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Provider-Directed Healthcare

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Provider Directed Healthcare

Redirect Health: Virtual Healthcare Services For Preventive Care And Small Expenses With A Medical Cost Sharing Back-Up Plan

PROVIDER-DIRECTED HEALTHCARE

Redirect Health's EverydayCARE program is a virtual health program using a 24 hour health concierge (the Care Logistics Team which is staffed by medical professionals). Members call the 24/7/365 Care Logistics Team to access care; telephone support is provided in English and Spanish. Service is provided nation-wide.

The EverydayCARE program is ACA-compliant, provides personalized proactive care management and has a $0 deductible and $0 co pays for all ACA-mandated preventive care (adult and child), including immunizations and listed medications; primary care office visits; chiropractic office visits; and covered labs through LabCorp.

Covered services can cover treatment through naturopathic physicians; naturopaths are included on the Care Logistic Team.

EverydayCARE is ACA-compliant and has $0 deductible and $0 co pays for all ACA-mandated preventive care (adult and child), including immunizations and listed medications; primary care office visits; chiropractic office visits; and covered labs through LabCorp.

There is NO pre-existing condition limitation for any of these services.

Between 75 and 80% of all calls are resolved over the telephone. If access to other services is required, the Care Logistics Team schedules the appointment and helps with care management.

For example, if someone needs to go to a hospital and has called the Care Logistics team, a Team member will be in contact with the hospital before the patient even arrives and will have provided that person's history and health condition.

This You Tube video presents an excellent explanation of how the Redirect Health program works as well as its benefits (please see this Employee Benefits Guide for details, as well):

When you enroll in this plan, it includes BOTH the Redirect Health EverydayCARE program AND the Sedera Medical Cost Sharing program, as well as all the programs and services of My Academy of Health Excellence.

The Medical Cost Sharing program takes over if you experience a Need (i.e. large medical expenses for a specific condition as defined in the Access Membership Guidelines).

Once your expenses for a Need exceed the Initial Unshareable Amount (similar to a deductible if this were traditional insurance) you selected, Medical Cost Sharing shares the full amount at 100% unless your Need is subject to sharing limitations for conditions listed in Sections 8 or 9 of the Access Membership Guidelines.

You should continue to use the Care Logistic Team’s 800 number to access services, BUT you also have access to a Sedera Personal Advisor as well as My Academy of Health Excellence Member and Concierge Services.

This plan should be especially attractive to millenials, who are comfortable with virtual technology, and are less likely to have relationships with specific practitioners. Busy professionals who want access to high quality, lower-cost medical services and who have limited time to research alternatives will also be attracted to this plan.

There is no tax penalty with this plan.

PROVIDER-DIRECTED HEALTHCARE
HDHP / BASIC MEC PLAN

Designated Provider (Redirect Health) For Preventive Care And Small Medical Expenses With A Back-Up Plan

Use Redirect Health as your designated provider for Preventive Care and Small Medical Expenses. Use Redirect Health’s Telemedicine protocol to access services. Includes all WellFit Wellness services; Preventive Care and Small Medical Expenses through Redirect Health; 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 Provider-Directed 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
  • 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 with Redirect Health’s EverydayCARE program. There are no pre-existing condition limitations under any portion of the EverydayCARE program. Call the 24/7/365 concierge (Care Logistics Team) to access care; telephone support is provided in English and Spanish. The program provides all ACA-mandated preventive care services (adult and child) including immunizations, flu shots, and preventive care medications.

Manage

You are NOT permitted to establish a tax-advantaged Health Savings Account with this option.

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

Redirect Health’s EverydayCARE program provides referrals for primary care and chiropractic offce visits with $0 deductible and $0 co-pay. Call the 24/7/365 concierge (Care Logistics Team) to access care. Redirect Health has found that between 75% and 80% of all calls can be remediated virtually without requiring referrals. Labs listed in a published schedule are provided at $0 co-pay. The program also includes an Rx discount program that offers signifcant savings. Redirect Health also helps determine members’ eligibility for any public or private assistance programs, and, if eligible, helps facilitate acceptance into the program.

Mitigate using these other services:
  • My AHE Member and Concierge Services
  • My AHE Pharmacy Programs
  • TelaDoc™ (telemedicine)
    (it’s recommended that Redirect Health members continue using the Care Logistics Team’s 24 hour telephone line, but TelaDoc™ is available)
  • Second Opinion Program (2nd MD™)
  • 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
  • NO AFFORDABLE CARE ACT TAX PENALTY
  • WELLFIT WELLNESS PLATFORM - Managed by My Academy of Health Excellence
  • PREVENTIVE CARE - Open Access (anywhere) with prior authorization from the Care Logistics Team, No cost for preventive services mandated by the Affordable Care Act
  • PRIMARY AND CHIROPRACTIC CARE NETW0RK Open Access (anywhere) with prior authorization from the Care Logistics Team. $0 deductible and $0 co-pay for primary care offce visits, chiropractic visits, and for labs listed in a published schedule. Discounts are available for some other services. Use this to meet most of your small needs
  • SMALL MEDICAL EXPENSES - $0 deductible and $0 co-pay for primary care and chiropractic offce visits and other services/benefts as described in the “PREVENT” and “MITIGATE” sections of the Plan Features section.
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 Medical 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 Medical 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 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, AND Medical Cost Sharing For Large Medical Expenses
LEARN MORE
Designed for individuals who want to live a healthy lifestyle
and share the costs with other like-minded community members.

Through an innovative layering of healthcare services, the MPowering Benefits Association provides individuals and families access to high quality healthcare that is affordable, flexible and effective.

Members join the Association to promote personal health and well-being and, as a result, have access to a complete set of wellness tools provided through My Academy of Health Excellence.  Members of the Association have the choice (see above) of electing to join one of five different programs.

The program provides healthcare through community; you share medical expenses with a community of like-minded, health-focused individuals. By enrolling in this new program you’ll often be able to save 30-90% or more over traditional approaches.

By reviewing this website you’ll be able to choose between two self-managed programs and three physician-managed programs. Whether you want to take back control of your own healthcare and related costs, want someone to manage healthcare costs for you, or you’re somewhere in between, there’s an option to fit your specific needs.

You can learn more by reviewing this site and then calling us at 877-734-3884 to answer any remaining questions you might have. Enrollment is available on a year-round basis. Individuals who enroll by the 20th of a specific month will have an effective date as of the first of the following month.

NOTE: Medical Cost Sharing members share medical expenses with a community of like-minded people. Medical Cost Sharing is not insurance and there is no sharing of risk.

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