Flexible, consistent plans for employers
Already a Pinnacle employer?
Looking for plan tools, forms, or account resources? Head to PERC, Pinnacle’s employer resource center, for quick access to the information and support you need.
Health benefits support that makes your job easier
Your benefits plan should work hard for your people without creating more work for your HR team. That’s why we help employers manage self-funded health benefits with experienced account support, practical cost-containment strategies, and a team built to solve problems before they become headaches.
Why employers choose us
Managing benefits shouldn’t mean managing chaos. We’re the benefits solutions partner who will work with you every step so benefits work in real life.
Less lift for HR
We help take employee questions, claims issues, vendor handoffs, and benefits confusion off your team’s plate, so HR can spend less time chasing answers.
Cost control you can explain
From out-of-network negotiation to subrogation, utilization management, case management, and chronic condition support, we help manage costs with strategies employers can track and understand.
Support employees can actually use
Members get access to real people, practical guidance, and digital tools that help them find answers, use their benefits, and get support before small issues become bigger ones.
Visibility beyond renewal season
Reporting and plan reviews help employers understand what is changing, where costs are coming from, and where adjustments may make a difference.
A smoother path to self-funding
We help employers and consultants think through funding, stop-loss, captives, plan design, partner needs, and implementation details with more confidence.
One team coordinating the moving pieces
Benefits involve a lot of partners. We help reduce the runaround by keeping responsibilities clearer and support more connected.
Self-funded support without the guesswork
Moving to a self-funded plan can open the door to more flexibility, better data, and stronger cost-control opportunities, but only if the plan is built and managed with care. We help employers understand the moving pieces, evaluate what makes sense, and put the right support around the plan from the start.
Funding strategy
Understand whether self-funding, level funding, stop-loss, or captive options may fit your workforce and risk profile.
Plan design
Build benefits around your people, cost goals, provider access needs, and long-term strategy.
Partner coordination
Connect the network, PBM, stop-loss, clinical programs, and point solutions without creating more confusion for members.
Member experience
Give employees clearer tools, guidance, and support so the plan is easier to use.
Performance visibility
Use reporting and plan reviews to understand what is happening and where to improve.
A smoother transition, from quote to go-live
Switching health benefits partners can feel like a lot. We make the process clearer from the start, with realistic timelines, organized implementation support, and a team that helps keep each step moving.
An extension of your HR team
HR teams are asked to do a lot: benefits education, employee questions, issue resolution, compliance coordination, vendor management, and everything in between. We help reduce that burden with experienced account managers and client service teams who understand your plan and stay close to the details.
That means fewer unresolved employee complaints sitting on HR’s desk, faster answers when questions come up, and a partner who knows the difference between “we’ll get back to you” and actually getting it handled.
Dedicated account support
A steady account team helps manage plan questions, renewals, reporting, and issue resolution.
Client service support
Our service team helps members and employers with everyday benefits questions, claims support, ID cards, and more.
Open enrollment support
We help employees understand their benefits through practical education, onsite support, and clear communications.
Issue escalation
When something needs more attention, we bring in the right people and keep the follow-through moving.
Benefits employees know how to use
A plan only works when employees know where to go and what to do next. We help members access benefits information, ask questions, find support, and use the tools available to them before they are in a stressful healthcare moment.
HealthView for members
A secure, mobile-friendly front door where members can access plan details, claims history, EOBs, ID cards, provider search, forms, and chat support.
Practical member communications
We help employers turn plan details into clearer communications, open enrollment materials, onboarding resources, reminders, and education members can actually use.
Onsite and year-round engagement
From open enrollment to health fairs and 1:1 help sessions, we support employees where benefits questions happen.
Practical cost control for financial leaders
For CFOs and finance teams, health benefits need to make financial sense. We help employers manage plan costs with practical strategies that are measurable, trackable, and built around real plan performance.
Cost-control areas we support
Out-of-network claim negotiation
We help manage surprise and out-of-network claims with negotiation strategies designed to reduce unnecessary spend and protect the plan.
Subrogation recovery
We identify and pursue third-party liability opportunities, helping recover dollars that can be credited back to the plan.
Payment integrity and bill review
We review claims for accuracy, coding issues, upcoding, unbundling, and other billing details that can drive avoidable spend.
Utilization management
We review care for medical necessity and appropriateness, helping employees get the right care while reducing avoidable costs.
Case management
We support members with complex health needs through coordinated guidance that can improve outcomes and reduce high-cost claim risk.
Chronic disease management
We help members manage ongoing conditions with proactive support, reducing complications and helping control long-term plan costs.
Plan reporting and performance visibility
We give employers clearer insight into plan activity, cost drivers, and savings opportunities so they can make informed benefits decisions.
Already a Pinnacle employer?
The Pinnacle Employer Resource Center (PERC) gives employers quick access to plan tools, forms, reports, and account resources so your team can find what it needs without starting from scratch every time.
Whether you’re checking plan information, requesting support, or pulling reports for a benefits conversation, PERC helps keep the day-to-day work moving.
Access plan and benefit information
Find key plan details in one place, so your team can quickly confirm coverage information and answer benefits questions with more confidence.
Run reports
Pull the reports you need to review plan activity, support internal conversations, and stay closer to what is happening across your benefits program.
Submit customer service requests
Send support requests directly through PERC, helping route questions and issues to the right team without extra back-and-forth.
Request ID cards
Request member ID cards when employees need replacements or additional support accessing their plan information.
Make updates at your convenience
Handle common plan or account updates when it works for your schedule, instead of waiting for the next email thread to get started.
Find forms and employer resources
Access commonly used forms, documents, and resources that help your team manage day-to-day benefits administration more easily.
Who works with us
Our experienced team works hard to create lasting relationships driven by industry knowledge and expertise, so we can provide long-term solutions and improve care outcomes meaningfully.
FAQs
Finding the right health plan for your employees can be daunting. Here are a few common questions we get about our services, and answers on how we can meet your needs.
In many cases, yes. Pinnacle’s flexible administration platform is designed to integrate with a wide variety of networks, pharmacy benefit managers, stop-loss carriers, and other healthcare vendors. Clients can maintain their existing relationships or leverage Pinnacle’s preferred solutions, including Pinnacle Rx Solutions for pharmacy benefits. We also support a broad range of network and cost-containment strategies, including partnerships with organizations such as Valenz, Fairos, and Imagine360, allowing employers to build a solution that best fits their needs.
Coverage for maternity, fertility, and family-building benefits varies by plan. To understand what services are covered under your specific benefits package, review your Summary of Benefits and Coverage (SBC) in the HealthView member portal or contact Customer Service for assistance.
Members can access HealthView via the online member portal to view health benefits information, claims status, provider lookup, and other features. Access is available through the website.
Preventive services are typically covered at 100% when received from an in-network provider. However, coverage can vary by plan, so please contact your HR team to confirm the preventive care benefits available under your specific plan.
Reach out to a benefits consultant representative
Have questions about our services? Want to get started with us? Reach out, we’re happy to get the conversation moving.
