting
Source subcategory: HR Management
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