New at Nice for 2027: What Brokers Need to Know
Healthcare costs continue to put pressure on employers. Benefits leaders and brokers are looking for strategies that make care easier to use while creating more opportunities to manage where and how healthcare dollars are spent.
For a deeper look at that challenge, see The 2027 Benefits Strategy: Why Better Access to Care Matters More Than Cost-Shifting.
That’s why we’ve made some changes at Nice, which we shared in our recent New at Nice for 2027 webinar.
The biggest news is Nice Plan, our new level-funded or self-funded health plan that builds on the convenient, in-home and virtual care model Nice already delivers. Announced earlier this month, Nice Plan brings Nice Care into a broader health plan experience.
We’re also adding more value to the Nice Care experience through Specialized Programs for common chronic and complex health needs, plus Intelligent Referrals powered by Garner to help members navigate specialty care using cost and quality data.
In the webinar, Ethan Merk walked brokers through what’s changing, how these pieces fit together, and what to know when evaluating options for clients in 2027.
If you missed the live session, here are the biggest takeaways, plus answers to some of the practical questions brokers asked during the session.
The Biggest News: Nice Plan
The biggest update for 2027 is Nice Plan, a level-funded or self-funded health plan that builds on the care model Nice already delivers.
Nice already has the clinicians, support, processes, and technology in place to help members access and navigate care. Nice Plan builds on that foundation by connecting Nice Care with broader major medical coverage, rather than asking employees to manage another separate healthcare solution.
For members, the experience is simple:
Know what you need? Schedule directly with Nice Clinical Care for everyday care.
Not sure where to go? Nice Member Support can help with plan questions and care navigation.
Need care outside Nice? Nice can make in-network referrals and guide patients to the right place.
It gives members a trusted place to start and more support when healthcare gets complicated.
And because Nice Care is built into Nice Plan, members can still access Nice’s services like primary care, virtual mental health therapy, virtual physical therapy, prescriptions, care coordination, labs, imaging, and more.
That connected member experience is an important part of the plan’s cost-containment strategy, which we’ll get into later.
What’s New in Nice Care
Nice Plan may be the biggest announcement for 2027, but we’re also adding more value to the Nice Care experience.
Two of the biggest updates are Specialized Programs and Intelligent Referrals powered by Garner.
Specialized Programs
Nice’s Specialized Programs offer more structured, high-touch support for some of the most common and costly health needs.
Current programs include:
Diabetes
Hypertension
Weight Management
Perimenopause & Menopause
Nice can still care for members with these conditions even if they are not enrolled in a Specialized Program. Routine and chronic care are already part of the broader Nice Care experience.
The difference is the added layer of support.
Specialized Programs are designed around specific conditions and offer more individualized 1:1 education, monitoring, and follow-up over time. Depending on the program, that can include help with symptoms, medication management, lifestyle changes, and ongoing health goals.
Intelligent Referrals Powered by Garner
We’re also adding more support for services beyond Nice’s scope.
Intelligent Referrals powered by Garner bring cost and quality information into the referral process, giving Nice clinicians better data to help members identify in-network specialists and facilities with the best outcomes.
Instead of sending employees off to research options on their own, Nice can help guide that next step within the same care experience. Members don’t need to download another app or manage another standalone benefit.
The cost savings are significant, with an average of $1,900 in employer savings per referral when Garner data is used to inform the decision.
Together, Specialized Programs and Intelligent Referrals add more support before, during, and beyond everyday care, while keeping Nice as a familiar place for members to start.
How Nice Plan Brings More of the Pieces Together
Everyday care, ongoing conditions, specialist referrals, pharmacy spend, and major medical claims can all affect healthcare costs.
Nice Plan helps impact all of those factors.
Nice Care as the Front Door
Primary care, virtual mental health therapy, virtual physical therapy, prescriptions, labs, diagnostics, care coordination, and other everyday care can all begin with Nice.
Nice-fronted plans already average a $1,593 per employee per year reduction in medical claims. Every Nice Care visit is an avoided claim.
Pharmacy Cost Management With SmithRx
Nice Plan also includes SmithRx as its pharmacy benefit partner.
The model includes pass-through pricing, 100% rebate return, claims visibility, a closed formulary, and additional support for high-dollar pharmacy needs.
Savings average $25 per member per month through SmithRx’s high-dollar Rx savings program and $74 per member per month all-in price across SmithRx clients.
Together, Nice Care, Specialized Programs, Intelligent Referrals, and SmithRx give Nice Plan several ways to address costs across the healthcare journey.
Broker Q&A: What You Asked During the Webinar
The second half of the webinar focused on practical questions about how Nice Plan and the new Nice Care capabilities work.
Here are some of the questions from the session:
Can members go directly to an in-network specialist, or do they have to start with Nice?
Members can still access in-network care directly. Nice Plan is not designed as a gatekeeper model.
When members want help, Nice can support the referral process and use Garner’s cost and quality data to help identify in-network options. The goal is to give members better guidance, not take away their choice.
How does Nice Plan work for employers with employees in multiple states?
Nice plan is designed for employers based in states where Nice operates, while the broader health plan network supports employees who may live in other areas.
Access to Nice Care can vary depending on location. In some markets, members may have access to both virtual and in-person care, while others may use Nice virtually along with the broader plan network for care outside Nice.
If an employee enrolls in employee-only medical coverage, can eligible family members still use Nice?
Yes. Nice’s household access model remains separate from the employee’s major medical enrollment tier.
That means benefit-eligible family members may still have access to Nice Care even if they are not enrolled in the employee’s medical plan.
If Nice recommends a specialist through Garner, does the member have to use that provider?
No. Intelligent Referrals help members make more informed decisions, but members are still free to go to a provider of their choosing.
Garner provides cost and quality data that can help Nice clinicians guide members toward appropriate in-network options with the best outcomes, but members can still choose where they receive care.
Who administers Nice Plan?
Yuzu serves as the third-party administrator, or TPA, for Nice Plan.
The TPA helps handle the administrative side of the health plan, including functions such as claims processing and plan administration.
What happens if a client already has stop-loss coverage?
That depends on the arrangement.
An existing stop-loss contract may need to be reviewed to determine whether it can work with Nice Plan and whether the carrier recognizes the cost-containment components built into the model.
When a new proposal is needed, Nice can also work with its stop-loss partners.
How quickly can brokers get an initial financial analysis?
The Nice team can typically work through the initial ROI and financial analysis in about 48 hours once the necessary group information is available.
A full stop-loss proposal may take longer depending on the group and underwriting requirements.
How much implementation time should brokers plan for?
The recommended lead time is approximately 45 days.
There are several moving parts beyond choosing a plan, including finalizing plan design, preparing plan documents and benefit summaries, completing enrollment, setting up systems, and getting ID cards ready.
Giving the process enough runway can help make the transition smoother for both the employer and employees.
Have a Group in Mind? Here’s What You’ll Need
If a client is considering Nice Plan, having the right information ready can help the Nice team evaluate the group more efficiently.
At a high level, brokers should be prepared to provide:
Group information, including employer and broker details
Census and enrollment data
Current plan information, including plan design and renewal details
Medical and pharmacy claims history
High-cost claimant information needed for underwriting
Once that information is available, the Nice team can begin reviewing the group and building out a quote.
Ready to Evaluate a Group?
Download the Stop-Loss RFP Submission Requirements Checklist
Download a copy of the deck.
