The Rebirth of Healthcare
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- Ralph Gardner
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1 The Rebirth of Healthcare
2 Highlights of the SHA Plans and Sharing options aailable through ASH Membership Three great programs are aailable Go to any doctor No more Networks Proider payments based on a percent of Medicare Low Member Responsibility Amount (MRA) Virtual Primary Care Program Access to diagnosis and treatment of nearly 1500 conditions Visit page 7 for more information Prescription drug access offered on all programs SHARx Program Adocacy fee waied High Cost Maintenance Medications Specialty Medications Visit page 8 for more information Designed to work as a supplement to other catastrophic health share programs Numerous health share programs are aailable - faith based and non-faith based Multiple sharing leels aailable to meet each person s needs from $500 to $5,000 Unlimited sharing limits aailable One premium collection point through Shared Health Alliance for certain health share programs Alliance for Shared Health (ASH) is a non-profit 501(c)(3) set up to help share in member medical and prescription expenses. ASH is open to people of all faiths that share a common goal of helping each other access more affordable health care solutions. 2
3 SHA PREVENTIVE SHA Preentie Single $119 Single + 1 $189 Family $235 Monthly Contribution Preentie Serices 100% Sharable Prescription Sharing Rx Assistance Virtual PCP Access Staying healthy needs a plan and action. Your PREVENTIVE plan includes benefits that can help support you and your family in preentie screenings & wellness. The PREVENTIVE plan also includes Rx Assistance & Virtual Primary Care access. Open Network ASH uses Value Based Pricing Virtual Primary Care includes diagnosis and treatment for 1500 Conditions See Any Doctor $50 MRA Preentie Care Serices (not shared if serices are from hospital) Shared at 100% Prescription Benefits No maximum Shareable Limit Tier 1 Tier 2 Tier 3 30-day supply Tier 1 Tier 2 Tier 3 60-day supply Tier 1 Tier 2 Tier 3 90-day supply Specialty & Drugs aboe $400 $10 MRA 20% MRA ($20 min MRA) 40% MRA (1 fill only) $20 MRA 20% MRA ($40 min MRA) SHARx $30 MRA 20% MRA ($60 min MRA) SHARx SHARx Tier 1 Drugs below $50 per 30-day supply Tier 2 Drugs between $50-$149 per 30-day supply Tier 3 - Drugs between $150-$400 per 30-day supply 3
4 SHA PREMIER SHA Premier Single $175 Single + 1 $286 Family $373 Preentie Serices 100% Sharable Low MRA to access doctors Prescription Sharing Monthly Contribution Open Network ASH uses Value Based Pricing Virtual Primary Care includes diagnosis and treatment for 1500 Conditions Rx Assistance Virtual PCP Access See Any Doctor $0 MRA Preentie Care Serices (not shared if serices are from hospital) Shared at 100% Primary Care (max 3 isits per year) Specialist (max 3 isits per year) Urgent Care (max 3 isits per year) Diagnostic X-Ray and Lab (In office, max 5 serices) non-hospital only Cat-Scan or MRI (1 per year) non-hospital only Outpatient Testing (1 per year) non-hospital only $30 MRA $65 MRA $75 MRA $50 MRA 50% MRA 50% MRA Prescription Benefits No maximum Shareable Limit Tier 1 Tier 2 Tier 3 30-day supply Tier 1 Tier 2 Tier 3 60-day supply Tier 1 Tier 2 Tier 3 90-day supply $10 MRA 20% MRA ($20 min MRA) 40% MRA (1 fill only) $20 MRA 20% MRA ($40 min MRA) SHARx $30 MRA 20% MRA ($60 min MRA) SHARx Specialty & Drugs aboe $400 SHARx Tier 1 Drugs below $50 per 30-day supply Tier 2 Drugs between $50-$149 per 30-day supply Tier 3 - Drugs between $150-$400 per 30-day supply 4
5 SHA Scripts Generic Name Brand Specialty SHA Scripts Benefits 80% of coered Generics are $10 or less SHARx SHARx The Solution to High Cost Rx Expense Access to expensie brand name and generic maintenance and specialty medications. *Insulin (all types) * Remicade * Xaralto *Vianse *Lyrica,*Cymbalta *Crestor, *Nexium *Spiria *Inokana *Humira *Concerta *Singulair *Synthroid *Enbrel, *Suboxone *Celebrex *Cialis *Toujeo *Xolair *Adair Discus *Adair *Dilantin *Microzide *Prozac *Restasis *Effient *Eliquis *Floent HFA *Welchol *Abilify *Janumet *Latuda *Lipitor *Plaix *Januia *Atripla *Multaq *budesonide *Onfi *Canasa *Seroquel *Victoza * Viagra MANY, MANY More!! Access Fee Waied for SHARx Members! $39 Single $43 Single +1 $50 - Family Monthly Contribution Includes a generic only Rx card to fill your generic meds at the pharmacy! 5
6 SHA Premier SHA Preentie SHA Scripts Open Network See Any Doctor See Any Doctor Not applicable Virtual Primary Care (Sherpaa) $0 MRA $50 MRA Catastrophic Sharing Through Health Share Through Health Share Through Health Share Preentie Care Serices Shared at 100% Shared at 100% Primary Care Physician Office Visit $30 MRA (max 3 isits per year) Specialist Office Visit $65 MRA (max 3 isits per year) Urgent Care $75 MRA (max 3 isits per year) Diagnostic X-ray and Lab $50 MRA (In office, max 5 serices) Cat-Scan or MRI Shared at 50% (1 per year) Outpatient Testing 50% (1 per year) Prescription Benefits Tier 1 $0 - $40 $10 MRA $10 MRA Generic Copay Card Tier 2 $50 - $149 20% MRA ($20 minimum) 20% MRA ($20 minimum) 80% of coered Generics are $10 or less Tier 3 $150 - $400 ( 1 fill at pharmacy for maintenance, then 40% MRA (1 st fill only) 40% MRA (1 st fill only) All other maintenance thru SHARx medications are accessed through SHARx Specialty Drugs SHARx Only SHARx Only Monthly Contribution Single $175 $119 $39 Single +1 $286 $189 $43 Family $373 $235 $50 6
7 Introducing The Virtual Primary Care Adantage Ø Start your conersation online, and talk lie if necessary Ø Your Sherpaa doctor will refer you to a local doctor if needed. Ø Can diagnose and treat around 1,500 conditions Ø On par with a traditional PCP or urgent care center Ø Superior to traditional telemedicine that can only treat 30 conditions Ø Work with the same doctor until you get better Ø Episode of Care will last Ø 3 days for a UTI Ø 3 weeks for a pneumonia Ø 3 months for a cancer scare. Ø Will order labs if needed and prescribe medication Ø Easy to begin care process with the Mobile App. Ø You will mostly message back and forth, you can share photos, and jump on the phone when needed Ø Your Sherpaa doctor is minutes away no matter what as long as it takes to get better Deelop a relationship with the same online proider while you are in our program. Access to Sherpaa is included in SHA Preentie and Premier 7
8 Shared Health Alliance Rx Program (SHARx) Non-Insurance Member Program for High Cost Drugs $0 Access Fee Many prescriptions are aailable for FREE! Nearly all other prescriptions are 75% - 90% off retail price! Includes Expensie Name Brand Maintenance Medications High Cost Specialty Medications High Cost Generics Sae thousands of dollars on prescription expenses I m a single father and was recently diagnosed with leukemia. The medication that was prescribed costs more than $16,000 per month. Through the program, I was able to get access to the medication for free! I lie in an assisted liing facility and was paying $370 month through the pharmacy. I called to see if they could help me and they were able to get my medications for only $50 a month. This program is such a God-send! I am thrilled that this company exists!!. I was taking medicine for my cystic acne. Painful bumps all oer my face, back, and chest. I called around to pharmaceutical companies looking for help with the cost of medicine. I finally got referred to this program after 16 other companies rejected me. Thank God for Anji! I got my medicine that was $800 a month for $25. Way better!!! Thank you sooo much, I am spreading the word. 8
9 SHA Healthy Essentials The sharing proisions listed below are optional and only apply to your membership if you selected this option during enrollment. Dental Sharing Proisions Dental Sharing Proisions Member Responsibility Amount Calendar Year Member Responsibility Amount (MRA) $50 / $150 (Per Person / Per Family) (Applies to Class II, III and IV) Dental Sharing Proisions Sharable Amount Calendar Year Maximum Sharing Amount $1,250 (Applies to Class I, II and III - Serices Combined) Dental Sharing Coered Serices Sharable Amount 100% - no MRA Class I Preentie Serices Class II Basic Serices (6 month waiting period) 80% - after calendar year MRA Class III Major Serices (12 month waiting period) 50% - after calendar year MRA Not Sharable Class IV Orthodontic Serices *Eligible benefits based on Usual and Customary at the 90th percentile of the National Dental Adisory Serice (NDAS) guidelines. Vision Sharing Proisions Vision Sharing Coered Serices Vision Exam Lenses Frames Contact Lens Contact Lens Fitting Lasik Surgery Sharable Amount $250 per year maximum sharing amount (combined benefit maximum) 9
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