Many Priority Health programs depend on what the employer opted into, so the plan document matters more than the program list.
Priority Health’s own provider manual warns that a program marked eligible for commercial plans may not apply to every member plan. Employer groups opt in or out.
What the program is and what members do.
What the manual says
Priority Health’s provider manual, updated July 1, 2026, lists a menu of additional health benefits, wellness programs and discounts. A note on the page says that where commercial plans are marked eligible, not all member plans may qualify, depending on whether employer groups opted into or out of the program.
Which programs are purchased
The manual ties several programs to something the employer bought. Livongo requires a buy-up. Garner Health requires the Garner supplemental product. Carrot Fertility requires the Carrot Core Buy-Up or Carrot Pro Rider. Sword Health virtual physical therapy and the Musculoskeletal Centers of Excellence each require a rider.
Which programs are opt-out or opt-in
Boulder Care substance use treatment is a core commercial group benefit, though the manual notes some self-funded groups may opt out. PriorityVision plans are available to all plan types, but employer groups and individuals who buy their own coverage must opt in. Details differ program by program.
Eligibility, funding and plan design.
Who it affects
Every Priority Health commercial group is affected, because the menu is shared across the book but the selections are not. Two groups with the same carrier can offer employees very different programs. The employee handbook should list only what your group actually has.
How it is sold
Riders and buy-ups are added to the base plan, usually with a cost. Core benefits are included, though some can be declined. Priority Health’s pages we reviewed do not publish rider prices, so cost comes from a quote or renewal.
Where it fits in plan design
Treat the menu as options to evaluate against your population, not a bundle to accept. A rider that addresses a real cost driver, such as musculoskeletal claims, may earn its price. A rider nobody uses is a recurring cost with no return.
What to settle before relying on it.
Which riders and buy-ups are on our group today?
Ask Priority Health for a list of every program, rider and buy-up attached to the group, with effective dates. Compare it with what employees have been told. Gaps between the two cause member complaints and, occasionally, compliance problems. Then check each item against the summary of benefits your employees received at open enrollment.
What are we paying for each add-on, and what do we get back?
Ask for the cost of each rider separately from the base rate, and for utilization by program. If a rider shows almost no use after a full year, that is a conversation to have at renewal, not after the next increase.
Do we know which core benefits we can decline?
Priority Health notes that some self-funded groups may opt out of Boulder Care. Ask whether other core items can be removed, whether doing so changes the rate, and whether removal affects any accreditation or mandate. Do not decline anything without understanding the member impact.
Common questions about this program.
Why does Priority Health say not all plans qualify?
Because employer groups opt into and out of programs. The manual lists what Priority Health offers across commercial business, but each group’s plan determines what applies to its members.
Where can an employer see what it has?
The plan documents and renewal materials from Priority Health should list the riders and buy-ups. If they do not, ask your Priority Health representative or broker for a written list.
Are riders subject to wellness regulations?
Riders that deliver services, such as virtual physical therapy, are generally benefit design questions. Anything that rewards members for health outcomes can fall under HIPAA and ACA wellness rules, so have employment counsel review reward features.
Programs and vendors named on this page
Official pages for the services mentioned above. Availability, cost and eligibility vary by plan and employer group, so confirm what applies to your group with the carrier.
Livongo by Teladoc Health
Connected diabetes and chronic condition program.
Where these details come from.
This page summarizes what Priority Health publishes. Programs change, so confirm current details with the carrier before relying on them.
Send us your renewal.
We’ll tell you whether it looks competitive, where we see opportunity, and the five questions we’d put to your carrier. No cost, and no obligation to move anything.
The renewal letter
Your current plan summary
Contribution split by tier
Enrolled counts by tier
Four documents — two more if your group is 50 or more. Nothing else; every extra one is a reason to postpone.
An independent employee benefits consulting firm. We look at the entire benefits program: cost, plan performance, risk and administration.
Switch to CFH. Unhappy with your broker? Your employees won’t notice. You will. →
Cookies on This Site
We use cookies to keep the site working properly and to understand how it is used. You can decline anything that is not essential. See our Privacy Policy for the detail.
- Essential: needed for the site to load and for you to move around it. These cannot be switched off.
- Analytics: tell us which pages get read, so we know what is worth writing more of.
- Advertising: set by third parties such as ad and social platforms to measure and target campaigns.