Coverages

The PRISMHealth Program was created in 2003 to provide members with a cost-effective alternative to their current healthcare coverage options. Available to both small (<100 eligible participants) and large (>100 eligible participants) member segments, the PRISMHealth Program capitalizes on the concept of risk share pooling in order to reduce healthcare premiums and ensure that all members are afforded equitable participation based on their benefit plans and specific claims performance.

The pooling approach creates value and long-term stability for your entity by securing the lowest possible fixed costs from our premier carrier partners and combining similar risk profiles in a financially stable pool. With the PRISMHealth program, you will have the flexibility to match current plan designs and implement product offerings to contain costs for both active and retired employees.

As the second largest public sector healthcare purchasing program in California, PRISMHealth now covers more than 43,000 employee /retiree primary subscribers. To maximize savings for the PRISMHealth pool, in 2006, PRISM entered into a risk sharing contract with SISC (Self Insured Schools of California).  The partnership resulted in the PRISMHealth program becoming part of an even larger pool, covering more than 400 agencies with 150,000 primary subscribers.

Since its inception, the PRISMHealth Program has consistently outperformed the marketplace, effectively competing with standalone plans, other pooled arrangements and CalPERS.  The PRISMHealth Program is founded on the basis of the RIGHT RATE, RIGHT NOW, focusing on maintaining a balanced renewal trend, with less year to year rate volatility.

Our carrier partners:

              

 

The PRISMHealth Program continues to grow in innovative and dynamic ways, ensuring that the needs of its diverse population are met.  Recently, several health care point solutions have been added to enhance the already robust plan offerings:

Accolade – dedicated care navigators that assist employees in understanding and navigating the healthcare system, helping them find the right doctors, schedule appointments, understand their health plan benefits, and advocate for their needs to access the best care possible, all while aiming to improve health outcomes and reduce costs.

Carrum Health – value-based Centers of Excellence network that negotiates directly with top-quality healthcare providers to provide employees with nationwide access to the very best specialty care in the areas of orthopedics, bariatric, and cancer care.

Hinge Health – a digital health platform that provides personalized, virtual physical therapy and pain management programs. It aims to help individuals with musculoskeletal conditions, such as back pain, neck pain, and joint pain, improve their mobility, reduce pain, and live healthier lives.

Livongo by Teledoc – a digital health platform that focuses on managing chronic conditions like diabetes, hypertension, and weight management through a combination of connected devices (like blood glucose meters and smart scales), personalized coaching from certified health experts, and a user-friendly mobile app.

Rx’nGo – a voluntary 90-day mail order service for generic maintenance medications at no cost for employees and 15%-25% savings for employers, covering 53 major maintenance medication categories for chronic conditions supporting asthma, cholesterol, diabetes, emotional health, and hypertension, as well as free insulin products, needles, syringes, monitors, and test strips.

COMING IN 2026

Digbi Health – a digital health platform providing chronic conditions care in the areas of weight management, pre/diabetes, hypertension, high cholesterol, GI/Digestive, skin conditions, mental health, chronic pain, and non-alcoholic fatty liver disease.  Utilizing at-home genetic tests, gut microbiome tests, and continuous glucose monitoring, Digby seeks to understand each person’s unique biological profile/root cause for their conditions and develops personalized care pathways tailored for each individual.

 

For more information on PRISMHealth , please contact:

Sidney DiDomenico, Director of Employee Benefits 
Phone:  916-850-7300