"Good health is true wealth" ~ Uruah Faber
United Healthcare HMO/PPO
A New Way to Navigate the Cost of Good Health
Apex Health/Sedera Medical Share Plan
There are 21 qualified tests for adults, 26 tests for women and 28 tests for children. These tests and services are provided at no cost to the members. For a complete list of covered preventive care services, please visit: www.healthcare.gov/center/regulations/prevention.html
When it comes to preventive care and testing, the PHCS network is the largest in the country. It's very likely your provider is already a member. For care regarding an illness or injury you have the freedom to choose your medical care provider - you cannot be "out of network". A member care adviser can assist with information to help you make a good decision.
No. If fact several common prescriptions are just $1. If your prescription is considered a maintenance medication our prescription plan provides tiered costs and mail order discounts. If your prescription is part of the cure for a "need" specific to an illness or injury it is submitted for sharing in the community. If your doctor recommends medication after the "need" has been cured, it would be considered a maintenance medication after 120 days.
Yes. doctor visits, specialists, urgent care, diagnostic x-rays and prescription drugs have nominal co-pays and co-insurance but only until you meet your initial unshared amount (IUA).
The IUA is the first $1,000 of cost paid by the member related to a need of a specific illness or injury. Once the initial unshared amount has been met, all remaining costs are subject to sharing within the community. Each member can have three (3) needs in one year and five (5) when there are family members participating. Everything is fully shareable after that point.
A need is triggered when a member experiences one or more medical expenses related to an illness or injury and ends when the doctor considers the "need" cured.
Preventive care and co-pays for doctor visits, specialists, etc., are covered at the time of the visit. Generally, no claims process is needed. When a member incurs medical expenses in excess of their initial unshared amount, they send in proof of the expense they receive from the provider. Qualified needs are then designated for sharing. Medical bills can be faxed, mailed or scanned.
At the time of service, members should present themselves as a self-pay patient to their provider. The provider will bill the member directly. The member then organizes their bills, completes a need processing form (NPF) and submits copies of all relative medical bills and proof of payments made towards their initial unsharaed amount. Our team of medical bill negotiators may contact the providers to discuss a more appropriate payment for services performed. Members will receive funds for the new amount, less their IUA.
It's as easy as 1.2.3. Contact Employee Solutions Group at 630-888-7144 to schedule a face to face or online enrollment. Download the benefits plan outline. Gather your family's social security information, jot down any questions and meet with your benefits specialist.
The ESG Service Team is on call Monday through Friday 9:00 to 5:00 or you can send an email to firstname.lastname@example.org