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What's the difference between exclusive and wide provider networks and is one better than the other?

Posted February 01, 2022 by Steve Chrzanowski, Director, Group Retention & Sales Support

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Choosing group healthcare for your business is a big task. Not only do you want to offer employees affordable options, but you also want them to have convenient access to local providers. So, in addition to considering the monthly premiums, deductibles and co-pays associated with a plan, it’s important to look at the facilities, pharmacies, labs and providers that are part of a network.

To give consumers better value, many insurers offer plans that are less expensive but limited as far as the providers and facilities a person can go to for covered services. This is referred to as an exclusive network. These networks will offer all the providers you need to get quality care, but may not have every provider in your area. Exclusive network plans can be a good choice for people who are looking for quality networks with upfront cost savings. Sometimes giving up a little, can save you a lot.

Conversely, plans with broader networks cost more, but they feature more providers, specialists and facilities and are usually spread out across a wider geographic range. This type of plan may appeal to people because it’s less restrictive and offers more options for care.

What’s nice about SummaCare is some employers let their employees choose what’s right for them. Employer groups with at least 51 employees can offer multiple networks as a dual network offering or can customize plans to their specifications. Multiple Employer Welfare Arrangement (MEWA) small groups with 10-50 enrollees can have up to two network options. Pairing two networks together features both provider access and savings for employers and employees alike. Some employers may want to offer two networks and provide a lower contribution to those employees choosing the exclusive network, lower cost plan.

SummaCare offers access to healthcare providers through both the SummaCare contracted network and affiliate networks – minimizing employee out-of-pocket costs when participating providers are used. Employees can use the “Find Your Doctor or Hospital” tool located on the SummaCare website to help them locate in-network providers for a specific plan.

Below we break down our different plan options as well as maps of hospitals included in each. Before deciding which plan is right for your company, we encourage you to contact a SummaCare sales team member who can go over all the details with you.

The Preferred Choice Network
The Preferred Choice Network is an exclusive network offering preferred access to three of the area’s premier health systems – Summa Health, Cleveland Clinic and Akron Children’s Hospital – all at a preferred price. The Preferred Choice Network includes 20 hospitals – including Cleveland Clinic Akron General – and more than 8,000 providers. See a map of hospitals in The Preferred Choice Network.

SCPremier is SummaCare's most comprehensive PPO network consisting of more than 22,000 providers and over 60 hospitals, including Cleveland Clinic, Cleveland Clinic Akron General, Summa Health System and University Hospitals. SCPremier also features access to statewide providers and emergency and urgent care services nationwide through our affiliation with First Health Network. It's available to groups of 51 or more employees in our 20-county service area as well as employers with 2-50 employees participating in a MEWA through the Greater Akron Chamber Benefits Plan. See a map of hospitals in the SCPremier network

SCSelect is a specialized PPO network that includes access to thousands of providers and some of the area's finest hospitals, including Summa Health System and University Hospitals. SCSelect features access to statewide providers and emergency and urgent care services nationwide through First Health. See a map of hospitals in the SCSelect network.

The SCConnect network features Summa Health's Accountable Care Organization (ACO), NewHealth Collaborative. SCConnect offers care through an exclusive network of providers while minimizing costs. NewHealth Collaborative features more than 30 enhanced Patient Centered Medical Home (PCMH) locations, which have received National Committee for Quality Assurance (NCQA) recognition and offer a team approach to care. SCConnect provides the best access to Summa Health. It's available to small businesses with 2-50 employees located in Summit, Stark, Portage and Medina counties. See a map of hospitals in the SCConnect network.