Highlights of the PCP Basic Membership

Transcription

1 PCP Basic Membership The Rebirth of Healthcare Alliance for Shared Healthcare serving the United States and the USVI Highlights of the PCP Basic Membership Access to Preventive Care Services Low Member Responsibility for Primary Care Physician, in office X-ray & Lab. Low cost access to Brand Name & Specialty Drugs (SHARx) High Cost Maintenance and Specialty Med Access through SHARx Program at $0 Access Fee Any Doctor / Facility (Balance Billing May occur if members visit providers outside of the PHCS Multi-plan Network) $1,000,000 Excess Hospital & Outpatient Benefit. (See Excess Benefit Limitations and Exclusions on page 7) Worldwide Emergency Transportation Services Alliance for Shared Health is a non profit 501c3 set up to help share in members medical and prescription expenses. ASH is not a qualified ACA program. Members can meet the current ACA requirement by simultaneously enrolling in a membership from a CMS Recognized Healthcare Sharing Ministry. This is not insurance.

2 PCP Basic Membership Low MRA Preventive Care Low MRA Doctor Access $0 Access Fee Prescription Program Immediate Cost Share PCPvisits Low MRA for Preventive Healthcare $0 Doctor Access *Preventive Care * PCP Visits (Max 3 visits) In Office X-Ray & Lab (3 per year) PHCS $50 MRA $30 MRA $50 MRA Access Fee! High Cost Prescription Relief is here! Generics (Tier 1) Prescription Drugs SHARx Program NO Brand Name Specialty SHARx Program SHARx Program Pre-existing Conditions limitations (if added simultaneously to your Heathcare Sharing Ministry Enrollment) * Colonoscopy not included in preventive care (see the guidelines of your Healthcare Sharing Ministry Membership for Colonoscopy Benefit) ** Items subject to Maximum Need Reimbursement

3 High Cost Drug Access Take the worry out of health share with access to the medications you need $0 Access Fee Many members get their prescriptions for FREE! Others receive their prescriptions at 75% - 90% off! Expensive Name Brand Maintenance Medications High Cost Specialty Medications High Cost Generics Save 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 live in an assisted living 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 over 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.

4 Shared Health Alliance rx Assistance Program (SHARx) High Cost Prescription Relief is Here! $0 Access Fee Many members get their prescriptions for FREE! Others receive their prescriptions at 75% - 90% off! Expensive Name Brand Maintenance Medications High Cost Specialty Medications Guaranteed Savings & Satisfaction there is a BETTER WAY U.S. Consumers pay up to 16 times more than any other country for the exact same medications. SHARx Accesses High Cost Generics direct from manufacturer programs Save thousands of dollars on prescription expenses charitable donor programs true wholesale costs

5 A Dose of Relief you need What Medications Does SHARx Help With? Any expensive brand name and generic maintenance and specialty medications. These would include Insulin (all types), Remicade, Xaralto, Vivanse, Lyrica, Cymbalta, Crestor, Nexium, Spiriva, Invokana, Humira, Concerta, Singulair, Synthroid, Enbrel, Suboxene, Celebrex, Cialis, Toujeo, Xolair, Advair Discus, Advair, Albuterol, Dilantin, Microzide, Prozac, Restasis, Effient, Eliquis, Flovent HFA, Welchol, Abilify, Janumet, Latuda, Lipitor, Plavix, Januvia, Atripla, Multaq, Budesonide, Onfi, Calcitriol, Canasa, Seroquel, Victoza, Viagra and MANY, MANY More!! See What Others Are Saying 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 live in an assisted living 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 over 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.

6 $1,000,000 Excess Hospital & Outpatient Benefit The Problem Many CMS recognized Healthcare Sharing Ministry Memberships have a maximum benefit that ranges from $150,000 to $1,000,000. Many times during a true catastrophic event this does not provide sufficient benefit to the member needing ongoing medical treatment. Guidelines This is an optional membership providing a $1,000,000 excess medical sharing benefit for Hospital & Outpatient services. Members must be enrolled into a membership with a CMS Recognized Healthcare Sharing Ministry. Benefits mirror the member's hospital & outpatient sharing benefits offered through their CMS Recognized Healthcare Sharing Ministry membership. (subject to the terms, conditions, guidelines, Pre-existing condition limitations and underwriting requirements of the members CMS Recognized Healthcare Sharing Ministry membership.) The excess benefits outlined in this document are secondary to the sharing benefits offered through the member's CMS Recognized Healthcare Sharing Ministry membership. Members must first incur $1,000,000 of eligible medical expenses through their membership with a CMS Recognized Healthcare Sharing Ministry prior to being eligible for any excess sharing benefits outlined in this document. All underwriting requirements, waiting periods, and pre-existing condition limitations outlined by the member's CMS Recognized Healthcare Sharing Ministry membership apply to the effective date of this excess sharing membership. Members may add up to $2,000,000 of excess sharing benefits to their CMS Recognized Healthcare Sharing Ministry membership This is not insurance

7 $1,000,000 Excess Hospital & Outpatient Benefit LIMITATIONS Expenses which have limitations are as follows: This membership is designed to provide an excess benefit to a member who is also enrolled in a membership through a CMS Recognized Healthcare Sharing Ministry. Benefit limitations for each unit of $1,000,000 of excess benefits are mirrored to the Terms, conditions, guidelines, pre-existing condition limitations, and underwriting requirements of the members CMS Recognized Healthcare Sharing Ministry membership. EXCLUSIONS Expenses which are not eligible for reimbursement are as follows: 1) Medical expenses for members who are not enrolled into a membership through a CMS Recognized Healthcare Sharing Ministry. 2) Members must first realize $1,000,000 of eligible medical expenses from the effective date of this membership (subject to the terms, conditions, & or guidelines of their CMS Recognized Healthshare membership) 3) Any expense which you are not legally obligated to pay. 4) Services which are not Medically Necessary or are not furnished by and under supervision of a Physician. 5) Expenses for services and supplies for which you are entitled to benefits, services or reimbursement through the Veterans Administration, Workers Compensation insurance, any private health plan or from any other source except Medicaid. 6) Expenses in excess of usual, customary and reasonable (UCR) fees. 7) Self-inflicted injuries while sane or insane. 8) Treatment for alcoholism, drug addiction, allergies, and/or mental or nervous disorders. 9) Rest cures, quarantine or isolation. 10) Cosmetic surgery unless necessitated by an accidental injury. 11) Dental exams, dental x-rays and general dental care except as a result of an accidental injury. 12) Eye glasses or eye examinations. 13) Hearing aids or hearing examinations. 14) General or routine examinations. 15) Injuries sustained from participation in Hazardous Sports or Activities, which include mountaineering, snow skiing, scuba diving, hang gliding, sky diving, racing of any kind, and all professional or semi-professional sports. 16) Pregnancy and pregnancy-related conditions including but not limited to fertility, pre-natal care, childbirth, miscarriage or abortion. 17) Injuries due to war or any act of war whether declared or undeclared. 18) Injuries sustained while committing a criminal or felonious act. 19) Expenses incurred for or resulting from pain which is not supported by medical diagnosis. 20) Cataract surgery or any elective surgery. 21) Custodial Care. This is not Insurance