For level-funded employers

A better claims year means surplus and a cleaner renewal.

You pay a level monthly amount, but claims still decide year-end surplus, stop-loss risk, and next year's rate. Ask Sunny is a healthcare access platform. Members text one number to get care for common conditions, delivered by Sunny's contracted physician-group partners licensed in all 50 states, plus a direct path to the right in-network, in-person care when they need more.

Benefits, finance and people leaders

Partner with Us ROI calculator

A benefits leader reviewing plan numbers at a laptop

Illustrative planning example

Four savings levers, sized to your plan

Set eligible lives to see how the four levers add up. Every figure is a planning illustration built from national data, not a reported result, and results vary by region, network and plan.

Starting point

Plan-paid claims today

1,000 lives at $5,800 to $6,700 each per year⁶

$5.8M to $6.7M

Text-based care for common conditions

700 of 1,000 text visits replace a $300 office or urgent care claim

Assumes 1 text visits per eligible member per year, and that 70% of them would otherwise have been a primary or urgent care visit paid by the plan. The $300 is our plan-paid planning value for that visit; sourced allowed amounts are $167 to $193².

$210k

ER and urgent care avoidance

20 low-acuity ER visits handled over text or in an office instead

ER visits a year (172 per 1,000 people¹)	172
Of which low-acuity and avoidable (18 of 46M, our derived 39%²)	67
Of which Sunny reaches first (planning assumption, 30%)	20
Saved per visit: ED cost less the $300 already counted in lever 1²	$1,732
Plan-paid share (85% of allowed)	$29.4k

Urgent care visits (156 per 1,000, 156 a year) are already counted in lever 1. Emergency symptoms are always directed to emergency care.

$29.4k

Site-of-care steerage

Procedures, imaging and labs done at independent in-network sites instead of hospital outpatient departments

	Surgery (ASC)	Imaging	Labs
Done at a hospital outpatient department a year	39	39	4,218
Of which could move to a lower-cost site³ ⁴ ⁵	22	27	1,055
Of which Sunny steers (planning assumption, 30%)	7	8	317
Saved per event (allowed charges)	$4,559	$1,156	$27.10
Plan-paid share (85% of allowed)	$27.1k	$7.86k	$7.3k

$42.3k

Employee productivity

1,000 hours back at work, about 60 minutes per text visit, valued at $46.15 an hour⁷

Employer time value rather than a claims saving. Leave it out of the total if your plan does not count it.

$46.2k

Levers 1 to 4

Total savings per year

$282k in avoided claims, about 4.2% to 4.9% of plan-paid spend, plus $46.2k in employer time⁸

$328k

An illustrative claims reduction can widen surplus and ease attachment and renewal. It is not cash off next month's invoice. If your arrangement has no surplus path, treat it as renewal and stop-loss leverage. Plan-paid basis (85% of allowed); some overlap possible.

See the math and sources

Sources and method

1 Health Care Cost Institute (HCCI), 2022 service year (2022 Health Care Cost and Utilization Report, published 2024): 172 emergency room visits and 156 urgent care visits per 1,000 people under 65 with employer-sponsored insurance.
2 UnitedHealth Group, 2019: 18M avoidable visits among 27M classifiable visits, out of 46M privately insured emergency department visits. The model uses 18 of 46, or 39%, as a conservative derived share; it is our assumption, not UHG's reported avoidable rate. For 10 common primary-care-treatable conditions, average 2018 allowed cost was $2,032 in an ED, $193 in urgent care and $167 in a physician office. The $300 offset against the ED cost is our anti-double-counting assumption for the visit already counted in lever 1.
3 UnitedHealth Group, September 2021, based on employer-plan claims from March 2019 to February 2020: more than 6M routine procedures a year in hospital outpatient departments, 56% involving non-complex patients with an ambulatory surgery center nearby; average allowed price $7,716 at a hospital outpatient department versus $3,157 at an ASC. About 39 per 1,000 is our conversion using KFF's 154M people with employer coverage, not a source-reported rate.
4 UnitedHealth Group, November 2020, based on employer-plan claims from September 2018 to August 2019: nearly 6M routine imaging tests a year in hospital outpatient departments, 70% involving non-complex patients with a lower-cost site nearby; average allowed price $1,855 at a hospital versus $699 at a freestanding center or physician office.
5 HCCI, July 2022 brief on 2019 commercial claims: 232M clinical lab tests, 25% billed by hospital outpatient departments; median paid $38.22 there versus $11.12 at an office or independent lab. Dividing 232M by the dataset's roughly 55M annual lives (about 4,218 per 1,000) is a crude sample ratio, not a nationally weighted utilization rate. The 30% impact rate across levers 2 and 3 is our planning assumption.
6 HCCI, 2022: about $6,710 in total claims spending per person with employer coverage, including $866 in patient cost sharing and before pharmacy rebates; it is not plan-paid spending. Milliman Medical Index 2025: $7,871 per average person, with the plan paying about 85%. The model applies 85% to allowed-charge deltas in levers 2 and 3 to estimate plan-paid savings, and uses a plan-paid denominator of $5,800 to $6,700 per life (HCCI total less cost sharing; 85% of the MMI) for percentages.
7 Bureau of Labor Statistics, Employer Costs for Employee Compensation, December 2025 reference period (published March 2026): private-industry employer cost of $46.15 per hour worked ($32.36 wages plus $13.79 benefits). One hour saved per text visit and full conversion of that hour into employer value are our assumptions; dependent visits and care outside work hours reduce how much applies.
8 Productivity is employer time value rather than a claims saving; it is included in the total and can be left out if your plan does not count it. Percentages scale to the plan-paid denominator above. Claims service periods span 2018 to 2022, with 2025 cost and compensation benchmarks; publications span 2019 to 2026. Some UHG figures are national extrapolations from one carrier's employer-covered members. Results vary by region, network, benefit design, clinical mix and achievable steerage, and are not guaranteed.

Talk to us about your plan

Why it matters when you level-fund

Three reasons the access layer matters

Claims still decide surplus

You fund a level monthly amount, but claims experience still drives surplus or refund, attachment, and stop-loss risk, typically against $5,800 to $6,700 of plan-paid spend per covered life per year.

Low-acuity spend eats the corridor

Routine primary and urgent care visits, plus wrong-site outpatient spend, quietly consume the corridor between funding and attachment.

Access decides ER, urgent care and hospital outpatient defaults

Hard-to-reach care pushes people to the ER or urgent care, and to labs, imaging, and procedures at hospital prices.

Two paths to care

Treated over text, or booked at the right site

Path 1

Text-based care for common conditions

Members describe symptoms over text. A licensed clinician from a Sunny physician-group partner handles the visit. No appointment needed.

Prescriptions or lab orders when clinically appropriate
Resolved over text instead of a claimable office visit

Path 2

In-person care at the right site

When a member needs to be seen, Sunny's provider data graph matches them to an in-network, high-value site of care.

Favors independent ASCs, imaging centers and labs over hospital outpatient
Sunny calls and faxes to book, then confirms and reminds

How it works

From first text to follow-through

01
Member texts Ask Sunny

Symptoms, benefits questions, or care to schedule. Covered dependents too.
02
Treat or route

Common conditions go to text care with a physician-group partner. The rest is routed in-network.
03
Schedule in person

Sunny finds the right in-network site, including independent ASCs, imaging and labs, and books it over the phone and fax lines offices already use.
04
Follow through

Prescription and lab updates, reminders, and easy rescheduling mean fewer no-shows.

Four ways Ask Sunny creates value

Fewer claimable visits, lower-cost sites, less time away

Text care for common conditions

Eligible issues are resolved over text with a physician-group partner, not as a claimable primary care visit.

ER and urgent care avoidance

Low-acuity issues are routed to text care or a lower-cost site instead of the ER or urgent care by default. Emergency symptoms are always directed to emergency care.

Site-of-care steerage

When a procedure or diagnostics are needed, members are steered to in-network independent ASCs, imaging centers and labs rather than hospital outpatient departments.

Less time away from work

A text visit replaces the trip and the wait.

Site of care

The right place, not the most expensive one

When a member needs a procedure, imaging or labs, Sunny's provider data graph favors in-network independent sites over hospital outpatient departments, then books the visit over the phone and fax lines the office already uses.

Independent ASCs, imaging centers and labs first
Emergency symptoms always go to emergency care
Confirmations, reminders and rescheduling handled

Who does what

Sunny is the platform. Physician-group partners deliver the care.

Ask Sunny: the platform

Member experience, navigation, provider data graph, scheduling, reporting. Technology only. Sunny does not practice medicine or deliver care.

Physician-group partners: the care

All clinical care is provided solely by Sunny's contracted physician-group partners, licensed in all 50 states.

HIPAA compliant
Secure and auditable
TPA, network, stop-loss and surplus mechanics unchanged.

Healthcare access platform; does not practice medicine. Clinical care solely by contracted physician-group partners licensed in all 50 states.

Pilot path

Four steps from metrics to a rollout decision

01
Agree on metrics

Text visits, avoided claims, ER and urgent care use, site-of-care mix.
02
Pick a cohort

A location, business unit, or the whole plan.
03
Launch

Eligibility data plus launch communications. Minimal IT lift.
04
Measure and decide

Compare to the claims baseline, then decide on rollout.

Other plans

Funded differently?

Self-insured

Every claim is your dollar. Keep the unnecessary ones off the plan.

PEOs

When the master plan bears claims, every avoided visit is the book's dollar.

Next step

Model this for your plan, or scope a pilot.

Member experience, network fit, and a savings model built on your claims mix.

Partner with Us ROI calculator Ask Sunny

A better claims year means surplus and a cleaner renewal.

Four savings levers, sized to your plan

Plan-paid claims today

Text-based care for common conditions

ER and urgent care avoidance

Site-of-care steerage

Employee productivity

Total savings per year

Three reasons the access layer matters

Claims still decide surplus

Low-acuity spend eats the corridor

Access decides ER, urgent care and hospital outpatient defaults

Treated over text, or booked at the right site

Text-based care for common conditions

In-person care at the right site

From first text to follow-through

Member texts Ask Sunny

Treat or route

Schedule in person

Follow through

Fewer claimable visits, lower-cost sites, less time away

Text care for common conditions

ER and urgent care avoidance

Site-of-care steerage

Less time away from work

The right place, not the most expensive one

Sunny is the platform. Physician-group partners deliver the care.

Ask Sunny: the platform

Physician-group partners: the care

Four steps from metrics to a rollout decision

Agree on metrics

Pick a cohort

Launch

Measure and decide

Funded differently?

Self-insured

PEOs

Model this for your plan, or scope a pilot.