What You Need to Know
Bright HealthCare focuses on personalized care with an online platform that makes it easier for customers to schedule appointments, pay bills and more.
The insurer counts more than 200,000 people across 12 states as members.
Bright HealthCare is an exclusive provider organization (EPO) and prides itself on its Care Partners, a curated network of doctors, clinics and hospitals.
Who Is Bright HealthCare?
Formerly Bright Health Plan, Bright HealthCare is a relatively new insurer focused on a healthcare model of personalized care powered by an intelligent technology platform. Founded in 2015, the Minneapolis, Minn.–based company has grown from serving its initial pilot market of Colorado to now having more than 200,000 members across 13 states. Cofounder and Executive Chairman Bob Sheehy previously spent over three decades in healthcare innovation. Tom Valdivia, cofounder and chief health officer, is an internist, physician and health informatics innovator.
In April 2020, former UnitedHealth Group Inc.’s Mike Mikan was brought on as the company’s CEO. Mikan also previously served as the interim CEO of Best Buy Co. Inc. In addition, Jeff Immelt, the former chairman and CEO of General Electric, joined the board, as did Kedrick Adkins, a former chief financial officer at Mayo Clinic. The company has raised over $1 billion in funding and plans nationwide expansion.1
Bright HealthCare is an exclusive provider organization (EPO), a type of managed care plan that covers services only if members use healthcare providers in the plan’s network — except in the case of an emergency.2
The company offers its health plans in:
- New York
- North Carolina
- South Carolina
What Health Insurance Does Bright HealthCare Offer?
Bright HealthCare offers health plans for individuals and families, small businesses and employees, and Medicare Advantage plans for seniors. Major medical plans cover the Affordable Care Act (ACA)’s 10 essential benefits, including preventive care, surgeries and hospitalizations, mental health, physical therapy, prescriptions, emergency services and lab work, among other services. These plans are similar to the ACA’s “metal” categories in that higher costs are linked with better coverage, while lower premiums tend to equate to more out-of-pocket costs. Some plans are also combined with health savings accounts.
An individual plan for a person in their 40s in Aurora, Colo., for example (the Bronze 8550 Rx Copay plan), costs $272.88 per month, with an $8,550 deductible, and a $50 copay for each of two primary care visits followed by 0% after the deductible is met. The Bronze 6300 plan is $278.46 per month with a $6,300 deductible and $0 for the first primary care visit followed by primary visit copays of $35.3
Similarly, a family plan for a family of four in Aurora, Colo. (the Bronze 8550 Rx Copay plan), costs $885.37 per month with a $17,100 deductible and a $50 copay for each of two primary care visits followed by 0% after the deductible is met. The Bronze 6300 plan is $903.47 per month with a $6,300 individual deductible and $12,600 family deductible, and $0 for the first primary care visits followed by primary visit copays of $35.4
The company offers a variety of plans for small businesses, including the BHE Platinum 15 Copay Plan, which has an individual deductible of $0, preventative care for a $0 copay, primary care for a $15 copay and a $10 copay for generic prescriptions.5
Its Medicare Advantage plans for seniors include $0 primary provider copays, $0 specialist copays and $0 coverage of commonly prescribed Tier 1 Preferred Generic and Tier 6 Select Maintenance drugs.6
Essential Benefits Covered
Bright HealthCare’s major medical plans cover the Affordable Care Act’s 10 essential health benefits and have no exclusions for preexising conditions.
What Are Member Benefits for Bright HealthCare?
Bright HealthCare prides itself on its Care Partners, which it describes as a carefully curated network of doctors, clinics and hospitals. Many of the healthcare providers the company contracts with feature no referrals, 24/7 nurse phone lines, same-day appointments, after-hours appointments, and predictable (or even $0) costs.
The company also has an intelligent technology platform that provides members with online bill pay, online scheduling, wait-time notifications, text reminders and more. Depending on the state, many plans include $0 unlimited primary care provider visits, $0 deductible plans and lower copays for specialists.7
All of Bright HealthCare’s major medical plans include:
- Financial protections in the case of severe illness
- No exclusions because of preexisting conditions
- Coverage on a parent’s plan until the age of 26
- Coverage for the ACA’s Essential Health Benefits
- Equal monthly premiums regardless of gender8
Bright HealthCare members also have access to phone or video appointments through the company’s partnership with Doctor on Demand, a video telemedicine company.
After Hour Conveniences
The company provides its members with conveniences such as 24/7 nurse phone lines and same-day and after-hours appointments.
How Do You Enroll in Coverage With Bright HealthCare?
Customers can enroll in coverage online on the company’s website or call 844-667-5502. Coverage is also available for purchase through a licensed insurance agent. The company also has Bright HealthCare Authorized Enrollment Centers, which are local offices where potential members can meet in person with a licensed agent or broker to sign up for Bright HealthCare Medicare Advantage plans.9
How Do You File Claims with Bright HealthCare?
The company notes that for Medicare Advantage, it can take up to 60 days to process a claim submission.10
To file claims for individual and family plans, mail them to:
Bright Health Plan
PO Box 16275
Reading, PA 19612-6275
Payer ID CB186
To file claims for Medicare Advantage plans, mail them to:
Bright Health Medicare
PO Box 853960
Richardson, TX 75085-3960
Payer ID BRT01
How Is Bright HealthCare Rated?
As one of a group of relatively new health insurance providers, Bright HealthCare has limited ratings. A.M. Best and Standard & Poor’s have yet to rate the company, nor has Consumer Affairs done so. The company, however, has been rated elsewhere by consumers on customer satisfaction and the number of patient complaints.
Of a total of 21 Accident and Health complaints in 2019 for Bright Hlth Ins Co, 17 were Individual, two Exchange, and one each was Group and Bronze, according to the National Association of Insurance Commissioners (NAIC).11 (“Exchange” refers to the online health insurance marketplaces where consumers can buy health insurance plans.) The Better Business Bureau (BBB) gives Bright Health Inc. an A+ rating and notes 39 complaints in the past three years, from care issues to problems with claims not being paid.12
What Are Strengths of Bright HealthCare?
Bright HealthCare’s model focuses on personalized care, and with its Care Partners it strives to make healthcare more flexible and convenient with no referrals, 24/7 nurse phone lines, same-day appointments and after-hours appointments. Initial costs can also be low, with many plans offering $0 copays for at least initial primary care visits and preventative care appointments.
What Are Weaknesses of Bright HealthCare?
The insurer is relatively new and currently does not have many reviews. Also, it operates in a limited number of states, so coverage isn’t available to everyone.
If you are interested in purchasing a Bright HealthCare plan, first check the company website where you can see if you’re in a coverage area by entering your zip code. If you are, be sure to find out about plans and costs — with an agent or on the website — including copays, deductibles and out-of-pocket limits. Also check the network of healthcare providers in your area. Consider how much coverage you need based on your (and your family’s) health. Finally, make sure you know what you are buying — ask questions and get answers about anything that is unclear.
The views and opinions expressed are those of the authors and do not necessarily reflect the official policy or position of HealthCareInsider.com or HealthCare, Inc.