The Tuition Exchange: Making Healthcare Work for a Small Nonprofit Team

Since 1954, The Tuition Exchange has helped thousands of families access higher education. But behind the scenes, this five-person nonprofit faced a different kind of test: finding healthcare benefits that worked for a small team without the scale or resources of a large organization.

For Kristine Lev, the organization’s Associate Vice President for Finance, navigating the healthcare system had always been difficult. “We tried to get a small group plan, but we’re just too small, it seems,” she explained.

With traditional coverage off the table, Kristine’s accountant suggested a new approach. “Our accountant recommended we look into an ICHRA to be more ACA compliant and that it would be good to have some sort of formal healthcare arrangement. So we got in touch with Liferaft.”

Through Liferaft, acquired by Vitable Health in April 2025, The Tuition Exchange implemented an Individual Coverage Health Reimbursement Arrangement (ICHRA), that allowed employees to choose individual health plans while the organization set a fixed reimbursement budget. It was a simple, flexible solution that finally gave them a path forward. Since they started offering an ICHRA, The Tuition Exchange reimbursed $58,000 across 43 claims, achieving a 100% utilization rate among employees who accepted the benefit.

“Liferaft has been great. It’s been very simple to manage the process, the claims, all of it. Everyone I’ve worked with at Liferaft and Vitable Health has been wonderful,” Kristine said.

Still, costs continued to climb. “Our employees’ premiums and deductibles are very high. Even though we reimburse a decent amount each year, they’re still paying a lot out of pocket,” she explained. “Premiums are going up again this year, maybe significantly and it’s not just marketplace plans; I’m reading that employer group plans are going to have premium hikes as well.”

Kristine has begun exploring Vitable Health’s direct primary care membership, which pairs seamlessly with ICHRAs. Every plan includes unlimited virtual primary care, urgent care, and mental health coaching with no copays or deductibles, plus access to over a thousand common prescriptions and more than 40 lab tests.

“I think the Vitable primary care membership sounds wonderful,” Kristine said.

Vitable Health’s primary care product is especially impactful for employees managing high premiums. By combining an ICHRA with Vitable Health’s virtual care model, teams can select a bronze-level or high-deductible plan and still maintain easy, consistent access to primary and preventive care.

Liferaft has been great. It’s been very simple to manage the process, the claims, all of it. Everyone I’ve worked with at Liferaft and Vitable Health has been wonderful.

What Kristine appreciated most, though, was the human support that came with the process. “It’s really nice to have the option to speak to licensed brokers and advisors during open enrollment,” she explained. The advisors help employees understand their options and choose coverage that fits both their needs and budgets.

As The Tuition Exchange looks to the future, Kristine hopes to continue building on the foundation of affordable, accessible benefits that Liferaft and Vitable Health helped create.