Question 1

What is Zero First?

Accepted Answer

Zero First is a Curative plan that pays first: members pay a share only after a set amount. Care is free until a person has used a set amount of in-network care in the plan year, the set amount. Above the set amount the member pays a flat share of each bill. Payments stop at an out-of-pocket max. Two tiers carry it: Zero First EPO (free to $2,500, then 30%, never more than $8,000) and Zero First PPO (free to $5,000, then 25%, never more than $6,350). Family amounts are double the set amount and double the out-of-pocket max. Groups can choose Zero First for a lower premium or stay on Zero Always, today's all-$0 plans, and Zero Always PPO Max can be offered beside the two Zero First tiers. On Curative's 2025 members, about 2 in 3 would have paid nothing for medical care in a full year on the Zero First EPO, and about 3 in 4 on the Zero First PPO (modelled on Curative's 2025 members). Preventive care, the Baseline Visit, primary care, outpatient mental-health and substance-use visits and urgent care are always $0, and prescriptions do not change.

Question 2

For Zero First, how do the set amount and the out-of-pocket max add up: per person, per family, and what counts?

Accepted Answer

Each person has their own set amount and their own out-of-pocket max. The family set amount and out-of-pocket max are twice the person's. Once the family's combined counted care reaches the family set amount, every family member pays the share, even one who has not used their own. Once the family's payments reach the family out-of-pocket max, everyone is back to $0. What counts is the allowed amount of in-network medical care (what Curative pays the provider), in the order claims are processed, per plan year. Always-$0 care never counts and never takes the share. Prescriptions never count toward the set amount; any pharmacy copays a member pays count toward the out-of-pocket max, so there is one out-of-pocket maximum. Out-of-network care on Zero First PPO never counts; it accumulates separately, as it does today.

Question 3

Is Zero First HSA-compatible?

Accepted Answer

No. The plan pays non-preventive care from the first dollar, so it is not a high-deductible health plan under IRS rules. A group that wants an HSA keeps an HDHP beside Zero First.

Question 4

What happens in the ER, or in an ambulance under Zero First?

Accepted Answer

Emergency care and ambulance count toward the set amount like any other care. Under the set amount they are $0. Above the set amount the member pays the share (30% on Zero First EPO, 25% on Zero First PPO) of each bill, up to the out-of-pocket max. Out-of-network emergency care is paid as in-network under the federal No Surprises Act. The member does not pay at the hospital; the Explanation of Benefits comes first.

Question 5

How does out-of-network care work under Zero First?

Accepted Answer

Zero First PPO: as today's PPO, with a separate out-of-network deductible and out-of-pocket maximum. Out-of-network amounts do not count toward the in-network set amount or out-of-pocket max, and the set amount and out-of-pocket max do not apply out of network. Zero First EPO has no out-of-network coverage except emergencies. Zero Always PPO Max covers out-of-network care at $0, as today.

Question 6

How do prescriptions work under Zero First?

Accepted Answer

Exactly as today, through CapitalRx: preferred generics and brands $0, non-preferred drugs $50, non-preferred specialty $250. Prescriptions do not count toward the set amount and do not take the share. Any pharmacy copays a member does pay count toward the out-of-pocket max, so there is one out-of-pocket maximum for medical and pharmacy together. Today 97% of fills are $0, and that stays. Most other plans apply their deductible and a share of the cost to drugs; Zero First does not.

Question 7

Under Zero First, what is always $0?

Accepted Answer

Five things, on every tier, never counted toward the set amount: ACA preventive services and screenings; the Baseline Visit; primary care, meaning an office, video or phone visit with a primary-care clinician (family medicine, general internal medicine, general pediatrics, general practice, geriatrics, a primary-care NP or PA, a Curative clinician or Curative Telehealth; the directory marks them "Primary Care: $0 visits"), plus the tests on the published Primary Care Lab List when that clinician orders them; outpatient mental-health and substance-use visits (therapy, psychiatry and counseling, in person or by video); and urgent care visits. Specialist visits, the ER, imaging, procedures and hospital care count toward the set amount.

Question 8

How are mental-health and substance-use visits covered under Zero First?

Accepted Answer

Outpatient office and virtual visits (therapy, psychiatry and counseling) are $0 all year and never count toward the set amount. Inpatient and residential stays, including residential substance-use treatment, intensive outpatient and partial hospitalization programs, count toward the set amount and the out-of-pocket max and take the share, exactly like a medical admission.

Question 9

Does the Baseline Visit still matter for Zero First?

Accepted Answer

Yes, exactly as today. Members complete it within 120 days of their effective date, and the first 120 days count as complete. With it, the Zero First design applies all year. Without it, from day 121 the member is on the plan's standard cost sharing: a $5,000 per person / $10,000 family in-network deductible, then 20%, with an out-of-pocket maximum at the federal limit for the year the plan year starts, so skipping the visit is never the better deal. Children under 18 do not do the visit; a parent's completion covers them. The visit is annual.

Question 10

For the Zero First plan, does the Curative Cash Card still work above the set amount?

Accepted Answer

Yes. Members keep using the card after they cross the set amount, including at health systems that only take the card. Curative pays the provider in full through the card and then bills the member directly for their share. The member never has to pay at the desk, and never pays more than the out-of-pocket max.

Question 11

For the Zero First plan, how do members see their share?

Accepted Answer

On the Explanation of Benefits, which Zero First members receive by email by default (members can switch to paper). Every EOB explains Zero First and shows how much of the set amount and the out-of-pocket max the member and the family have used. The app shows the same number all year, and a care navigator calls before a member reaches the set amount and again if they cross it.

Question 12

Under Zero First, can my group have a different set amount, share or out-of-pocket max?

Accepted Answer

Yes. Underwriting sets the three numbers for the group, and the quote carries them in the plan's name, for example "Zero First EPO 3000/30/8000". Family amounts are always double. Raising the share lowers the price most; lowering the out-of-pocket max costs least; raising the set amount moves more members to $0. Ask your broker or your Curative account executive; a tuned design comes with the standard quote.

Question 13

Who can buy Zero First, and when?

Accepted Answer

Zero First is available to level-funded groups effective 1 December 2026 or later. That means groups that are self-funded under ERISA with stop-loss, new and renewing. December effective dates are on the default designs and must be bound by 31 October; tuned designs start 1 January. Fully insured availability is subject to state approval. A fully insured group can also convert to level funding at renewal and take Zero First from 1 December or later; the quote includes stop-loss and the ERISA plan documents.

Meet Zero First: $0 for most, priced to compete

Priced for a routine year. Capped for a hard one.

How Zero First works

Free up to a set amount

Above it, a known share of each bill

Never more than the out-of-pocket max

Some care is $0 all year

The numbers

Zero First EPO

Zero First PPO

Prescriptions stay simple

Zero First frequently asked questions

Get a Zero First quote