The Triad Benefits program
A better path for healthcare costs
Where small and mid-size employers finally get the claims data, pricing power, and strategic control that large employers have relied on for years.
Program range and case-study count as published by Apex Benefits Partners. The largest single-group reduction in the reconciled table below computes to 45.7%. Every client figure on this page is drawn from an Apex rate proposal, renewal comparison, or claims review, used in de-identified form — no client is named.
How Triad Benefits works
Simple as fully insured. Powerful as self-funded.
Triad delivers small-group health coverage through a self-funded platform. From the employer's side it behaves like a fully insured plan — a fixed monthly payment, no cash-flow surprises. Underneath, claims are funded through the program with aggregate stop-loss protection, which is what makes the claims data available to you.
Underwrite your risk
We start with your census data, or with employee personal health questionnaires where the group profile calls for it. This is the step that determines whether the program can beat your renewal at all — and we will tell you if it can't.
Learn the program
See how self-funding works for a group your size across eight different PPO plan options on the Cigna network — from richer $1,000-deductible designs through HSA-qualified and value plans. The ladder is the point: you choose where on it you want to land.
Join and see your data
Apex provides monthly de-identified claims analysis to drive wellness strategy, HR decisions, and financial planning — plus a formal mid-year review. This is the part no fully insured small group gets.
What it is, precisely
All plans in the program meet or exceed Affordable Care Act compliance and applicable federal regulatory requirements. Larger organizations have used self-funded arrangements for decades to control cost and manage their own benefit programs; Triad built the same structure for employers who are too small to do it alone.
Depending on group size and year, an employer's arrangement may be structured as level-funded with aggregate stop-loss, or through a small-group medical captive. Confirm your specific funding structure, attachment point, and participation requirements at quote time — they are not uniform across groups.
Why it works in Southern New Hampshire specifically
The program runs on the Cigna national PPO network. In a region where employees live in Nashua, work in Manchester, see specialists in Burlington, and have surgery in Boston, a national PPO is not a luxury — it is the difference between a plan that works and a plan that generates complaints.
Preliminary 2027 New Hampshire small-group filings request a weighted-average increase of 12.4%. When the traditional market keeps producing that answer, employers reasonably start asking what else exists.
Source: ACASignups.net analysis of NH 2027 preliminary rate filings, 08/25/2026. Preliminary filings remain subject to NH Insurance Department review.
The claims data advantage
What you can see that fully insured employers can't
Traditional fully insured carriers provide no claims data to a small group. You pay your premium, you receive your renewal, and you have no way to understand what drove it. You cannot manage a cost you are not allowed to see.
What one month of visibility actually looks like
- Surgery: $9,110 billed across 6 claim lines — identified as the single largest cost driver that month and flagged for monitoring.
- Preventive: 29 ACA wellness claims at $0 member cost-share. Strong preventive utilization, which is a good sign, not a cost problem.
- ER utilization: 2–4 encounters flagged with diagnoses appropriate for urgent care. Telemedicine promotion recommended.
- Pharmacy: 94.7% generic utilization — excellent against an 85–88% industry benchmark. No specialty drug spend in month one.
- Wellness: maternity support, hypertension monitoring, and diabetes management programs recommended based on the group's own diagnosis-code patterns.
- The point: that is month one. A fully insured employer of the same size would have received nothing at all.
Group case studies
Real results. Real employers. Real New England.
Every employer below came to Apex facing a renewal they could not afford. The table shows what happened, with the arithmetic reconciled from the source proposals rather than repeated from a headline. Clients are not named.
| Employer | Size | Incumbent | Incumbent premium | Triad premium | Annual saving | Reduction |
|---|---|---|---|---|---|---|
| PE-backed services New York |
75 EEs | National carrier ~10% renewal |
$1,182,500 | $642,077 | $540,423 | 45.7% |
| Financial services Rhode Island |
24 EEs | Regional Blue plan +13% renewal |
$595,823 | $362,298 | $233,525 | 39.2% |
| Construction Cape Cod, MA |
12 EEs | Regional Blue HMO +4.65% renewal |
$158,993 renewal $166,385 |
$94,343 | $64,650 | 40.7% |
| Fuel, retail & car wash multi-location New England |
~200 EEs | Regional New England carrier | $394,608 | $282,740 | $111,868 | 28.3% |
| Professional services Boston, MA |
44 EEs | Regional New England carrier +26% renewal |
$989,204 | Turned a +26% increase into a 9% decrease — a 35-point swing | −9% | |
Reductions are computed from the premium figures in each column. The Cape Cod reduction is measured against the employer's prior premium of $158,993 — against the $166,385 renewal it is 43.3%. The fuel/retail reduction is measured at a like-for-like $1,000 deductible; leaner designs in the same ladder ran up to 47.5% below the prior premium. The Boston result is reported as published by Apex Benefits Partners; the percentage swing is theirs and the underlying premium detail is available on request. Sources: Apex/Triad rate proposals and client case studies, 2025–2026. Every result is specific to that employer's census, plan design, and underwriting and is not a projection for any other group.
Savings did not mean a worse plan
The Rhode Island group added an HSA-qualified option it never had. The Cape Cod employer raised its contribution to 75% and moved to a broader national PPO. The Boston firm added a $0-deductible PPO option. The New York group reinvested savings into benefits administration and compliance technology.
Anyone can "save" by cutting the plan
The fuel and retail employer's 28.3% is the number measured at the same deductible as the prior plan. That is the honest comparison, and it is the one we lead with even though the ladder had bigger numbers on it.
$17,969 more, off a different line
That same engagement also replaced a state paid-family-leave program with a compliant private plan — $93,017 down to $75,048, a 19.3% reduction, with employee leave protections preserved. Paired with an added group term life benefit, $13,237 in combined net annual savings.
New Hampshire case study · the mid-year review
This is the part nobody else shows you
A New Hampshire professional services employer, roughly 25 enrolled subscribers and 50 covered lives, moved onto the Triad Benefits Cigna plan effective January 1, 2026. By July we sat down with them and put the entire plan year on the table — six months in, with time left to act.
What the data actually told us
Six months of paid-claims detail let us separate signal from noise, which is the whole game at this group size:
- The cost drivers, ranked. Surgery, preventive screening, rehabilitative services, primary care, and specialist visits — each with its own plan-paid dollar figure, not a category guess.
- Professional vs. facility split. Office-based and professional claims ran close to facility claims, consistent with a plan year led by one surgical event plus steady primary and preventive use.
- Pharmacy, drug by drug. A single GLP-1 medication accounted for roughly 40% of all pharmacy spend. The generic dispensing rate came in at 88% across 161 scripts — above the 85–88% industry benchmark, and quietly offsetting that GLP-1 pressure.
- Utilization patterns. An earlier April review counted 211 claim lines and flagged roughly 8–15 emergency room encounters as redirectable to urgent care or telehealth — worth an estimated $400–$800 per redirected visit.
- Stop-loss position. Aggregate filings tracked dollar-for-dollar with paid claims, and the platform export showed a $0 attachment factor — which we flagged to be verified rather than assumed.
Sources: Apex Benefits Partners 2026 Mid-Year Claims & Renewal Review (claims paid through 7/16/2026) and 2026 Year-to-Date Claims Review (paid through April 2026), used here in de-identified, plan-level aggregate form only. No client name, member, diagnosis, procedure, or drug brand is disclosed. Results are specific to this employer's experience and are not a projection for any other group.
Why the mid-year review is the differentiator
Most small-group employers get a renewal letter. That's it.
In a traditional fully insured small-group plan there is no claims detail, no cost-driver ranking, no pharmacy breakdown, and no opportunity to change anything before the number arrives. Triad's reporting, run through an Apex mid-year review, produces all of the following in month six.
- Paid claims by month, split medical vs. pharmacy vs. plan-level
- Top medical cost categories ranked by plan-paid dollars
- Professional vs. facility claim mix
- Large-claimant identification and its share of total spend
- Pharmacy detail: top drugs by cost, therapeutic class mix, generic dispensing rate
- Specialty drug and GLP-1 exposure, tracked rather than discovered at renewal
- Utilization counts: ER encounters, inpatient lines, imaging, preventive visits, script fills
- Deductible progress across the covered population
- HRA funding, utilization rate, and dollars still available
- Aggregate stop-loss position against the attachment point
- Medical loss ratio against premium paid
- An annualized run-rate with and without shock claims, as a renewal range
- Specific, costed steerage recommendations — ER redirection, imaging, telehealth
- Clinical program opportunities the claims actually support, not a generic wellness pitch
The reason this matters in dollars
A mid-year review is not a report. It is the only point in the plan year when an employer can still change an outcome — launch an ER steerage campaign, redirect imaging, fix HRA communication, or adjust next year's plan design with six months of their own evidence rather than a carrier's trend assumption. An employer who first sees claims data in October has already lost the year.
Member stories
Real savings. Real care. Real outcomes.
Premium savings are the employer's story. These are the employee's — what actually happens when a member hits a problem and somebody picks up the phone. Delivered through transparent pharmacy management, the Cigna PPO network, and an embedded 24/7 virtual care benefit.
Specialty pharmacy
A specialty biologic
Newly prescribed, priced at the pharmacy counter
The challenge: $3,559 per fill — a price that stops most people from ever starting therapy.
What happened: one call to the pharmacy savings department. Copay assistance coordinated, same-day eligibility confirmed, prescription routed to a specialty pharmacy in time for the next injection.
Result: $0 out of pocket, every fill, every month. Therapy started on time. No skipped doses.
Mail-order pharmacy
A maintenance inhaler
Same medication, same dose, same brand
The challenge: roughly $400 for a 30-day retail supply — about $4,800 a year, indefinitely, on a medication the member cannot stop taking.
What happened: the medication was sourced through an international mail-order channel and a 90-day supply shipped to the member's home.
Result: $0 for a 90-day fill. Annualized saving of roughly $4,800 on one prescription.
Medical network · imaging
Advanced CT imaging
Physician-ordered scan at a regional hospital
The challenge: member cost for advanced imaging routinely reaches four figures out of pocket on a fully insured plan.
What happened: Cigna PPO network pricing applied, pre-certification handled, and the claim flowed through the platform for plan-level adjudication.
Result: a clean explanation of benefits, no balance-bill surprise, and no appeal to fight. This is the same lever our imaging guide is about.
24/7 virtual care
After-hours family care
The moment when the ER is the only obvious option
The challenge: a family needed care after hours. Urgent care meant a copay, a wait, and lost time. An ER visit meant a bill in the hundreds.
What happened: the embedded 24/7 virtual care benefit connected them to a board-certified provider in minutes, who diagnosed and prescribed in the same video visit.
Result: $0 copay, same-day resolution, no urgent care bill, no waiting room, no time off work.
What's under the hood
The four pieces that make the program work
Triad is not a single carrier product. It is a stack, and knowing which vendor does what is how you evaluate it properly.
Cigna national PPO
Broad provider access with genuine cross-state flexibility, and specialist access without referral gatekeeping. In this region that is the single most important component — employees cross into Massachusetts and Maine as a matter of routine.
See the regional provider mapSecurus Benefits
The third-party administration platform behind claims adjudication, plan-level reporting, and the data that makes a mid-year review possible. Pre-certification handled, clean EOBs, and claims detail an employer can actually use.
DisclosedRx
Transparent pharmacy benefit management, with a savings department that handles copay assistance, manufacturer programs, specialty routing, and mail-order sourcing — the mechanics behind both pharmacy member stories above.
EVO Telehealth
Unlimited 24/7 virtual consults included in the program rather than sold as a rider. The fastest and cheapest first stop for a large share of acute complaints, and in this market the shortest route to behavioral health care.
Behavioral health accessIncluded claims navigation
Someone whose job is to help before the bill arrives
Most cost management happens after the fact, as a denial letter or a balance nobody expected. Claims navigation moves that work forward: helping members find in-network options, understand what a procedure will cost, choose a lower-cost site of care, and resolve billing problems.
For an employer, the value shows up in two places — lower claims from better site-of-care decisions, and fewer employees walking into HR with a bill nobody can explain.
Imaging is where this is most visible. The CT story above is the whole thesis in one claim: $1,154.89 billed, $152.64 paid by the member, no appeal required.
What navigation actually does
- Finds in-network providers with real availability
- Gives cost expectations before a procedure, not after
- Identifies lower-cost sites of care for imaging, labs, and outpatient procedures
- Coordinates copay assistance and manufacturer programs on specialty drugs
- Helps with prior authorization problems
- Untangles billing errors and balance bills
- Answers the questions employees would otherwise bring to you
One more comparison · proposal stage
+25.56% became flat — at a better plan
A 10-subscriber, 18-member New England contractor received a 25.56% renewal increase from its incumbent HMO: $117,129 up to $147,065 annually. We priced the full Triad ladder against it on the same census. This is what the eight-plan ladder looks like in practice.
| Option | Annual premium | vs. renewal | Deductible | Out-of-pocket max |
|---|---|---|---|---|
| Incumbent renewal (baseline) | $147,065 | — | $2,000 | $10,150 |
| Triad $1,500 Classic — our recommendation | $146,646 | −0.3% | $1,500 | $7,350 |
| Triad $2,500 Classic | $137,236 | −6.7% | $2,500 | $7,350 |
| Triad $3,500 Classic | $128,440 | −12.7% | $3,500 | $7,350 |
| Triad $5,000 Classic | $120,220 | −18.3% | $5,000 | $7,350 |
| Triad $3,500 HSA | $114,628 | −22.1% | $3,500 | $6,550 |
| Triad $5,000 HSA | $109,303 | −25.7% | $5,000 | $6,550 |
| Triad $7,350 Value | $104,230 | −29.1% | $7,350 | $7,350 |
The recommendation
Hold the cost, improve the plan. Premium landed $419 a year under the renewal — call it flat — while the individual deductible fell from $2,000 to $1,500, the family deductible from $4,000 to $3,000, and the out-of-pocket maximum from $10,150 to $7,350. Worst-case annual exposure dropped $2,800 per employee.
Or take the money
Every step down the ladder is real cash: $9,829 a year back at the $2,500 deductible while still improving the out-of-pocket maximum by $2,800; $18,625 at $3,500; $42,835 at the leanest design.
What we told them to watch
The incumbent used fixed copays after the deductible; the Triad Classic plans pay 80% after deductible. Premium and deductible can look comparable while a single hospital claim feels different. That gets walked through at enrollment, not discovered at the first bill.
Read this before quoting it: these are proposal-stage figures from a rate comparison prepared 08/21/2026 for a 09/01/2026 renewal, not a realized result. Premium only — no modeling of claims experience, employee out-of-pocket cost, or HRA/HSA funding. Incumbent rates from the 2026 renewal letter; Triad rates from the proposal dated 08/19/2026, re-priced onto the group's own 10-subscriber census. Every premium total in the source document was rebuilt by two independent methods and reconciled before publication. Client not named. Rates are subject to underwriting, participation minimums, and final enrollment.
Positioned honestly
Who this fits — and who it doesn't
Not every employer needs Triad. Every employer should understand it. We would rather tell you it isn't a fit than sell you into a program that produces a bad second year.
This sounds like you
- You have between 1 and 150 employees
- You have absorbed multiple consecutive double-digit renewals
- Your employees use providers on both sides of the Massachusetts border
- Broad PPO access matters more to your workforce than a narrow-network discount
- You want claims data you can actually manage the plan with
- Someone on your side will read the monthly reports and the mid-year review, and act on them
- You are willing to communicate a change to employees properly
This also sounds like you
- Your current fully insured renewal came in flat or better
- Your workforce is entirely local and a regional network serves them well for less
- You need the absolute lowest premium and will narrow the network to get it
- Your group's profile does not meet the program's underwriting requirements
- Nobody internally has the bandwidth to engage with plan data
- You have no appetite for changing carriers this year
See what Triad looks like against your own renewal
We will underwrite your census, price the full eight-plan ladder, put it side by side with your renewal and the other realistic structures, show the math so you can check it, and tell you plainly if the answer is to stay where you are.