Question 1

How do I compare health insurance networks for my employees?

Accepted Answer

Network comparison should evaluate: (1) provider access — can employees access their current PCPs, specialists, and hospitals in-network?; (2) network breadth — how many providers are in-network in your employees' zip codes?; (3) cost performance — what are the network's unit cost levels relative to benchmarks?; (4) quality indicators — does the network include high-value, high-quality providers?; (5) disruption risk — how many current employees would need to change providers? This tool evaluates all five dimensions.

Question 2

What is network disruption and how do I minimize it?

Accepted Answer

Network disruption occurs when employees' current providers are not included in a new network, forcing them to change doctors or pay out-of-network costs. Disruption is one of the most common reasons employees resist plan changes. To minimize disruption: (1) survey employees about their current providers before switching networks; (2) use the network comparison tool to identify disruption risk by zip code; (3) provide adequate advance notice and transition support; (4) consider a transition-of-care provision for employees with ongoing treatment.

Question 3

What is a narrow network health plan?

Accepted Answer

A narrow network health plan restricts coverage to a smaller set of providers — typically high-value, lower-cost providers — in exchange for lower premiums. Narrow networks can reduce costs by 10–20% compared to broad networks, but they require employees to change providers if their current doctors are not included. High-performance networks (HPNs) are a variant that selects providers based on quality and cost efficiency rather than simply limiting access.

Question 4

What is reference-based pricing and how does it relate to network selection?

Accepted Answer

Reference-based pricing (RBP) is an alternative to traditional network contracting where the plan pays a fixed percentage of Medicare rates (typically 140–200%) for services, regardless of whether the provider has a network contract. RBP eliminates the need for a traditional network and can significantly reduce unit costs, but it requires robust member advocacy support and may result in balance billing. Some employers use RBP as a complement to a narrow network for out-of-network services.

Question 5

How do I evaluate network adequacy for my employees?

Accepted Answer

Network adequacy evaluation should include: (1) geographic access analysis — what percentage of employees have in-network providers within 15/30/60 miles?; (2) specialty access — are key specialists (oncology, cardiology, orthopedics) available in-network?; (3) hospital access — are employees' preferred hospitals in-network?; (4) behavioral health access — are mental health and substance use disorder providers adequately represented?; (5) telehealth integration — does the network include virtual care options? The AI Network Comparison tool evaluates all of these dimensions.

AI Medical Network Comparison Tool

Frequently Asked Questions

How do I compare health insurance networks for my employees?

What is network disruption and how do I minimize it?

What is a narrow network health plan?

What is reference-based pricing and how does it relate to network selection?

How do I evaluate network adequacy for my employees?