Membership Sharing Program
Membership Sharing Program
| Basic | Enhanced | Crown | |
|---|---|---|---|
| Sharing Services Review Membership Guide for full details, waiting periods, pre-existing limitations, limits and ISA for all
Sharing Services. |
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| Provider Network (First Health®) |
In Network / Out-of-Network Out-of-Network sharing reimbursement is based on the lesser of the Out-of-Network provider actual
billed amount or Maximum Reasonable Guidelines for Eligible Services provided. |
In Network / Out-of-Network Out-of-Network sharing reimbursement is based on the lesser of the Out-of-Network provider actual
billed amount or Maximum Reasonable Guidelines for Eligible Services provided. |
In Network / Out-of-Network Out-of-Network sharing reimbursement is based on the lesser of the Out-of-Network provider actual
billed amount or Maximum Reasonable Guidelines for Eligible Services provided. |
| Individual Sharing Amount (ISA) Options | $5,000 / $7,500 / $10,000 | $5,000 / $7,500 / $10,000 | $5,000 / $7,500 / $10,000 |
| Sharing for Eligible Expenses | |||
| Preventive Services and 1 Wellness Visit | 100% Shared Up to $1,000 | 100% Shared Up to $1,000 | 100% Shared Up to $1,000 |
| Primary Care Physician | 1 Per Program Year $20 Visit Fee per Visit |
3 Per Program Year $20 Visit Fee per Visit |
5 Per Program Year $20 Visit Fee per Visit |
| Specialist | Not Eligible | Not Eligible | $75 Visit Fee per Visit |
| Maternity Natural Delivery $5,000; C-Section $8,000; complications $50,000. |
Not Eligible | Not Eligible | Eligible |
| Urgent Care Facility | 1 Per Program Year $20 Visit Fee per Visit |
1 Per Program Year $20 Visit Fee per Visit |
2 Per Program Year $20 Visit Fee per Visit |
| X-rays / Labs / Diagnostic Eligible for Emergency Room and Hospitalization only. |
Eligible | Eligible | Eligible |
| Emergency Room | $500 Visit Fee per Visit | $500 Visit Fee per Visit | $300 Visit Fee per Visit |
| In/Outpatient Surgery | 180-Day Waiting Period | 180-Day Waiting Period | 90-Day Waiting Period |
| Hospitalization | Eligible | Eligible | Eligible |
| Maximum Limit Per Incident | $150,000 | $250,000 | $500,000 |
| Lifetime Sharing Maximum | $1,000,000 | $1,000,000 | $1,000,000 |
| Smart Virtual Care (Telemedicine) Smart Virtual Care (Telemedicine) is not owned or operated by OneShare Health, LLC but made available to OneShare Members by Clever Health™.updated thrive |
Consult Fee 100% Shared | Consult Fee 100% Shared | Consult Fee 100% Shared |
| Additional Member Services Available | |||
| Prescription Discount Program Prescription Discount Programs are not owned or operated by OneShare Health, but made available to Members by Careington and/or Clever Health™, depending on the Program or state in which the Member is enrolled. Members in Washington state are eligible for the state’s WPDP Discount Card through the Washington State HCA. Other Discount Programs for Services like Vision, Dental, Diabetic Supplies, Labs, or Hearing are not owned or operated by OneShare Health, but made available to Members by Careington in most states and in most Programs.
|
Elixir and Clever HealthTM RX Savings Program | Elixir and Clever HealthTM RX Savings Program | Elixir and Clever HealthTM RX Savings Program |
| Membership Discount Program Prescription Discount Programs are not owned or operated by OneShare Health, but made available to Members by Careington and/or Clever Health™, depending on the Program or state in which the Member is enrolled. Members in Washington state are eligible for the state’s WPDP Discount Card through the Washington State HCA. Other Discount Programs for Services like Vision, Dental, Diabetic Supplies, Labs, or Hearing are not owned or operated by OneShare Health, but made available to Members by Careington in most states and in most Programs.
|
Included (see below) |
Included (see below) |
Included (see below) |
| Mental Health Support Mental Health Support is not owned or operated by OneShare Health. |
24/7 Intuitive Mental Health Chatbot from Clever HealthTM |
24/7 Intuitive Mental Health Chatbot from Clever HealthTM |
24/7 Intuitive Mental Health Chatbot from Clever HealthTM |
