Learn More About Ryze Health
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Eligibility
Independent physicians, benefits-eligible employees of independent practices and your families.
Dependent Eligibility Rules
When you enroll in a benefit plan, you can add the following eligible dependents to coverage:
• Spouse
• Children under age 26 including biological, step, and legally adopted (or placed for adoption)
• Children age 26 or older who have been deemed disabled by the Social Security Administration prior to turning 26.
Coverage Options
Choose from a range of coverage options including preventive care, prescription drug coverage, mental health services, and more. Find the plan that suits you best.
Deductible
The amount that you are responsible for each year before the plan begins to pay for covered services (with the exception of preventive care services, which are covered 100% by the plan based on age guidelines). Non-covered items do not count toward the deductible, and your deductible can vary by how many family members are covered and the networks your providers participate in. Deductible amounts incurred in different network tiers will cross over and be counted in the other network tiers.
Copayment
This is a fixed amount you pay to receive services. Your copayment(s) will count towards your out-of-pocket maximum but not your deductible.
Coinsurance
This is your share of the expense when the plan is paying a percentage, after your deductible is met.
Out-of-Pocket
The annual limit on your expenses for deductible, copayments and coinsurance. Like the deductible, your OOP Maximum will (OOP) Maximum vary depending on how many family members are covered and the networks your providers participate in. However, OOP Maximum amounts incurred in different network tiers will cross over and be counted in the other network tiers. After your expenses have met the OOP Maximum, the plan will pay 100% of covered services for the remainder of the calendar year.
HSA Account
Health Savings Account. It's a tax-advantaged savings account designed to help people save and pay for qualified medical expenses. The funds no not expire at the end of the year. Single and family savings limits apply. Please make sure you check the annual limits each year.
Coverage Benefits
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Primary Care Visit to Treat an Injury or Illness
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Specialist Visit
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Other Practitioner Office Visit (Nurse, PA)
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Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
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Outpatient Surgery Physician/Surgical Services
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Preventive Care/Screening/Immunization
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Urgent Care Centers or Facilities
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Emergency Room Services
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Emergency Transportation/Ambulance
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Inpatient Hospital Services (e.g., Hospital Stay)
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Inpatient Physician and Surgical Services
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Prenatal and Postnatal Care
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Delivery and All Inpatient Services for Maternity Care
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Routine Eye Exam for Children
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Eye Glasses for Children
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Dental Check-Up for Children
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Well Baby Visits and Care
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Abortion
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Family Planning
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Rehabilitative Occupational & Physical Therapy
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Rehabilitative Speech Therapy
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Outpatient Rehabilitation Services
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Habilitation Services
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Generic Drugs
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Preferred Brand Drugs
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Non-Preferred Brand Drugs
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Specialty Drugs
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Mental/Behavioral Health Outpatient Services Mental/Behavioral Health Inpatient Services
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Substance Abuse Disorder Outpatient Services
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Substance Abuse Disorder Inpatient Services
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Skilled Nursing Facility
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Home Health Care Services
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Hospice Services
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Transplant
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Dialysis
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Chemotherapy
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Radiation
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Diabetes Education
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Infusion Therapy
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Reconstructive Surgery
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Durable Medical Equipment
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Imaging (CT/PET Scans, MRIs)
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Laboratory Outpatient and Professional Services
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X-rays and Diagnostic Imaging
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Allergy Testing
What Happens the First Time You See a Doctor?
When you first join Ryze our team asks you for your doctors and we proactively contract with them and their practices.
As a member of Ryze, when you need to see a new provider,
you start by contacting the Smart Care Navigator - your 24/7 health concierge.
They will schedule your appointment for you.
At the same time in the background our team will work to directly with your doctor.
As long as they take insurance we can contract with the provider so that when you arrive they will already be in Ryze’s network.
What if there is a situation where you see a provider directly?
See the sample insurance card and the steps laid out below.
Show card or provide information to provider prior to your visit
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Ryze Health will always be your primary network
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You will have also have a nationwide network provided by Cigna or BlueCross Blue Shield. You will have one or the other but not both.
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EDI (Electronic Data Interchange) number is needed to to check with Cigna/BCBS clearing houses.
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The provider can also call us directly for eligbility and coverage
Who's in the Ryze Network?
Ryze is accepted at over 90% of providers and hospitals across the nation so you can see your existing doctor and feel at ease when you travel cross country.
Ryze direct network: Ryze is building out our direct network with practices and hospitals
Ryze nationwide network: Ryze utilizes Blue Cross Blue Shield and Cigna for our extended network (in network). Your ID card will indicate the nationwide network you are on.
What is Considered Out of Network?
The only scenarios where you would be out of network
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The provider does not take any form of insurance
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The provider does not take Blue Cross Blue Shield or Cigna
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The provider is unwilling to contract directly with Ryze
If Ryze Offers Both Cigna and Blue Cross Blue Shield Am I On Both Networks?
No you will have one of the two networks based on which has the stronger network in your home location.
Ryze network will always be the primary network
Why Would a Provider Want to Contract with Ryze?
Ryze is private insurance which is the majority of coverage in the US. Both hospitals and independent practices are used to taking private insurance.
As a champion of private practice, Ryze pays a higher reimbursement rate to independent providers than other insurances which creates a strong incentive to contract with Ryze.
Faster payment. You get paid in days vs weeks or months.
Can You Go to Local Pharmacies?
Yes you can go to local pharmacies as they are on a common network. This includes all the big pharmacy chains such as Walgreens and CVS as well as your independent pharmacies. Members have access to a live search function in your member portal.
How Does Ryze Cut the Cost of Prescriptions?
We use preferred mail order partners and leverage advocacy programs such as 403B plans and direct manufacturer partnerships to lower costs for members
What Labs are in Ryze’s Network?
Ryze has large group and hospital labs in network.
As champions of independent providers we actively incentivize patients go to go independent labs. If you have a preferred independent lab please call the support number on your membership card so that we can check eligibility.
Are Dental and Vision Covered?
Dental and vision insurance only covers routine check ups, glasses/contacts, teeth cleaning, orthonditics and endodontics.
We don’t recommend this type of coverage because these routine costs are low enough that it is more beneficial to save the money and pay directly out of pocket rather than pay a company to hold and administer your own money.
However, Ryze does cover medical dental and medical vision as part of your health insurance.
These vision and dental services are not covered
For normal dental care benefits, including any dental, gum treatments, or oral surgery,
except as otherwise specifically provided herein.
Vision Care. Expenses for the following are not covered:
1. For eye refractions, eyeglasses, contact lenses, or the vision examination for prescribing or fitting
eyeglasses or contact lenses (except for aphakic patients, and soft lenses or sclera shells
intended for use in the treatment of Illness or Injury).
2. For refractive procedures or other plastic surgeries to correct vision in lieu of eyeglasses.
3. Vision therapy (orthoptics) and supplies.
4. Orthokeratology lenses for reshaping the cornea of the eye to improve vision.