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Direct Primary Healthcare

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Co Pay Network Healthcare

DPC Doctor for Preventive And Small Medical Expenses With A Medical Cost Sharing Back-Up Plan

DIRECT PRIMARY HEALTHCARE

Direct Primary Care (DPC) providers charge patients a monthly, quarterly or annual fee that covers all or most primary care services. Most DPC’s limit their practices to about 600 patients and guarantee access to the doctor either on the same or next day.

This video shows how Direct Primary Care works and improves quality, access to care, and cost of primary healthcare:

This option supplements the services provided by your Direct Primary Care provider, and monthly contributions are in addition to the monthly amount you pay that provider.

Most DPC providers offer in-office preventive care services but do not cover expensive preventive services like mammograms, colonoscopies, and childhood immunizations. A plan of minimum essential coverage (MEC) that covers all ACA-required preventive services is included for 2018 but will be eliminated for members who join the plan on or after January 1. 2019 (and the monthly share contributions for this plan will be reduced). The MEC will also be eliminated for members who join in 2018, but these members will have the option of continuing the MEC (based on the monthly share contribution they had been paying). The MEC requires the use of PHCS network providers.

Your DPC provider coordinates your care and guides you to other service providers. Colonoscopies for members age 50 and over, mammograms for members age 40 and over, and childhood immunizations (excluding flu shots) and vaccinations are included as no-cost services in the Medical Cost Sharing portion of the plan.

If your “Need” (i.e. a large medical expense) exceeds the Initial Unshareable Amount (similar to a deductible if this were traditional insurance) you selected, Medical Cost Sharing takes over from your DPC plan and will share the full amount at 100% thereafter unless your Need is subject to sharing limitations for conditions listed in Sections 8 or 9 of the Access Membership Guidelines.

You can choose any doctor or facility when you use Medical Cost Sharing. Tell the provider you're a "self-pay" patient and want their “best cash price." Providers will usually be happy to give you a large discount because they won’t have to deal with an insurance company or meet the company's oversight requirements and interference with the way they practice medicine.

There is no tax penalty with this plan for either 2018 or starting January 1, 2019.

DIRECT PRIMARY CARE HEALTHCARE

Designed To Complement The Services Of Your Direct Primary Care Doctor With Preventive Care And A Back-Up Plan

This plan complements the services of your Direct Primary Care Doctor with SOME Preventive Care services, the Manage and Mitigate portions of the strategy; AND Medical Cost Sharing using any provider who accepts cash or credit (“Open Access”)

Plan Features
Avoid

AVOID medical costs with education and a proactive and interactive wellness program (called WellFit Wellness) provided by My Academy of Health Excellence. You become a member of WellFit Wellness when you join the MPowering Benefts Association. As a member of the Association, you’re entitled to become a member of the Direct Primary Care Healthcare Program.

  • Single Point of Access for Services
  • Fully Integrated Health and Wellness Program
  • Wellness Assessment Program
    (health risk assessment to inform you your current health status)
  • QR For Life Code for Emergencies and Personal Medical Vault
  • WellFit Community (on-line forum for blogs and group interaction)
  • Twelve Habits of Highly Healthy People
  • Artifcial Intelligence Based on Functional Medicine
    (functional medicine-based risk assessment, personalized recommendations, and coaching service)
  • On-line Resource Center
    (webinars, podcasts, interviews with experts, newsletters and e-books)
  • Healthy Rewards Program
Prevent

PREVENT medical expenses using the preventive care services provided by your Direct Primary Care doctor. Expenses for colonoscopies for members 50 and over, mammograms for members 40 and over, and childhood immunizations (excluding flu shots) are provided at no cost (i.e. with no Individual Unshareable Amount) in the Medical Cost Sharing portion of the program.

Manage

You can NOT establish a health savings account if you’re a participant in a Direct Primary Care program.

Money Management: You CAN elect to establish a patented, proprietary Health Matching Account™ (HMA) provided through Health Matching Account™ Services, Inc. to help pay for expenses that are either unshareable or subject to high Individual Unshareable Amounts (IUA) under the Medical Cost Sharing portion of the program.
Call us at 877-734-3884 to see how an HMA may beneft you.

Mitigate

Mitigate using My AHE Pharmacy Programs, My AHE Member and Concierge Services, TelaDoc™ (telemedicine), the Second Opinion Program (2nd MD™), and Counseling services.

Contain
  • Contain large medical expenses with Medical Cost Sharing powered by Sedera Health
  • Services included:
    Sedera Medical Advisor and Medical Bill Negotiation
Plan Specifications
  • THERE IS NO AFFORDABLE CARE ACT TAX PENALTY FOR THIS PLAN EFFECTIVE 1/1/2019
  • WELLFIT WELLNESS PLATFORM - Managed by My Academy of Health Excellence
  • COORDINATED CARE - The principle of Direct Primary Care is that your primary care doctor is your frst point of contact and focal point for services and coordinates all care. He or she provides most preventive care [colonoscopies for members 50+, mammograms for members 40+, and childhood immunizations (excluding flu shots) and vaccinations are fully shareable under the Medical Cost Sharing portion of the program (see below)
  • SMALL MEDICAL EXPENSES - Mitigate using your DPC doctor, My AHE Pharmacy Programs, My AHE Member and Concierge Services, TelaDoc™ (telemedicine), the 2nd Opinion Program (2nd MD™), and Counseling services
Large Medical Expenses
  • Contain With Medical Cost Sharing Powered By Sedera Health
  • Medical Cost Sharing Network - Open Access network; can use any provider who accepts cash payment
  • Initial Unshared Amount (IUA) Options - Choice of $500, $1000, $1500, $2500, or $5000
  • Maximum Number Of IUA’s Annually - 3 per individual/5 per membership unit
  • Prescription Drugs - normal sharing rules apply for curative medications;
    120 days for maintenance medications (blood pressure, cholesterol, etc.)
  • Pre-Existing Conditions - 36 month look-back: no coverage for 1st 12 months;
    $15K 2nd year; $30K 3rd year; unlimited thereafter
  • Maternity Benefts - $5K IUA for normal deliveries and $7.5K for non-emergency/elective C-sections;
    conception must have occurred after membership per section 9 of the Guidelines
  • Therapies And TMJ - range from $1.5K to $2.5K/Need under Section 8 of the Guidelines
  • Psychiatric And Behavioral Health - $5K inpatient maximum/Need; $1.5K outpatient/Need under Section 8 of the Guidelines
  • Tobacco Use - $75 surcharge per membership unit.
    If age 50 or over, $25K sharing restriction for cancer, stroke, heart conditions and COPD
  • Sharing Limits - No annual or lifetime limits unless restricted by Sections 8 or 9 of the Guidelines
Review the 5 types of plans
health excellence plus

SELF-MANAGED PLAN OPTIONS
Self-Directed Healthcare
Self-Directed Healthcare
Totally Self-Directed Program Combining Wellness Services AND Health Cost Sharing For Large Expenses And Mammograms, Colonoscopies and Childhood Immunizations
LEARN MORE
Partially Self-Directed Healthcare
Partially Self-Directed Healthcare
Partially Self-Directed Program Combining Wellness Services, Preventive Care, An Optional Health Savings Account, AND Medical Cost Sharing For Large Expenses
LEARN MORE
PHYSICIAN-DIRECTED PLAN OPTIONS
Co-Pay Network Healthcare
Co-Pay Network Healthcare
Provider-Directed Program Combining Wellness Services, Preventive Care, Co-Pays For Most Small Expenses, AND Healthcare Cost Sharing For Large Expenses
LEARN MORE
DPC - Direct Primary Healthcare
DPC - Direct Primary Healthcare
Provider-Directed Program Supplementing Direct Primary Care With Wellness Services AND Medical Cost Sharing Plan For Large Expenses And Mammograms, Colonoscopies, and Childhood Immunizations
LEARN MORE
Provider-Directed Healthcare
Provider-Directed Healthcare
Provider-Directed Program Combining Wellness Services, Redirect Health for Preventive Care And Most Small Expenses, Medical and Healthcare Cost Sharing For Large Medical Expenses
LEARN MORE
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