Meet ClearPay: A New Era in Small Group Plan Design
Why Now? Timing the Launch for Peak Broker Value
Small group renewal season is here, and with it comes pressure: rising premiums, member dissatisfaction, and intense competition for every case. ClearPay gives brokers a truly differentiated option to cut through that noise.
Traditional plans have leaned harder than ever on deductibles and coinsurance to control costs. But for the average small business employee, that means less coverage, more complexity, and more financial risk.
ClearPay flips that model on its head, removing those barriers and restoring transparency. Brokers finally have a plan design that feels different and solves real pain points.
How It Works: Simplicity for Members, Value for Employers
ClearPay replaces deductible-based cost sharing with dynamic, provider-specific copays. Each copay is calculated based on a “value score” that considers provider cost, quality, and balance billing risk. The better the value, the lower the copay.
Member experience
- Search for care via a mobile-optimized tool
- See real copay prices for specific providers in their area
- Lock in the copay with one click, guaranteed at the time of claim
- Pay the exact amount—no surprises, no coinsurance math
Example
- Provider A (high quality, low cost): $200 copay
- Provider B (average): $500 copay
- Provider C (low quality, high cost): $1,500 copay
That $500 for an outpatient surgery? It’s all-in—not per claim, not per provider. One copay covers the entire episode.
The platform even includes concierge support. If a member calls for help, Optimyl’s support team can impersonate their view in the system, walking them through care options live. It’s all about guidance, transparency, and confidence—without friction.
Broker Benefits: Win More, Quote Faster
- No direct-to-employer sales
- No house accounts
- No conflicts of interest
This product is only available through licensed brokers. You get full support from our Regional Sales Directors and onboarding teams—plus ExpressScreen underwriting to speed up quoting without sacrificing pricing accuracy.
ClearPay also integrates with the full Optimyl toolbox:
- Stop-loss refund rider for groups with a loss ratio under 70%
- 100% RX rebate pass-through options for employer savings
Key Eligibility & Market Guidelines
Availability
Groups with 2–300 enrolled employees (soft cap). Network and state-specific rules apply.
Networks
- Cigna OAP
- Reference-Based Pricing
Copay Ranges
| Service | Range |
|---|---|
| Specialist Visit | $20 – $250 |
| Outpatient Surgery | $500 – $5,000 |
| Max Out-of-Pocket | $9,000 |
Underwriting Notes
- No employee choice (ClearPay must be selected as a standalone plan)
- ExpressScreen available for faster, broker-friendly IHQ underwriting
State Restrictions
- RBP not available in FL, TX, WI
- Cigna OAP not available in AL, AK, IA, ID KY, MO, NE, NM, MT, SD, OK, WY
- Zip code–level exclusions may apply in rural areas with limited provider density
Ready to Quote Your First Case?
ClearPay is open for quoting now, ideal for Fall effective dates and beyond. Whether you’re defending a renewal or breaking into a new account, ClearPay offers a conversation-starting plan design that’s easy to understand and hard to beat.
- ✅ No deductible.
- ✅ No coinsurance.
- ✅ No guesswork.
Contact your Optimyl Sales Director today to quote ClearPay for your next group. Or email sales@optimyl.com to learn more.
