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Provider-Directed Healthcare

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Provider Directed Healthcare

Redirect Health: 24 Hour Healthcare Services For Preventive Care And Small Expenses With Medical Cost Sharing As A Back-Up For Large Expenses

PROVIDER-DIRECTED HEALTHCARE

Redirect Health's EverydayCARE program is a health program that uses 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; up to 12 chiropractic office visits per year; 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 already have forwarded 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):

Note: There are $0 co pays and no deductibles for primary care office and chiropractic visits. There is no limit on authorized primary care office visits, but except under unique circumstances chiropractic visits are limited to 12 per year.

When you enroll in this program, 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 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, 9, or the Appendix 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 program should be especially attractive to millennials, who are less likely to have relationships with specific practitioners and are comfortable with the processes used by Redirect Health. 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 program.

PROVIDER-DIRECTED HEALTHCARE

Designated Provider (Redirect Health) for Preventive Care and Small Medical Expenses with Medical Cost Sharing as a Back-Up

Use Redirect Health as your designated provider for Preventive Care and Small Medical Expenses. Use Redirect Health’s Telemedicine protocol to access services. Includes Wellness services AND Medical Cost Sharing using an Open Access network of care providers. This option provides membership in BOTH Redirect Health AND Sedera Medical Cost Sharing.

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 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 are 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

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 benefit you.

Mitigate

Redirect Health’s EverydayCARE program provides referrals for primary care and chiropractic office visits with $0 deductible and $0 co-pay. There is no limit on authorized primary care office visits, and unless under unique circumstances chiropractic visits are limited to 12 per year. 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 significant 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)
  • Expert Second Opinion Program (2nd MD™)
  • 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
  • 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 NETWORK Open Access (anywhere) with prior authorization from the Care Logistics Team. $0 deductible and $0 co-pay for primary care office visits, chiropractic visits (limited to 12 per year except under unique circumstances), and for labs listed in a published schedule.
  • SMALL MEDICAL EXPENSES - $0 deductible and $0 co-pay for primary care and chiropractic office visits and other services/benefits as described in the “PREVENT” and “MITIGATE” sections of the Features section
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 Unshareable 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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