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Centivo

Public facts

Primary-care-centered high-performance network and TPA

Self-funded plan and curated PCP-centered network for employers of about 50–3,000 employees, with $0 primary care and optional PPO or RBP alongside the Centivo network.

Visit centivo.com

Overview

Centivo is not an insurance company. It builds curated, primary-care-centered networks, administers self-funded plans for employers of roughly 50–3,000 employees working with brokers, and can sit the Centivo Network next to a traditional PPO and/or a reference-based pricing reimbursement model. Employer pages describe $0 in-person and virtual primary care, no deductibles, predictable copays, an integrated PBM, virtual primary care with NCQA PCMH recognition, and partner stop-loss. Named active markets include Wisconsin, Texas, Florida, New York, Missouri, Connecticut, Pennsylvania, Washington, North Carolina, and more. Vendor-stated outcomes include ~15–30% total-cost savings versus replaced health plans.

Why it matters Centivo is a high-performance network-plus-TPA, not a silent rental PPO; it belongs here because plans can pair the Centivo Network with RBP or a carrier PPO.

Target buyer
Mid-market employers (about 50–3,000 employees) and their brokers replacing a fully insured or broad PPO plan with a high-performance network.
Pricing model
Not published; self-funded ASO plus partner stop-loss
Vendor cites 15–30% total-cost savings vs traditional / replaced plans and vs fully insured. No PEPM list. A savings calculator is offered on the site.
Availability
WI, TX, FL, NY, MO, CT, PA, WA, NC
Research
Last researched 2026-08-23
Public facts category

Key features

  • Curated local high-value provider contracts (Centivo Network)
  • Option to offer Centivo Network alongside a traditional PPO and/or RBP
  • No deductibles and $0 primary care (in-person and virtual)
  • Predictable copay plan design
  • Integrated virtual primary-care practice (NCQA PCMH-recognized)
  • Claims payment, FSA/HSA/COBRA administration, member support
  • Partner stop-loss / reinsurance coordination
  • Integrated transparent PBM

Integrations

  • Broker distribution
  • Partner stop-loss carriers (names not published on the employer FAQ)
  • PBM integration (unnamed on the public employer page)
  • Optional third-party PPO or RBP reimbursement model beside the Centivo Network

Overview

Centivo sells a self-funded, primary-care-centered health plan to employers of 50–3,000 employees that work with a broker. Savings are attributed to direct contracts with high-value providers, a plan design that removes cost barriers to primary care, and the absence of carrier profit margins. The company says it is a full replacement for a traditional health plan, not only a claims administrator.

The employer site states Centivo can offer its network alongside traditional PPO options and/or reimbursement models such as reference-based pricing, plus its own virtual providers. It is not a licensed health insurance company; catastrophic risk is handled through partner reinsurance/stop-loss.

Named markets: Wisconsin, Texas, Florida, New York, Missouri, Connecticut, Pennsylvania, Washington, North Carolina, and more. Network composition varies by region.

Key Capabilities

  • Direct provider contracts at what Centivo calls a significant discount versus other health plans.
  • $0 primary care, no deductibles, low transparent copays.
  • Virtual primary-care practice; one of the first to receive NCQA Patient-Centered Medical Home recognition (vendor-stated).
  • Administration: claims payments, FSA/HSA and COBRA, member support, PBM integration, implementation.
  • Coordinated individual and aggregate stop-loss through partner carriers.
  • Vendor-stated utilization: PCP visits 34% above benchmark, ER 32% below, inpatient admits 10% below; ~15–30% average total cost-of-care savings versus replaced plans. FAQ also says members use primary care 40% more than with traditional plans.

Integrations & Ecosystem

Broker-sold. Stop-loss and PBM are integrated but not named on the public employer FAQ. The network can be paired with a third-party PPO or an RBP reimbursement model. Mobile app and member communications are part of the stated experience.

Pricing

Self-funded: employer pays claims plus administration and stop-loss. No public PEPM. Savings of 15–30% versus traditional or fully insured plans are vendor-stated.

Notes & Limitations

  • Network is curated and market-specific, not a nationwide rental PPO. Access must be checked per site.
  • states_available lists only markets Centivo named; the site says “and more.”
  • Outcome and utilization figures are company-reported.
  • Stop-loss paper is partnered, not Centivo-issued.

Sources

Tags: high-performance network · self-funded · primary care · TPA · RBP-adjacent