European employers already have statutory health insurance for their employees. So why would a broker build an independent provider network? Because statutory coverage—while comprehensive for acute care—leaves significant gaps in access, speed, and supplementary services. Smart brokers are turning these gaps into a new business line.
The Opportunity: What Statutory Insurance Does Not Cover Well
Statutory insurance in Europe works well for emergency care and essential treatments. But employers face three persistent problems that insurance does not solve effectively.
Waiting Lists That Hurt Productivity
In the Netherlands, the average wait time for an MRI is six to twelve weeks through statutory insurance. In the UK, NHS waiting lists have stretched even longer. For employers, these delays mean extended sick leave, delayed diagnoses, and lost productivity. Employees who could return to work after a quick scan instead wait months.
Average MRI wait time in Netherlands through statutory insurance
Coverage Gaps in Supplementary Categories
Dental, mental health, physiotherapy, and executive health checks have minimal or no statutory coverage across most EU markets. Employers already pay for these services out of pocket—either through supplementary insurance or direct payment. The spending exists; it just lacks price intelligence and volume leverage.
- •Dental: Minimal statutory coverage across most EU countries. Large self-pay market.
- •Mental health: Long public waiting lists. Employers pay privately to reduce absenteeism.
- •Physio and MSK: Massive price variation with direct impact on sick days.
- •Executive health checks: Common corporate benefit with zero statutory coverage.
Hidden Costs from Above-Tariff Pricing
Many providers offer faster access for a premium above statutory tariff rates. Employers pay this premium anyway—they just do it without any comparative pricing data or negotiating leverage. A broker who aggregates volume can negotiate better rates than any single employer could achieve alone.
What Is Healthcare Carve-Out Procurement?
A carve-out program separates specific healthcare categories from the main insurance relationship for independent procurement. Instead of accepting whatever network the insurer provides, the broker builds direct relationships with providers—imaging centers, dental clinics, mental health practices—and negotiates volume-based rates.
How It Works: The Four-Step Playbook
Building a Carve-Out Program
Aggregate Your Portfolio
Pool your corporate clients into a single buying group. Fifteen employers with 30,000 total employees gives you real negotiating power that no single employer could achieve alone.
Benchmark Provider Pricing
Collect quotes from providers in your market. Normalize pricing against national tariffs (NZa, GOÄ, CCAM) to identify which providers are competitive and which are overcharging.
Negotiate Volume Rates
Approach imaging centers, clinics, or specialists as a bloc: "We can guarantee X procedures per year at this rate." Your aggregated volume is your leverage.
Deliver and Earn
Offer the carve-out network to employers. Charge a procurement fee per employee per month, earn the spread between contracted and client rates, or collect volume fees from providers.
Six Categories with the Highest Price Variance
Not all healthcare categories are equally suitable for carve-out procurement. The best opportunities combine high price variance, significant employer spend, and minimal statutory coverage. Six categories consistently meet these criteria across European markets.
1. Diagnostic Imaging
MRI, CT, X-ray, and ultrasound show price variance of three to eight times between providers in the same city. An MRI scan that costs €280 at an independent imaging center might cost €1,400 at a hospital-based facility. This is the highest-variance category and often the best starting point for carve-out programs.
Price variance for imaging services within the same city
2. Dental Care
Dental has minimal statutory coverage across most EU countries, creating a large self-pay market. Employers already purchase dental benefits separately—carve-out procurement brings competitive bidding to an existing spend category.
3. Mental Health Services
Long public waiting lists in the Netherlands, UK, Germany, and Nordic countries mean employers increasingly pay for private mental health access. With workplace mental health a growing priority, this category represents significant employer spend outside statutory coverage.
4. Physiotherapy and Musculoskeletal Care
MSK conditions are a leading cause of workplace absenteeism. Physiotherapy shows massive price variation, and faster access to treatment directly reduces sick days. Employers see clear ROI from quality physio networks.
5. Elective Surgery
Hip replacements, knee surgery, and eye procedures show significant price differences between providers and between countries. Under EU Directive 2011/24/EU, patients can seek care in other member states, subject to national rules on prior authorization and reimbursement.
6. Executive Health Checks
Comprehensive health screenings are a common corporate benefit with zero statutory coverage. This category is an easy entry point for new broker relationships—employers already budget for it, and price variance between providers is substantial.
Revenue Models: How Brokers Earn from Carve-Outs
Carve-out programs create multiple revenue opportunities for brokers. The right model depends on your market, client base, and regulatory environment. Note that fee structures may be subject to local regulations—consult qualified legal advisors in your jurisdiction.
Option A: Rate Spread
Negotiate €350 with the provider. Charge the employer €400. Keep the €50 spread per procedure. This model works best for high-volume categories where procedure counts justify the margin.
Option B: Per-Employee-Per-Month (PEPM) Fee
Charge employers €2 per employee per month for network access. Pass through contracted rates at cost. This model provides predictable recurring revenue regardless of utilization patterns.
Option C: Volume Fee from Providers
Charge providers a referral fee for guaranteed patient volume. This is common in imaging, where centers value predictable utilization. The employer pays contracted rates while the broker earns from the provider side.
Benchmarking Without Medicare: Using National Tariffs
US healthcare procurement uses Medicare rates as the pricing benchmark. European markets have their own reference points: published national tariffs that serve the same function. Every major European market has a tariff system you can use to normalize provider pricing.
- •Netherlands: NZa tariffs — the most developed selective contracting market in Europe
- •Germany: GOÄ for private (PKV) patients, EBM for statutory — large PKV market with broker opportunities
- •United Kingdom: NHS tariff — established private medical insurance market where brokers already negotiate directly
- •France: CCAM tariffs — Sector 2 physicians charge above convention rates, ideal for benchmarking
- •Belgium: RIZIV/INAMI nomenclature — pricing opportunities in dental and specialist care
By normalizing provider quotes against local tariffs, brokers can identify which providers are competitive and build data-driven network selections—the same approach US employers use with Medicare multiples, adapted for European markets.
Who Should Consider Carve-Out Programs?
Carve-out procurement is not for every broker. It requires portfolio scale, willingness to build provider relationships, and operational capability to manage the network. Three broker profiles are best positioned for success.
- •Corporate benefits brokers: Advisors placing group supplementary health plans who want to differentiate with procurement intelligence
- •Expat and international brokers: Managing healthcare across borders for multinational employers, international schools, NGOs, and embassies
- •Employee benefits consultants: Looking to add carve-out procurement as a new revenue stream beyond traditional plan placement
Getting Started: Your First Carve-Out
Most brokers start with imaging—it has the highest price variance, clear utilization patterns, and straightforward provider relationships. Here is a practical path to launching your first carve-out program.
- 1.Audit your portfolio: How many total employees across your corporate clients? Larger numbers mean more leverage.
- 2.Estimate imaging demand: Roughly 8% of employees will need MRI, CT, or X-ray annually.
- 3.Collect provider quotes: Get pricing from four to six imaging centers in your primary market.
- 4.Benchmark against tariffs: Normalize quotes to NZa, GOÄ, or your local tariff reference.
- 5.Model the opportunity: Calculate potential savings versus market average and your fee structure.
- 6.Approach employers: Present the carve-out as a value-add to your existing relationship.
“Brokers who help employers structure aggregated demand and leverage pricing intelligence create real value. You own the client relationship and advisory process—employers retain purchasing authority.”
Important Considerations
Carve-out programs involve regulatory, legal, and operational considerations that vary by jurisdiction. Before launching a program, work with qualified advisors to understand local requirements.
- •Regulatory requirements vary by country—some markets may classify certain activities under insurance distribution (IDD) or healthcare mediation regulations
- •Provider benchmarks are based on pricing data, not clinical quality metrics or patient outcomes
- •Fee structures should be reviewed by legal counsel familiar with your specific jurisdiction
- •Data processing must comply with GDPR and applicable local data protection requirements
- •All savings projections are illustrative—actual results depend on implementation and market conditions