Transform Your Benefits Strategy
Discover a revolutionary approach to employee health benefits that protects your bottom line while delivering premium care. OptimalMD provides a private, claims-free alternative that stabilizes benefits costs, safeguards renewal rates, and creates an executive-level health experience your employees deserve.
Executive Summary: Renewals, Claims & OptimalMD's Private Network
The Renewal Crisis
Premium increases of 15–40% driven by visible claims activity
Private Healthcare Network
Confidential care that never impacts your insurance rates
Proven Results
60–80% RX reduction with stable, predictable renewals
The Employer Renewal Challenge
Most employers face premium increases of 15–40% for their January 1 renewals, driven primarily by claims activity—especially prescriptions and ongoing medical conditions. This creates a cycle of escalating costs that becomes increasingly difficult to manage.
Insurance carriers and underwriters use claims data, particularly high pharmacy and chronic disease spending, to set rates and assign risk categories. Even minor conditions can artificially inflate future renewal costs—an athlete taking a single medication could be flagged as high-risk, dramatically impacting your group's premiums.
The OptimalMD Solution: Confidential Concierge Care
OptimalMD is a Private Healthcare Network—not insurance and not tied to any insurer. Our utilization is kept completely confidential from carriers and aggregators, ensuring your claim history cannot be used against your group. This fundamental difference creates a protective barrier between your employees' healthcare needs and your renewal rates.
Shift Pharmacy Claims
Move RX, labs, and virtual care off your insurance plan into a private, insurance-free zone
Protect Your Renewal
Keep high-utilization services confidential, preventing them from impacting your rates
Stabilize Long-Term Trend
Create predictable benefits costs year after year with claims-free healthcare delivery
Our major pharmacy discounts include over 1,100 medications completely free, 4,000+ medications under $15, and specialty drugs available via Patient Assistance Programs. This comprehensive coverage ensures your employees receive the medications they need while dramatically reducing your visible claims exposure.
Case Study: Claims Reduction & Cost Impact
200
Employee Lives
Mid-sized employer group
69%
RX Spend Reduction
From $360K to $110K annually
-10%
Net Insurance Cost
Projected savings for 2026
3,900
Lab Tests Available
Unlimited access at $0 cost
A real employer with 200 lives achieved remarkable results by transitioning pharmacy benefits to OptimalMD. The group reduced annual RX spend from $360,000 to $110,000—a dramatic 69% reduction that immediately impacted their claims profile.
The group then added OptimalMD's lab program ("Zero Dollar Labs"), offloading all diagnostics at no member cost. This provided unlimited access to 3,900+ tests including CMP, lipid panels, A1c, CBC, Vitamin D, and many others—tests that are typically excluded or limited by traditional insurance plans.
The stop-loss carrier responded by lowering aggregate claim maximums, resulting in a projected net –10% insurance cost for 2025 when considering OptimalMD fees and insurance savings. Future years' renewals become significantly more predictable because high-claim activity is "off-book" and managed privately.
Breadth of Coverage: Insurance-Free, Claims-Free Ecosystem
OptimalMD delivers a comprehensive healthcare solution that operates entirely outside the traditional insurance ecosystem. Every service provided through our network remains confidential and never appears on your claims reports.
Zero-Dollar Labs
Access to 3,900+ tests with unlimited frequency. Full metabolic, hormonal, cardiovascular, and diagnostic screening—all off-plan and confidential. No deductibles, no copays, no claims reported.
Comprehensive Pharmacy Program
$0 for 1,100 medications, $15 or less for thousands more. Specialty medications and GLP-1 drugs included. HRA-friendly reimbursement structure with transparent pricing.
Unlimited Virtual Care
24/7 access to urgent care, primary care, behavioral health, dermatology, and more—far beyond standard telehealth. E-consults with 13 specialties available at no extra cost.
Chronic Condition Management
Private management of diabetes, obesity, hypertension, weight loss, and mental health. No deductibles, no copays, transparent pricing. Never reported or underwritten by your carrier.
OptimalMD offers unparalleled flexibility for employers. Use it as a bolt-on to HDHP, MEC, or ICHRA plans, or integrate it with Impact Health Sharing for surgical and hospital events. The platform adapts to your existing benefits strategy while providing a protective layer that shields your group from claims-driven premium increases.
Employer Impact & Competitive Advantage
Shield your group from multi-year premium escalations by keeping chronic condition management private and off insurance. This approach simultaneously improves employee health outcomes, increases satisfaction levels, and provides unprecedented access to quality care.
Your employees receive an executive-level healthcare experience with no deductibles, no copays, and no barriers to care. Meanwhile, your organization benefits from stable, predictable costs and renewal rates that reflect your strategic approach to benefits management rather than claims volatility.
Implementation & Next Steps
01
Pre-Renewal Integration
If not yet renewed: Integrate OptimalMD to immediately lower pharmacy and lab claims before your renewal date
02
Mid-Cycle Addition
If already renewed: Add OptimalMD mid-cycle to begin offboarding claims and improve group health profile
03
Long-Term Strategy
Set up favorable renewals for subsequent years while building a healthier, more satisfied workforce
Our implementation strategy is proven with multiple client case studies demonstrating substantial RX and lab savings, renewal stability, stop-loss carrier buy-in, and dramatically enhanced employee experience. Whether you're facing an upcoming renewal or looking to optimize your current benefits structure, OptimalMD provides the strategic advantage you need.
Schedule Your Personalized Demo
See the Impact for Your Group
Schedule a demo to model the specific impact OptimalMD can deliver for your organization. We'll review real results from similar groups, walk through our comprehensive platform, and develop a customized strategy tailored to your benefits goals.
OptimalMD offers Proof of Concept demonstrations, expert onboarding support, and fully customizable implementation strategies for employer clients seeking to stabilize benefits costs and optimize renewal outcomes.
Proof of Concept
See real modeling based on your group size, current pharmacy spend, and benefits structure
Expert Onboarding
Dedicated implementation team ensures seamless integration with your existing benefits
Customized Strategy
Tailored approach designed specifically for your organization's goals and employee population
"Transform your benefits strategy from reactive cost management to proactive value creation. OptimalMD provides the tools, technology, and expertise to deliver exceptional care while protecting your organization's financial future."
Ready to stabilize your renewals and enhance your employee benefits? Contact Your Global Benefits today to schedule your personalized demo and discover how our private healthcare network can transform your benefits strategy.
Contact Information
Jeff Bacot
Phone: (713) 446-7011
Email: jeff@yourglobalbenefits.com
Jeff Bacot
Phone: (713) 446-7011
Email: jeff@yourglobalbenefits.com