Employer & Self-Funded Plans in Denton, TX

Plain-English explainer

Three names, three different jobs

1. Your employer pays the bills. In a traditional plan, an insurance company takes the risk. In a self-funded plan, your employer pays employees' medical claims out of its own funds. Bigger employers and school districts often choose this because it costs less to run.

2. A TPA runs the paperwork. Employers hire a third-party administrator (TPA) to do everything an insurer normally does day-to-day: enrollments, ID cards, processing claims, answering phones. The TPA's name is usually the biggest name on your card — which is exactly why these cards confuse everyone.

3. A network decides where you're covered. Neither your employer nor the TPA builds a list of doctors. They rent a provider network — Cigna, Aetna, MultiPlan/PHCS, First Health and others. Clinics sign contracts with these networks. So when you ask "do you take my insurance?", the honest answer depends on the network named on your card — not the TPA's name.

Administrators we see often

Got one of these names on your card?

• Allied Benefit Systems — TPA; many Allied-administered plans use the Cigna PPO network
• AmeriBen — TPA; plans use various national networks, including several we participate in
• Meritain Health — TPA (an Aetna company); many Meritain-administered plans use the Aetna network
• Freedom Life (USHEALTH Group) — individual plans from Freedom Life Insurance Company; plans typically access the PHCS / MultiPlan networks

And one name that works differently: Curative Health is an insurance company, not an administrator — and Evolve Health is directly in-network with its EPO, PPO and PPO Max plans.

Find your network

How to find the network name on your card

• Front of the card: look for a network name or logo — often in a corner, in finer print than the administrator's name
• Back of the card: the claims address and phone numbers usually belong to the TPA; a network logo often appears there too
• "PPO" wording: if the card mentions a PPO network, that network's name is the one that matters
• Compare with our list: if the network is on our accepted plans page, your visits are very likely covered in-network
• Still not sure? Call us at (940) 257-2002 — describe the card and we will sort it out with you, free

Visiting Denton?

One more special case

Kaiser Permanente member visiting Denton? Kaiser doesn't offer plans in Texas, and we are not a Kaiser clinic — but if you need care while you're in town, read this first for what Kaiser covers when you travel and your options here.

← See the full list of insurance plans we accept