3 Low-Cost Programs
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Direct Primary Healthcare

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Co Pay Network Healthcare

DPC Doctor For Preventive And Small Medical Expenses With Medical Cost Sharing As A Back-up For Large Expenses

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 provider 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 colonoscopies, mammograms, and childhood immunizations for children through age 18.

Your DPC provider coordinates your care and guides you to other service providers. Screening colonoscopies for members age 50 and over, screening mammograms for females age 40 and over, and childhood immunizations and vaccinations for children through age 18 are included in the Medical Cost Sharing portion of the program without any Individual Unshareable Amount (IUA) requirement.

If your “Need” (i.e. a large medical expense) exceeds the Initial Unshareable Amount (you might call this a deductible if this were 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, 9 or the Appendix of the Access Membership Guidelines.

You can choose any doctor or facility when you use Medical Cost Sharing. Tell the provider you're a "cash-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.

DIRECT PRIMARY CARE HEALTHCARE

Designed to complement the services of your Direct Primary Care Doctor with Preventive Care and Medical Cost Sharing as a Back-up

This program complements the services of your Direct Primary Care Doctor by including three expensive Preventive Care Services (screening colonoscopies, screening mammograms, and childhood vaccinations and immunizations for children through age 18) in Medical Cost Sharing. The program includes Medical Cost Sharing for large expenses using an Open Access network of care providers

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 Benefits 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 re 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
  • Artificial Intelligence Manager*
    (functional medicine-based risk assessment, personalized recommendations, and coaching service)
  • HealthGenie Symptom Checker*
    (links symptoms to user-friendly disease information and the appropriate setting to seek care)
  • On-line Resource Center
    (webinars, podcasts, interviews with experts, newsletters and e-books)
  • Healthy Rewards Program
*Note: These wellness options can be added to the membership for a small monthly charge.
Prevent

to PREVENT medical expenses using the preventive care services provided by your Direct Primary Care doctor. Expenses for colorectal screening colonoscopies for members 50 and over, breast cancer screening mammograms for female members 40 and over, and immunizations and vaccinations for children from birth through age 18 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 benefit you.

Mitigate

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

Contain
  • Contain large medical expenses with Medical Cost Sharing powered by Sedera, Inc.*
  • Services included:
    Sedera Medical Advisor and Medical Bill Negotiation
Specifications
  • 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 first point of contact and focal point for services and coordinates all care. He or she provides most preventive care [colorectal screening colonoscopies for members 50+, breast cancer screening mammograms for female members 40+, and vaccinations and immunizations for children from birth through age 18] 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 Expert Second Opinion Program (2nd MD™), and Counseling services
Large Medical Expenses
  • Contain With Medical Cost Sharing Powered By Sedera, Inc.
  • 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
  • Outpatient Prescription Drugs - maximum of 120 days for conditions diagnosed after the effective date of membership. No maximum for cancer drugs or sublingual immunotherapy medications and one year maximum for transplant medications
  • Pre-Existing Conditions - 36 month look-back: no coverage for 1st 12 months; $15K 2nd year; $30K 3rd year; unlimited thereafter
  • Maternity Benefits - $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 3 types of programs
health excellence plus

SELF-MANAGED PROGRAM OPTIONS
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
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PHYSICIAN-DIRECTED PLAN OPTIONS
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, Screening Colonoscopies And Mammograms, And Childhood Immunizations/Vaccinations
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Provider-Directed Healthcare
Provider-Directed Healthcare
Provider-Directed Program Combining Wellness Services, Redirect Health for Preventive Care And Most Small Expenses, AND Medical Cost Sharing For Large Medical Expenses

LEARN MORE
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