Understanding Prior Authorization in Pharmacy Benefits. Heading to the pharmacy to fill a prescription only to be told it needs prior authorization can be frustrating for employees, but it is an important step in the healthcare system.In many pharmacy benefit plans, prior authorization is a built-in review step designed to ensure certain medications are safe, […]

Navigating Prior Authorization: A Checkpoint on Your Healthcare Journey. Just like planning a road trip, navigating a medical plan involves important checkpoints along the way. With employee benefits, one of the most important checkpoints is prior authorization, a step that helps ensure the care provided is safe, appropriate, and aligned with the plan’s benefits.Before certain […]

NICE Healthcare is Bringing a New Standard of Care to Indianapolis in 2026. With a shortage of primary care providers, high patient loads, and long wait times, accessing primary care can be challenging. Employees often struggle to get timely care. In fact, in 2023, nearly 85% of adults in the United States saw a physician […]

In today’s competitive business landscape, delivering employee benefits that are both cost-effective for companies and user-friendly for employees is essential. Companies want healthcare options that are clear and affordable, while employees need care that is personal, easy to navigate, and, most importantly, accessible. Navigating a web of referrals, confusing coverage, or long wait times can […]

Designing a benefits program that supports employees means offering tools that work when real life events happen. A Health Savings Account (HSA) can be one of those tools. In this edition of Benefits Architecture: Learn the framework. Elevate the design., we explore how HSAs help employees take control of healthcare costs today while building financial […]

Life has a way of raining down unexpected costs. A trip to urgent care, a child’s dental procedure, or even a round of prescriptions. That’s where a Flexible Spending Account (FSA) can help. Acting like a financial umbrella, an FSA offers protection from those sudden downpours of out-of-pocket expenses.In this edition of Benefits Architecture: Learn […]

Medical care doesn’t end when a patient walks out of the doctor’s office or hospital. The next step in the healthcare journey often arrives in the mail or on an online portal. An Explanation of Benefits (EOB) plays a crucial role in helping employees understand how their claim was processed. Issued by the insurance company, it […]

Navigating health insurance can be challenging, especially during emergencies. That’s why in this edition of the Benefits Architecture: Learn the framework. Elevate the design, we’re taking a deep dive into one of the most useful, but often overlooked, tools in your benefits toolkit: the Summary of Benefits and Coverage (SBC).The Summary of Benefits and Coverage […]

Benefits Architecture: Understanding Copay Plans. Behind every medical decision, there’s a benefits plan quietly working in the background—determining what gets billed, what’s covered, and what the patient ultimately pays. Choosing the right health plan for your people can be challenging, and the best option often depends on your workforce’s healthcare needs and financial situation. While […]

Navigating health insurance can feel like decoding a secret language—especially when you’re trying to help your team make sense of their employee benefits. That’s why we created the Benefits Architecture series—to help employers and employees better understand their benefits and how they work in the real world.Recently, we explored the life of a medical claim, […]