Download to read offline
Uploaded byC. Rod Maxson
Association Health Plan Overview
This document summarizes an innovative healthcare strategy that provides affordable, flexible plans through medical cost sharing and preventative wellness services. It offers two major plan categories - Self-Managed plans for healthy individuals who pay out-of-pocket up to an initial amount, after which medical costs are shared, and Physician-Managed plans for those wanting predefined pricing and networks similar to traditional insurance. Both plan types provide medical cost sharing through a community to limit out-of-pocket costs from major medical expenses above the initial unshared amount. The strategy aims to control costs through various wellness, advocacy, and technology services.
Healthcareâ—¦
More Related Content
Similar to Association Health Plan Overview
Association Health Plan Overview
- 1. American Healthcare Today! Throughan innovative layering of healthcare services, we enable individuals and families access to high quality healthcare that is affordable, flexible and effective
- 2. Every Member isable to Build Their Own Healthcare Plan Because we all have different needs
- 3. Our Healthy CareStrategy to Control your Medical Costs has (5) five Components that combined together create Our Health Excellence Plus™ Plans
- 4. All plans provideEducation and Wellness to Medical Costs Control medical costs with lifestyle modification. We believe that the # 1 Reason people don’t reach their health goals is the everyday interruptions of Life. Our Wellness Coordinators use a multi-touch outreach program to engage members with • The MyAHE Secure Members Communication Portal • “Welcome Call” onboarding every member personally • Secure Audio and Video Connections, • Direct Mail, Email Campaigns, Text Messaging, • Webinars and Seminars • “MPowering Benefit Association” Newsletter • The Health Rewards Program and more…
- 5. My Academy ofHealth Excellence and MPowering Benefits combine together to provide the most innovative and effective Member Education, Engagement and Wellness Platform in the Industry. The MPB 1-1-1 Access to Services Program MPB Member and Concierge Services The US Corporate Wellness Platform “Welcome Call” onboarding every member personally QR for Life Code for Emergencies & Medical Vault The Wellfit Community (Facebook for Wellness) Twelve Habits of Highly Healthy People (sponsored by Mayo Clinic) “Seven Normals” Rewards Program (modeled after the Cleveland Clinic’s) REDUCING member monthly amount Pharmacy Consulting Services (including World Meds, Canadian Drugs and GoodRx) And More...
- 6. and Medical CostSharing to Medical Costs Eliminates the chance of financial catastrophe from bad health. Sedera Health (Sedera) is a group healthcare solutions and benevolence organization. It’s modeled after a number of proven and highly successful medical sharing ministries that have facilitated the sharing of their member’s healthcare expenses for more than two decades within the confines of the Christian community.
- 7. Sedera Health (Sedera)is a group healthcare solutions and benevolence organization. It’s modeled after a number of proven and highly successful medical sharing ministries that have facilitated the sharing of their member’s healthcare expenses for more than two decades within the confines of the Christian community. In addition to sharing medical expenses, Sedera provides access to: • Valuable Counseling • Medical Bill Negotiation • Telemedicine • Expert Second Opinion • Personal Member Advisor services to all members.
- 8. Medical Cost Sharing– a Fast Growing Health Solution
- 9. Medical Cost Sharing– a Better Way Health Care through Community vs Health Care through Insurance Industry Wide Estimate: 1 Billion in Sharing 1 Million Members Freedom from Networks Big Savings Over Health Insurance Sharing begins at $500, $1000, $1500, $2500 or $5000 per need you decide Promotes a Healthy Lifestyle Medical cost sharing by Sedera Health is not insurance and is specific to the Sedera Health membership community. “Industry-wide statistic source: www.healthcaresharing.org
- 10. Medical Cost Sharingis “Need” Based Defining a “Need” and how it works A “Need” is one or more medical expenses caused by a SINGLE accident or illness Initial Unshared Amount (IUA) What members pay before Sharing begins for the Need Needs over the IUA ($500, $1000, $1500, $2500 or $5000) Limiting your out-of-pocket costs Fully Shared with the Community Three (3) for Individual and five (5) when there are family members participating. Everything is fully shareable after that point.
- 11. Medical Cost Sharingin Real Life Comparing $5000/Family Member Insurance Deductible vs a $500 Initial Unshareable Amount For Example, a family’s two year old daughter had a persistent ear infection. Their deductible was $5,000/per family member threshold Care for the child required: 1. A series of antibiotics and booster injections 2. Visit with an ENT specialist who inserted tubes in the child’s ear at a local hospital Cost of an average family insurance policy with a Primary of 45 and a $5000 deductible is $1450.00 per month, a $500 IUA Healthy Care Strategy is $783.00/mn
- 12. Medical Cost Sharingin Real Life (continued) Members pay for visits and treatments up to the IUA, costs are fully shared thereafter.
- 13. Pre-Existing Conditions Pre-existing Conditions: Whenwell controlled, these conditions DO NOT have sharing restrictions • High Blood Pressure • High Cholesterol • Sleep Apnea • Non-Insulin Dependent Diabetes Pre-existing Conditions: Sharing Restrictions* A condition is considered pre-existing if a member had symptoms or treatment in the last 36 months at the time of joining the community. • Year 1: No Sharing for the Condition • Year 2: $15,000 sharing limit • Year 3: $30,000 sharing limit • Year 4: Fully Shareable * Standard sharing restrictions apply when joining the community for genetic defects and/or hereditary disease. There are also restrictions on existing pregnancies when joining the community. Please see the Sedera Member Access Membership Guidelines for more information..
- 14. Prescription Drug Coverage Medications: Cure Examples:Antibiotics, pain medications related to a care accident or post pregnancy, chemotherapy drugs + Same sharing rules apply Maintenance Examples: Blood pressure medication, cholesterol medications + Sharing eligible for first 120 days following a new diagnosis + After 120 days on a new diagnosis (or for an existing diagnosis): Our Pharmacy Consultant has good resources for securing discounted prices for maintenance medications (paid from pre-tax HSA or Health Matching Account HMA)
- 15. Combined with theother (3) three layers of the Healthy Care Strategy to Control Medical Costs & Creates the Core Health Excellence Plus Healthcare Plans Preventive Care Money Management Advocacy & Technology with with
- 16. The Core HealthExcellence Plus™ Healthcare Plans are broken into two Major Categories
- 17. Self-Managed Healthy CarePlans are designed for our healthiest Members who are living a “Lifestyle” of nutritious eating and regular exercise. They are Self-Pay Patients with a backup plan and as such will receive the “Best Cash Price”. Physicians & Hospitals will be happy do give them a 30-70% discount because they don’t have to wait several months to receive payment as with health insurance. Should a “Need” (i.e. large medical expense) be more than the Initial Unshared Amount (similar to a deductible) they selected, the Medical Cost Sharing Community will pay the full amount at 100%.
- 18. Limited Coverage Self-Pay Patient (Optional) HMAHealth Matching Account Teladoc Bill Negotiations Advocacy Colonoscopy Mammograms Immunizations only Self-Directed Healthcare
- 19. Self-Pay Patient Teladoc Bill Negotiations Advocacy (optional) HSAHealth Savings Account HMA Health Matching Account Partially-Directed Healthcare Minimum Essential Coverage 64 Preventive Services PHCS Network
- 20. are designed forour health-focused Members who desire a strategy that is more like a traditional health plan. They prefer to pay a little higher amount each month to have pre-defined pricing for their small and medium sized medical expenses. Choose from a co-pay program with a large PPO network, a Direct Primary Care Doctor, or a Provider Directed Access Program whichever is best for you. Should a “Need” (i.e. large medical expense) be more than the Initial Unshared Amount (similar to a deductible) they selected, the Medical Cost Sharing Community will pay the full amount at 100%. Physician-Managed Healthy Care Plans
- 21. PHCS Network PHCS Network OfficeVisits, Labs, Imaging Teladoc Bill Negotiations Advocacy PHCS Network Co-Pay Network Healthcare Minimum Essential Coverage 64 Preventive Services (Optional) HMA Health Matching Account
- 22. All Covered by DirectPrimary Care DPC-Direct Primary Healthcare Direct Primary Care Direct Primary Care Office Visits, Labs, Imaging Bill Negotiations Advocacy (Optional) HMA Health Matching Account
- 23. All Covered by RedirectHealth Redirect Health Office Visits, Labs, Imaging Chiropractic Bill Negotiations Advocacy Provider-Directed Healthcare Redirect Health (Optional) HMA Health Matching Account
- 24. found on www.MPoweringBenefits.org Useour “Healthcare Needs Analysis” or talk it through with your Agent to determine which of the five core Health Excellence Plus™ Plans is best for you.