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Escape the beast. Design your own health insurance.

Yuzu administers custom-built employer health plans. We build the tools to do this in-house so your care models and incentive structures are integrated and whole.

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We Exist for Plan Designers

An employer health insurance plan is a social contract binding a group of people to common principles of how to take care of themselves and spend shared resources. A health insurance plan doesn’t need to be bureaucratic, antagonistic, or confusing. Traditional Network-Style health plans have made it feel like this is the only option.

Yuzu exists to empower Plan Designers who see things differently. Plan Designers are industry leaders who have a vision of how to make health insurance better for employees, their dependents, and their employer sponsors.

We support Plan Designers who have designed plans around direct primary care and smart navigation to providers who accept direct cash payments. Building plans this way eliminates the admin work of filing low-dollar claims and gives members certainty they won’t get any surprise bills. Yuzu’s north star is a world where health insurance plans are “claimless”.

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DPC + Yuzu

Putting deep and real primary care at the center of health plans

For direct primary care (DPC) plans, Yuzu can:

  • • Include DPC fees in health insurance premiums, instead of having these fees be an extra expense.
  • • Refer patients without paperwork. DPCs function as the prior auth layer of plans, instead of fighting it.
  • • Wholesale labs and images, when recommended by a DPC, are covered with no member cost-sharing.
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    Navigated Cash-Pay

    Get access and affordable prices through directly paying providers

    Care navigation plus direct cash-payment is a lower-admin version of direct contracting. By having patients present as “self-pay”, they can get better rates than what national networks are paying, see more providers, and eliminate the possibility of balance bills.

    With Yuzu, these self-pay claims can be covered by insurance. This includes medical and pharmacy claims paid out of pocket or with navigation assistance.

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    Batteries Included

    Yuzu builds tools in-house so endless partnerships and complexity are not needed.

  • • We build new integrations (with PBMs, etc) in-house for free since we built our own EDI integrations stack.
  • • We can generate custom reporting for no added cost to help you show stakeholders the value your Plan Design provides.
  • • We perform compliance, stoploss quoting, and plan design drafting services for no added cost.
  • • Yuzu has member and employer dashboards that offer some customization and come for free.

    • How it actually works

    Plan Design + Launch

  • 1. You decide the plan’s benefit categories, cost-sharing, and care model. Yuzu helps advise based on tradeoffs we have seen and capabilities we have.
  • 2. You talk to employers who are excited about your model. Together with Yuzu, you collect the information needed to get these employers level-funded health insurance quotes.
  • 3. Yuzu shops for competitive stoploss quotes for the employers interested in your plan. We come back to you with a detailed and itemized cost breakdown and proposal.
  • 4. About 60% of groups are able to get at least one quote that beats their current health plan option, even with new plan designs.

    • Plan Ops + Improvement

  • 1. Once a group is won, Yuzu manages all tasks related to onboarding the group to their insurance including printing member ID cards, giving users access to online portals, and crafting custom documentation and plan documents for groups.
  • 2. Yuzu manages billing, compliance, and day-to-day plan operation including claim adjudication, eligibility verification, provider payments, accounting, reporting, and stoploss claims filing.
  • 3. Yuzu provides you full visibility into claims, eligibility, and more so that you can get the data and the access you need to ensure your plan design thrives and its benefits can be communicated to future customers and partners.
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    Contact Us

    Use our suite of plan-adjudication technology to bring your health insurance plan designs to life.

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