Network Requirement:
There are no network requirements for comprehensive care events.
Initial Unshareable Amount (IUA): $2500.00
There are a maximum of 3 IUA expenses per plan within a 12 month period from the date of the first comprehensive care event. This means that whether you’re comprehensive care plan is for an individual member or for a family, the total times that you will be out of pocket for an IUA is three. There is no IUA expense after the 3rd IUA has been met within the twelve month period from the 1st comprehensive care event.
What is an "IUA"?
An IUA (initial unshareable amount) is the out of pocket portion the member must provide before the medical share plan contributes to the balance due for the benefit provided under the comprehensive portion of the plan. The full amount of the IUA must be paid to the provider within 6 months of the service date for the balance to be shareable under the comprehensive care plan. Once the IUA is met the comprehensive care plan provides 100% of the balance due for the shareable medical need(s) related to the comprehensive care event.
COMPREHENSIVE CARE EVENT
A comprehensive care event is specific to the medical care required for a single shareable medical need such as surgery, maternity, or hospitalization. A comprehensive care event includes the initial care and treatment required as well as any follow up doctor appointments, rehab, or an additional medical care related to the initial shareable medical need. This means treatment for a broken leg is considered 1 event; treatment for a dislocated shoulder would be considered a 2nd event; and pregnancy and delivery would be a 3rd event if they all occurred within the twelve period from the date of the 1st event. Routine doctor visits for acute medical care such as minor injuries or illnesses are not considered as comprehensive care events.
COMPREHENSIVE CARE IN-PATIENT BENEFITS - 100% shareable after IUA is met
- Hospital Confinement (initial hospital admission & stay)
- ICU & sub-acute ICU
- Surgery & Anesthesia
- Rehabilitation Unit
- Labs & Diagnostic Imaging (Diagnostic Lab Tests, X-Ray, MRI, CT, PET, EEG, Gastroenterology)
- Physician & Specialist visits
- Emergency Room Visit (with hospital admission)
COMPREHENSIVE CARE OUTPATIENT BENEFITS - 100% shareable after IUA is met
- Surgery & Anesthesia (includes. Physician & facility fees)
- Rehabilitation Physical Therapy (not drug or alcohol related)
- Labs & Diagnostic Imaging (Diagnostic Lab Tests, X-Ray, MRI, CT, PET, EEG, Gastroenterology)
- Physician & Specialist visits
- Emergency Room (without hospital admission)
MATERNITY BENEFITS - 100% shareable after IUA is met
PRENATAL
- Routine office visits
- Routine lab work
- Fetal non-stress test (after 36 weeks)
- Up to three standard ultrasounds (unless an unexpected complication requires
additional scans)
- STD/STI screenings prescribed by a licensed practitioner as part of routine prenatal
care
DELIVERY
- Ob-gyn labor and delivery
- Cesarean
- Multiple births
- Hospital labor and delivery
- Hospital room and board
- Anesthesiologist
- Legally practicing midwives (In order for midwifery costs to be shareable, an itemized
breakdown of the services provided in their global package must be provided before services are rendered. Not all midwifery services may be eligible
for sharing.)
- Home births
- Maternal fetal medical specialist consultations, when ordered by the medical provider managing the pregnancy.
- Pelvic manipulation (only shareable if new onset of back and/or pelvic pain, after the 30th week, and with a total of 20 visits but no more than $2000, whichever occurs first. Exceptions will be considered for multiple births.)
- Birthing centers
- Charges related to unexpected complications for the mother
- One in-hospital pediatrician visit including routine immunizations, routine lab work, and routine hearing tests (all shareable when the baby is added to the membership within 30 days of delivery and when these services occur prior to discharge from hospital)
POSTNATAL
- Mother’s six-week postpartum checkup with pap test
- Two-week cesarean post-op appointment
END OF LIFE BENEFITS
End of life services (shareable for all services required at time of death for a participating member)
- Primary or spouse: $10,000
- Child: $2500
- Paid once per decedent
Non-Comprehensive Care Outpatient Physician Office Visits
Non-comprehensive care events are typically medical needs that do not require surgery, hospitalization, extensive/expensive lab testing or diagnostic imaging such as routine
office visits for primary care doctors, specialist physicians, or urgent care.
NETWORK: Multiplan PHCS Selected Services
OUTPATIENT PHYSICIAN VISITS (non-comprehensive care primary care, specialists, and urgent care visits)
- IN-NETWORK
$25 co-pay for all outpatient physician office visits at primary care physician, specialist, urgent care, or retail medical clinic. Plan pays up to $200 for services rendered per visit after co-pay. Max. benefit 4 visits per insured/year.
- OUT-OF-NETWORK
$25 co-pay for all outpatient physician office visits at primary care physician, specialist, urgent care, or retail medical clinic. Plan pays up to $200 for services based upon 125% of Medicare rates per visits after co-pay. Max. benefit 4 per insured/year.
Annual Wellness Exam (non-comprehensive care visit)
NETWORK: Multiplan PHCS Selected Services IN-NETWORK BENEFIT ONLY.
- Maximum benefit: 1 per year per insured
- No copay, deductible, or out of pocket cost
- Plan pays 100% of annual welness exam
- Wellness exam includes medical history reveiw, physical exam, measurements (height, weight, body mass index), and preventive care
Preventive Care for Adults (non-comprehensive care visit)
for men and women ages 18-64
NETWORK: Multiplan PHCS Selected Services IN-NETWORK BENEFIT ONLY.
- Blood Pressure screening - One-time per plan year
- Cholesterol screening - One-time per plan year
- Type 2 Diabetes screening - One-time per plan year
- Hepatitis B screening for adults at high risk - One-time per plan year
- Hepatitis C screening for adults at high risk - One-time per plan year
- HIV screening & counseling - One-time per plan year
- Immunization vaccines One-time per plan year per immunization (EACH): hepatitis A & B, herpes zoster, human papillomavirus, influenza (flu shot), measles, mumps, rubella, meningococcal, pneumococcal, tetanus, diphtheria, pertussis, and varicella
- Obesity screening & counseling - One-time per plan year
- Sexually Transmitted Infection (STI) prevention counseling - One-time per plan year
- Syphilis screening - One-time per plan year
Preventive Care for Women (non-comprehensive care visit)
ages 18-64
NETWORK: Multiplan PHCS Selected Services IN-NETWORK BENEFIT ONLY.
- BRCA counseling and genetic testing - One-time per plan year for Women at higher risk
- Breast Cancer Mammography Screenings - One-time per plan year for women age 40+
- Breast Cancer Chemo prevention counseling - One-time per plan year
- Cervical Cancer screening - One-time per plan year
- Gestational Diabetes screening - One-time per plan year
- Hepatitis B screening - One-time per plan year
- HIV screening & counseling - One-time per plan year
- Human Papillomavirus (HPV) DNA test - One-time every 3 years for women with normal cytology age 30+
- Osteoporosis screening - One-time per plan year for women age 60+
- Well-woman visits - To obtain recommended preventive services
Preventive Care for Children (non-comprehensive care visit) ages 0-17
NETWORK: Multiplan PHCS Selected Services IN-NETWORK BENEFIT ONLY.
- Immunization vaccines One-time per plan year per immunization (EACH): hepatitis A & B, herpes zoster, human papillomavirus, influenza (flu shot), measles, mumps, rubella, meningococcal, pneumococcal, tetanus, diphtheria, pertussis, and varicella
- Autism screening - Limited to 2 screenings up to age 26 months
- Blood Pressure screening - One-time per plan year
- Congenital Hypothyroidism screening - One-time per plan year for Newborns up to age 3 months
- Phenylketonuria (PKU) screening - One-time per plan year for Newborns up to age 3 months
- Sexually Transmitted Infection (STI) prevention counseling & screening
One-time per plan year for adolescents aged 12 to 17 years
- Tuberculin testing - One-time per plan year
- Vision screening - One-time per plan year for children up to age 5
Virtual Direct Primary Care
Unlimited access to top primary care physicians dedicated to understanding patient needs and developing a tailored care plan with ongoing access to care via message-based or video interactions. Patients can choose a consistent provider who meets their needs and preferences.
Virtual Direct Primary Care physicians can diagnosis and treat up to 90% of the medical needs incidences as an in-person primary care physician office visit, including cases involving chronic illness/disease management and chronic pain management.
Virtual Direct Primary Care physicians can also prescribe medications, when medically necessary. Virtual services included with your HealthConnect plan are always without copays, deductibles, consult fees, or usage limitations. Use these benefits as often as needed.
Virtual Urgent Care
Unlimited access to board certified physicians and Rn's that can treat and prescribe medications (when medically necessary) for minor illnesses and minor injuries such as:
| • Acne |
• Allergies |
• Alopecia (Hair Loss) |
• Asthma |
| • Birth Control |
• Boils |
• Cold & Flu |
• Cold Sores |
| • Cough |
• COVID-19 symptoms |
• Cysts |
• Dermatitis |
| • Diabetes (Type 2) |
• Ear Pain |
• Eczema |
• Folliculitis |
| • Fungal Skin Infections |
• Headache |
• High Blood Pressure |
• High Cholesterol |
| • Hives |
• Insect Bites |
• Keratosis |
• Medication Refills |
| • Obesity |
• Pink Eye |
• Prediabetes |
• Rash |
| • Rosacea |
• Routine Care |
• Sinus Infection/Problems |
• Skin Pigmentation Disorders |
| • Sore Throat |
• Suspicious Spots & Moles |
• Thyroid Issues |
• UTI |
| • Warts |
• Wellness Screenings |
• Yeast Infections |
|
Additionally, you'll have professional experienced medical practioners available for general medical questions. Virtual services included with your HealthConnect plan are always without copays, deductibles, consult fees, or usage limitations. Use these benefits as often as needed.
Virtual Behavioral Health
The goal of Virtual Mental Health is to provide the mental health treatment and support that people need when they need it most. This approach naturally facilitates the reduction in long-term demand on expensive treatment programs for the consumer.
Virtual services included with your HealthConnect plan are always without copays, deductibles, consult fees, or usage limitations. Use these benefits as often as needed.
Enter Where & When You Need...
Exit When Ready
Common Virtual Behavioral Health topics include:
| • Addictions |
• Aging & Caregiver Support |
• Anxiety |
• Bipolar Disorder |
| • Depression |
• Grief & Loss |
• LGBTQ+ Support |
• Life Changes |
| • Obsessive Compulsive Disorder (OCD) |
• Panic Disorders |
• Parenting Support |
• Phobias |
| • Relationship Issues |
• Stress Management |
• Trauma & PTSD |
|
QmpleteRx Premium Prescription Plan
At QmpleteRx, our commitment to public health goes beyond words; it's our mission. We believe everyone should access needed medications without financial strain. Our tiered subscription model ensures personalized plans for individuals and families, offering a diverse range of FREE generic medications. With no mark-ups or dispensing fees on ANY medications, we address the issue of rising medication costs, providing you with affordable solutions.
• 3,150 Generic Medications under $20 - 100% FREE
• Guaranteed Lowest Available Rate On Medications Over $20
• Dependent Coverage Available For Immediate Family Members
• Unlimited Use
• No Maximum Benefit $ Cap
• Over 65K Local Participating Pharmacies
Quick & Comprehensive Lab Tests You Can Order Online
We provide direct access to laboratory testing and health screening services for members, making it possible for you to work with your provider on what’s best for your health and well-being. With access to over 2,100 nationwide patient service centers and tools to track and monitor your results, we empower our members to know their lab numbers and take control of their health. You can get the tests you need without spending a lot of time or money.
We offer over 2,000 lab tests and panels including:
Comprehensive Metabolic Panel Blood Test (CMP Blood Test), Complete Blood Count Blood Test (CBC Test), Thyroid-stimulating Hormone Blood Test (TSH Blood Test), Vitamin D and other vitamin and nutrition tests, cholesterol lab tests, and plus these categories of tests:
Virtual Pre & Post Natal Support
For expectant mothers and parents, the months leading up to your due date can be filled with many questions, thoughts, and emotions. Navigating the multitude of online and offline resources offering advice can be daunting for a new mother or soon-to-be parent. It's very important to have trustworthy and easily accessible resources for assistance when you need it most.
Virtual Pre-natal and Post-natal support provides you with consultations with our maternal and fetal medicine specialists; professional medical advice and guidance for expecting and new-born parents; lactation consults; and much more.
Virtual Health & Wellness Coaching
The goal of health and wellness coaches is to assist clients in discovering practical strategies for making small adjustments that have a significant impact. Our highly qualified coaches will increase your chances of success while you make changes to your health through their expertise in behavior modification, motivational interviewing, positive psychology, and other cutting-edge coaching techniques.
Whether you want to shed a few extra pounds, stop smoking, get more organized, or work on lifestyle goals consultations and ongoing support from a licensed and certified health and wellness coach can help to dramatically improve your chance of success and fulfillment.
Patient Concierge & Advocacy
We are here 24/7/365 to help you find and get the quality of care you need.
We are here to give patients the information they need to make decisions about their care. Our patient concierge team assists patients in communicating with their medical providers to help make sense of it all.
In addition to scheduling doctor's appointments and testing; patient concierges can also assist with medical billing and medical bill cost reduction; finding the most affordable providers and resources in their local area such as prescription drugs, neighborhood labs, imaging, and other diagnostic services.
This healthcare benefit plan is not an ACA Qualified major medical health insurance plan. This plan contains limitations and exclusions per the respective underwriter(s) or non-insured healthcare benefit provider(s).
