BENEFIT PLANS
HEALTHSHARE CONNECTION +
MEGA PLAN
MEDICAL COST-SHARING MEMBERSHIP
HSC + MEGA PLAN
PRICING
MEGA PLAN
PHCS Network of Doctors
Unlimited Telehealth – No Copay
Behavioral Telehealth
Prescription Discount Card
Doctors & Specialist Office Visits
Dental & Vision
Limited Lab Work
Out-Patient Testing
Urgent Care Visits
HEALTHSHARE
Surgery Care
Emergency Room Procedures
Covid Related Care
In-Patient Hospital Care
Outpatient Procedures
Extended Lab Work
Extended Out-Patient Testing
Accident Care
Maternity (See Limitations)
UNDER 30
OVER 30
MEMBER
$150
$180
MEMBER + SPOUSE
$325
$375
MEMBER + FAMILY
UP TO 5 MEMBERS
EACH ADDITIONAL FAMILY MEMBER
$490
$25
$540
$25
* ABOVE RATES DO NOT INCLUDE MEGA PLAN COSTS *
* THERE IS A $75 PER MEMBER MONTHLY SMOKING SURCHARGE. ADULT DEPENDENTS (AGES 18-26) WILL REQUIRE PROOF OF ENROLLMENT IN A COLLEGE OR TRADE SCHOOL PROGRAM, OTHERWISE, A FEE OF $50 PER DEPENDENT, PER MONTH, MAY BE ASSESSED. *
EXPLANATION OF
PLAN BENEFITS
For so many employers the goal of healthcare is to provide employees with both an ACA compliant plan and a full range of medical benefits. The challenge of today’s employers is to find this combination of services at the lowest possible cost. The HealthShare Connection + Mega Plan is a non-insurance alternative for managing large healthcare costs. This is a membership-based cost-sharing program, whereby members can have their approved medical expenses paid by the community (with a minimal portion paid by the member). This plan combines the HealthShare Connection Plan (extended care related expenses) with all of the benefits of National Health’s Mega Plan (first-dollar coverage for out-patient medical needs) to deliver a well-rounded alternative to traditional health insurance.
Here are some important terms we use when discussing the HSC + Mega Plan.
PLEASE NOTE: Individuals and families can have unlimited needs throughout the year, however, they are only responsible for paying a non-shareable amount ($1500) for the first 3 (individuals) or 5 (families) needs. This non-shareable amount can become less by utilizing the copay program included in their HSC + Mega Plan.
HOW IT WORKS
HSC offers membership to a cost-sharing community of like-minded individuals for the purpose of sharing legitimate healthcare expenses between members. Our members lead a healthy lifestyle and agree to established guidelines put forth by HealthShare Connection that encourage good health (and in turn, fewer medically necessary treatments). Members will not be excluded based on pre-existing conditions, but limitations may apply.
- Individual/Family joins the HealthShare Connection Cost-Sharing Community by electing membership. Member begins to contribute monthly to sharing in the medical Needs of the Community.
- When Member has an eligible medical “Need” caused by an injury or illness, they pay their Non-Shareable Amount (NSA) and the remaining bills are submitted to the Community by using their membership card at time of service.
- Member’s NSA of $1500 can become less if any National Health coverage has been utilized for medical needs.
- Community shares funds with Member for the eligible Need
PRE-EXISTING CONDITIONS
Any pre-existing medical condition whether diagnosed or not, that has been active or needed treatment within 36 months prior to a Member’s membership start date is subject to sharing limitations. Pre-existing conditions will become eligible for sharing based on the Member’s tenure in the HealthShare Connection + Mega’s cost-sharing community as indicated by the following graduated sharing schedule:
| TIME CONSTRAINTS FOR PRE-EXISTING CONDITIONS AFTER MEMBERSHIP EFFECTIVE DATE | SHARING ELIGIBILITY |
|---|---|
| First 12 Months | Not Shareable |
| Months 13-24 | Shareable to $15,000 |
| Months 25-36 | Shareable to $30,000 |
| Months 37 & After | Shareable |
MEMBER HAS A LARGE
MEDICAL EXPENSE RELATED TO A NEW INJURY OR ILLNESS
EXAMPLES
Broken Bones, Lacerations, Fractures, Cyst Removal, Infectious Diseases, Stroke, Heart Attacks, Cancer, Liver Disease, Gastrointestinal Issues, Medically Necessary Surgery… etc.
HSC COST-SHARING PROCESS
HEALTH & WELLNESS VISITS
Included in this MEC coverage are 15 Covered Preventative Services for Adults, 23 additional Covered Preventative Services for Women (including pregnant women), and an additional 26 Covered Preventative Services for Children and Newborns. The majority of the covered preventative services included in this plan allow for screenings, vaccinations, counseling and other preventative tests. It also includes a colonoscopy screening for adults 50 years and older every 5 years as well as an annual mammogram screening for women 40 and over.
MEDICAL & BEHAVIORAL TELEHEALTH
The Total Telehealth Plan included in this package includes Unlimited Free Medical Visits available 24/7/365 from MeMd’s smartphone app or website. These medical visits can range in type from an Urgent Care Telehealth visit to Men’s and Women’s Telehealth Services. Behavioral Health visits can be scheduled with an online provider for a low $60 per visit copay. The Behavioral Telehealth services include Talk Therapy, Teen Therapy and Telepsychiatry.
TOBACCO & VAPING
SHARING RESTRICTIONS
Due to the increased likelihood of higher medical costs associated with tobacco and vaping use, HSC households with one or more tobacco or vape users are required to contribute an additional $75 per month. Unless tobacco or vape users age 50 and older are confirmed tobacco-free for 12 months, they will have a sharing limit of $25,000 for each of the following conditions: 1. Cancer, 2. Heart Conditions, 3. COPD, 4. Stroke.
EMPLOYER
CONTRIBUTIONS
This plan requires an employer contribution of $30 per employee to maintain the “employer-sponsored” designation requirement of the ERISA Act legislation that this plan is founded on. Employers may contribute more than $30 per employee if they so choose, but the minimum standard contribution starts at $30 per employee.
INCLUSIONS
Our HealthShare + Mega Plan includes all claims fees, administration costs, a Total Telehealth package through MeMd with no copay on medical services, and a Prescription Discount Card. This plan includes all government reporting including Forms 1094’s, 1095’s, 720 Report, Form 5500 section 4980H, PCORI annual filing fee, Cobra Notices, and TPA fees. It also includes the
COPAY PROGRAM SHOWN HERE.
COVERED PREVENTATIVE SERVICES
COVERED PREVENTATIVE SERVICES
ALL ADULTS
- Blood Pressure Screening
- Cholesterol Screening
- Type II Diabetes Screening
- Syphilis Screening
- HIV Screening
- Sexually Transmitted Infection Prevention Counseling
- Tobacco Use Screening For All Adults & Cessation Interventions
- Aspirin use for men ages 45-79 & women ages 55-79 to prevent CVD when prescribed by a physician
- Colonoscopy (Colorectal cancer screening for adults starting at age 50, limited to one every 5 years)
- Diet counseling
- Immunizations and vaccines (Hepatitis A&B, Herpes, Zoster, Influenza, Measles, Mumps, Tetanus, Rubella, Human Papillomavirus, Meningococcal, Pneumococcal, Diphtheria, Pertussis)
- Abdominal aortic aneurysm one-time screening for age 65-75
- Depression screening & counseling
- Obesity screening
COVERED PREVENTATIVE SERVICES
WOMEN’S SERVICES
- Breast cancer mammography screening every year for women age 40 and over
- Breast cancer chemo prevention counseling
- Cervical cancer screening
- Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs
- Domestic and interpersonal violence screening and counseling for women
- Gonorrhea screening
- Syphilis screening
- Chlamydia infection screening
- HIV screening and counseling
- Human Papillomavirus (HPV) DNA testing every three years for women with normal cytology results who are age 30 or older
- Osteoporosis screening over age 60
- Tobacco use screening and interventions
- Sexually transmitted infections counseling
- Wellness visits
COVERED PREVENTATIVE SERVICES
PRENATAL / POSTNATAL SERVICES
- Anemia screening on a routine basis
- Bacteria, urinary tract and infection screening
- BRCA counseling and genetic testing for women at higher risk
- Breastfeeding comprehensive support and counseling from trained providers, as well as access to breastfeeding supplies
- Folic acid supplements
- Gestational diabetes screening
- Hepatitis B screening
- Routine prenatal visits
- Rh-incompatibility screening including follow-up testing
- Expanded counseling for pregnant tobacco users
- Delivery, C-Section, Inductions not covered at this time
COVERED PREVENTATIVE SERVICES
NEWBORN SERVICES
- Hearing screening
- Immunization vaccines for children from birth to age 18 with variable doses, according to recommended ages and populations
- Cervical Dysplasia screening and vaccines for Diphtheria, Tetanus, Pertussis, Hepatitis A & B, Human Papillomavirus, Inactivated Poliovirus, Influenza (Flu Shot), Measles, Mumps, Rubella, Meningococcal, Pneumococcal, Rotavirus, Varicella
- Congenital Hypothyroidism screening
- Gonorrhea preventive medication for eyes
- Hemoglobinopathies or sickle sale screening
- Phenylketonuria (PKU) screening
- Iron supplements for newborns to 12 months when prescribed by a physician
COVERED PREVENTATIVE SERVICES
ALL CHILDREN SERVICES
- Autism screening for children, limited to two screenings up to age 24 months
- Vision screening, 5 and younger
- Developmental screening for children under the age of 3 and surveillance throughout childhood
- Lead screening
- Dyslipidemia screening
- Height, Weight and Body Mass Index measurements
- Obesity screening and counseling
- Hematocrit or Hemoglobin screening
- Oral health risk assessment, up to age 10
- Depression screening, 12 and older
- Alcohol and drug use assessments
- Blood pressure screening
- Sexually transmitted infection prevention counseling and screening for adolescents
- Tuberculin testing