Franchises | Reef Health

How is Reef Health different from traditional health insurance?

Reef Health is not traditional insurance—it's a cost-effective, tech-driven healthcare solution tailored for small businesses, solopreneurs, families and individuals. Unlike traditional insurers that inflate costs—often charging 8-10 times more than cash pay while prioritizing profits over people—Reef Health eliminates unnecessary markups and administrative barriers, ensuring transparent pricing and seamless access to quality healthcare without the risk of denied coverage.

Unlike traditional insurance, Reef Health:
• Eliminates expensive middlemen (insurance carriers, third-party administrators, and pharmacy benefit managers)
• Offers direct-to-provider national access for lower costs and better care
• Provides concierge-level support for a seamless healthcare experience
• Ensures transparent, upfront pricing with no hidden fees

It seems too good to be true—how can Reef Health offer such low costs?

We understand the skepticism! Traditional insurance includes multiple intermediaries that drive up costs. Reef Health eliminates administrative inefficiencies by working directly with providers.

How we keep costs low:
• Lower premiums due to elimination of excess billing and traditional profit over people model
• No excessive markups from third parties
• Transparent pricing with no surprise fees

This approach allows Reef Health to deliver high-quality care without the inflated premiums and deductibles of traditional insurance.

What types of health coverage is offered by Reef Health?

Reef Health is designed for:
• Individuals and Families
• Small businesses
• Independent operators

Whether you own a single location or multiple businesses, Reef Health provides flexible, scalable healthcare solutions tailored to your budget and employee needs.

Is the Reef Health plan a Minimum Essential Care (MEC) Plan under the Affordable Care Act (ACA)?

Yes! Reef Health plans comply with ACA regulations in multiple ways:

Part A (Minimum Essential Coverage)
The Premium ($199) and Premium Plus ($479) plans meet MEC requirements.

Part B (Affordability Standard)
In 2024, ACA affordability is based on 8.39% of an employee's household income. In 2025, it's projected to rise to 9.02%.

Reef Health's employer-sponsored plans make ACA compliance simple for Applicable Large Employers (ALEs) with 50+ employees. For ALEs needing affordable and compliant healthcare solutions, Reef Health provides a cost-effective alternative that meets minimum contribution requirements.

Does Reef Health cover people in all 50 states?

Yes! Reef Health provides nationwide coverage.

Employees across all 50 states can access:
• Virtual care & telehealth
• Direct provider and hospital care
• Concierge support for seamless healthcare navigation

No matter where your employees are located, they can receive high-quality, affordable care.

What healthcare services are included in Reef Health plans?

Reef Health offers customizable plans that may include:
• 24/7 Virtual Care (Telehealth Services)
• Preventive & Primary Care
• Urgent Care & Hospitalization Support
• Prescription Drug Savings
• Mental Health & Wellness Services
• Chiropractic & Alternative Therapies
• Specialist Care Coordination

Our goal is to provide comprehensive coverage without high deductibles or surprise costs.

How does Reef Health handle prescriptions and pharmacy costs?

Reef Health works directly with pharmacies, eliminating pharmacy benefit managers (PBMs) that inflate drug prices.

Prescription Benefits:
• No-cost generic medications included in many plans
• Discounted brand-name drugs through direct pharmacy partnerships
• Transparent pricing so members always know their costs upfront

By cutting out PBMs, Reef Health ensures lower prescription costs for both businesses and employees.

Do you have to switch doctors to use Reef Health?

No! You can keep their preferred doctors while still benefiting from Reef Health's cost-saving approach.

Members have three options:
• Use Reef Health's direct provider network
• Visit out-of-network providers with cost-saving guidance
• Access telehealth & virtual care for added convenience

If a doctor is currently out-of-network, Reef Health will work to onboard them, with a high success rate in making them an in-network provider.

How much do businesses need to contribute to provide Reef Health?

Employers can choose from three contribution models:
• Fully fund coverage for employees
• Partially fund the cost
• Allow employees to self-pay

Employer contributions start at $199 per employee per month for hospital and in-person care—significantly lower than traditional insurance premiums.

Additional Options:
• $29 & $99 non-hospital plans for virtual health and wellness benefits
• Employers can cover these plans at no extra cost to employees

Reef Health provides flexible options to fit any business budget.

What if my business already offers traditional health insurance? Can I still use Reef Health?

Yes! Reef Health can be used as a standalone alternative or as a supplement to traditional insurance.

Why businesses add Reef Health:
• Up to 40% cost savings over traditional plans
• Affordable options for part-time & uninsured employees
• Lower healthcare expenses while maintaining essential benefits
• Concierge-level service with fewer out-of-pocket expenses

Many businesses use Reef Health to provide flexible and affordable healthcare solutions while reducing overall insurance costs.

How do you enroll in Reef Health?

Enrollment is simple and hassle-free!

1. Fill out an online contact form
2. Schedule a call with our sales & support team
3. Select the right plan & complete enrollment
4. Gain immediate access to:
• Virtual care
• Concierge support
• In-network services

Reef Health's integrated technology makes it easy for businesses to manage enrollment, billing, and employee healthcare access—without the red tape of traditional insurance.

Who Does Reef Health Use for Their Health Network Service Providers?

Reef Health partners with the PHCS Practitioner Network (through MultiPlan) for its in-person care network. This gives members access to over 800,000 doctors, hospitals, and healthcare professionals nationwide. Since Reef Health is able to onboard any doctor, they consider themselves to be in Open Network.

In addition to PHCS, Reef Health also leverages Redirect Health's own Care Navigation services to schedule care, manage costs, and optimize member experience — providing 24/7 virtual care, referrals, and case management to ensure the best possible outcomes at the most affordable prices.

Summary:
• In-Person Care Network: PHCS Practitioner Only Network (MultiPlan) – approximate 1 million providers.
• Virtual and Navigation Support: Redirect Health's 24/7 Care Team through the Redirect Health Member App.

Important: Members can also request to add a doctor to the network with 48 hours' notice if their preferred provider isn't already listed.

If a Doctor I Want to See Is Not In-Network, Can I Still Use Them?

Yes, you can still use a doctor who is not currently in-network!

Reef Health makes it simple:
• You can request to add your preferred doctor to the network by notifying Redirect Health at least 48 hours before your visit.
• Redirect Health will work to negotiate and add the doctor under their Usual, Customary, and Reasonable (UCR) agreement.
• If the doctor agrees, your visit will be treated as in-network with minimal or no additional costs.
• If the doctor does not accept the agreement, you can still see them, but out-of-network costs may apply.

Summary:
• Submit a request 48 hours in advance to add your preferred doctor.
• Redirect Health will attempt to add the doctor to the network.
• If successful: Your visit is treated as in-network.
• If not: You can still proceed, but at out-of-network rates of $20.

Always contact the Redirect Health Care Team through the Member App for assistance before your appointment!

How to Best Utilize the Redirect Health Plan?

The best way to use your healthcare plan is to start by downloading the Redirect Health Member App. If you have any dependents 16+, ensure that they have the App downloaded on their phones as well to ensure a seamless experience.

What If I Need to Fill a Prescription?

Start by downloading the Redirect Health Member App and selecting \"Prescription Refills.\" Simply fill out the requested fields and a Redirect Health Provider will reach out at a time that works best for you to discuss further. We always aim to find the most affordable price for your prescriptions and work directly with your preferred pharmacy to set up your prescriptions. Just like with any change of insurance you may see changes in what is covered on your new insurance's formulary. To view overview pricing for prescriptions, you can view the Rx Formulary. If you are unable to download the App, you can also request a prescription refill at RedirectHealth.com/ExtraHelp or by texting or calling us at 888-407-7928.

Did You Know? Most times the same prescription can be found at a significantly lower cost by visiting a pharmacy within a grocery store.

What if I get a refill or new prescription from my provider in person?

We still recommend contacting Redirect Health to make sure you are getting the best pricing. If you get to the pharmacy and they tell you a price that does not match your copay tier, call Redirect Health right away. Chances are the pharmacy is not running your card correctly or needs to update your insurance information. We will call that pharmacy in real time to make sure you have the correct pricing.

If I Have Specialty or Non-Formulary Medication Does Redirect Health Have Any Solutions to Help Me?

We absolutely have many solutions for these kinds of prescriptions. Below are the solutions our Prescription Advocacy Team can help with. Please note this is why we highly encourage members to activate immediately after enrolling. This will spark our care and provider team to begin working on any upcoming refills or pricing solutions.

• Look to see if there is a cheaper generic version. You can provide our Redirect Health Formulary to your prescribing providers to see if there is another medication on our formulary for a lower price that your provider recommends
• Our Chief Medical Officer, Dr. Johnston, can personally review your case to see if we can add your prescription to your custom formulary at a lower copay or provide you with a week to two-week supply at a lower copay to allow our care team time to provide more pricing solutions.
• Did you know most prescriptions can also be found in Canada for half of the price? Our Prescription Advocacy Team is always happy to look into these options for you! However, please note, due to FDA regulations, some drugs may not be allowed within the United States just yet.
• Look into Patient Assistance Programs directly through the drug manufacturer. Most program members can still get their medications from a $0-$20 cost. Contact us and we will help discover what you may be eligible for.

How Do I Schedule Visits?

Scheduling is easy! All you need to do is download the Redirect Health Member App and click on \"Medical Need\" to be guided through the medical need process. A Redirect Health Provider will call you at your selected time to discuss further. If you need a prescription, we will fill it for you at your preferred pharmacy. If further evaluation is needed, an in-office appointment will be scheduled for you with your preferred provider and at a time that works best for you. If you are unable to download the App, you can also schedule an appointment by calling or texting us at 888-407-7928.

How do I schedule an in-person appointment?

We take care of this for you after you submit your Medical Need in the Member App! We will help you schedule your appointment and inform the office of your copay or member responsibility. We will also explain to them how they will need to submit a claim to the MultiPlan PHCS network for proper billing.

What if I already scheduled an appointment or follow-up visit?

Simply let us know through the Redirect Health Member App as soon as you are aware of the appointment time so we can document the appointment and let you know what your expected copay or member responsibility will be. If you are unable to download the App, you can also notify us by calling or texting us at 888-407-7928.

What if I Need to See a Specialist of Need Imaging or Lab Services?

After downloading the Redirect Health Member App, simply select the option \"Medical Need\" and provide some details about what specialist or imaging you need. The Care Team will reach out to you at a preferred time to confirm what is needed. The Team will locate the best price for your care and set up an appointment at a time and location that works best for you. If you are unable to download the App, you can also give us a call at 888-407-7928. To view overview pricing for labs, view the Lab Formulary.

Where Can I Find My ID Card?

Your ID card for you and all of your dependents is in the Redirect Health Member App. Simply download the app and click \"My Membership Card\" to view. If you are unable to download the App, you can also request a digital/physical card at RedirectHealth.com/ExtraHelp or by texting or calling us at 888-407-7928.

I've Received a Bill from My Provider. What Do I Do?

We find that when one our members receive a bill from a facility, this usually means either:

A. Your visit may have not been guided by our team, so the facility wasn't given the appropriate information for billing.
OR
B. The facility didn't send us a claim, even though your visit was guided.

That's okay! Just let us know by submitting your bill in the Redirect Health Member App. We will contact your provider to ensure they send us a claim so we can submit payment appropriately, per your plan benefits. When you submit a bill, please be aware that your provider must also submit a claim in order for Redirect Health to pay it. Claims can take up to 45 days for payment to be completed. If you are unable to download the App, you can also submit bills or receipts at RedirectHealth.com/ExtraHelp or by texting or calling us at 888-407-7928.

If I Have a Medical Emergency, do I Still Need to Call Redirect Health First?

We know in a serious emergency you may not be able to give us a call or text right away. Please call 911 and visit the ER. As soon as you are able to, please contact us in the Redirect Health Member App or by calling us at 888-407-7928 to let us know which ER you are at so we can start coordinating your visit. You may also show a provider your ID card and they can give us a call to let us know you are there.

What if I Need to Have Surgery?

Health first. You can contact us through the Redirect Health Member App. We will immediately begin coordinating with the provider and facility and negotiate the rates, so you get the best pricing. From there, we will work with you from beginning to end to explain your member responsibility, your aftercare, and any follow-up appointments. If you are unable to download the App, you can let us know about your upcoming surgery at RedirectHealth.com/ExtraHelp or by texting or calling us at 888-407-7928.

Franchise the evolution of small business health benefits.

We save American companies a fortune on healthcare + benefits.

What are Reef Benefits? 5 pillars of better health.

Medical & Mental

Physical & Financial

Social

Why franchise? No brick + mortar overhead. No royalties. No ad fund fees. Just low cost entry and a prebuilt lead pipeline.

Sound too good to be true? We've heard that one before.

We remove the middle man.

We evolved the dinosaur model of insurance + healthcare.

Proven + loved by over 100,000 covered members.

Easy Appointments

Saved Thousands

Game-Changing Benefits

Huge Value & Convenience

Frequently Asked

Join 100,000+ community members who chose Reef Health for better coverage