| Basic | Enhanced | Crown | |
|---|---|---|---|
| Eligible for Sharing Review Membership Guidelines for full details: Waiting Periods, Pre-Existing Limitations, service-specific limits, ISA, Fair and Reasonable Amount, and Visit
Fees for all Eligible Expenses. All ISAs, fees, Per Incident Limits and Lifetime Maximums are per Member. |
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| Individual Sharing Amount (ISA) | $5,000 / $7,500 / $10,000 | $5,000 / $7,500 / $10,000 | $5,000 / $7,500 / $10,000 |
| Maximum Limit Per Incident | $150,000 | $250,000 | $500,000 |
| Lifetime Sharing Maximum | $1,000,000 | $1,000,000 | $1,000,000 |
| Provider Choice Eligible Program Members can seek treatment from any medical Provider. All medical service Providers are reimbursed by the Membership in accordance
with the terms of the Membership Guidelines at a Fair and Reasonable Amount. |
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| Smart Virtual Care (Telemedicine) Smart Virtual Care is immediately available. It is not owned or operated by OneShare Health, LLC. but is made available by Clever HealthTM. |
$0 Visit Fee / 100% Shared | $0 Visit Fee / 100% Shared | $0 Visit Fee / 100% Shared |
| Preventive Services and 1 Wellness Visit Preventive Services and 1 Wellness Visit are Eligible after a 180-day waiting period. |
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 $40 Visit Fee |
3 Per Program Year $40 Visit Fee |
5 Per Program Year $40 Visit Fee |
| Specialist | Not Eligible | Not Eligible | $75 Visit Fee |
| Facility Services | |||
| Urgent Care Facility | 1 Per Program Year $75 Visit Fee |
1 Per Program Year $75 Visit Fee |
2 Per Program Year $75 Visit Fee |
| Emergency Room Emergency Room services are shared up to $10,000, then ISA applies. |
$500 Visit Fee | $500 Visit Fee | $500 Visit Fee |
| All Other Services Eligible Program Members can seek treatment from any medical Provider. All medical service Providers are reimbursed by the Membership in accordance
with the terms of the Membership Guidelines at a Fair and Reasonable Amount. |
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| X-rays / Labs / Diagnostic | Eligible | Eligible | Eligible |
| In/Outpatient Surgery After ISA is met, Eligible up to Maximum Limit Per Incident. Outpatient, Pre and Post Admission for Hospitalization/Outpatient Surgery. |
Eligible after ISA | Eligible after ISA | Eligible after ISA |
| Maternity Maternity is Eligible for Sharing up to the following limits - Natural Delivery expenses are Eligible up to a maximum of $5,000, C-Section expenses are Eligible
up to a maximum of $8,000, Complications of delivery expenses are Eligible up to a maximum of $50,000. |
Not Eligible | Not Eligible | Eligible after ISA |
| Hospitalization After ISA is met, Eligible up to Maximum Limit Per Incident. Outpatient, Pre and Post Admission for Hospitalization/Outpatient Surgery. |
Eligible after ISA | Eligible after ISA | Eligible after ISA |
| Membership Services | |||
| Prescription Discount Program /
Health, Wellness, Entertainment
Disocunts Discount Programs will vary by state and are not owned or operated by OneShare Health, LLC. Members in Washington state are eligible for the state’s
WPDP Discount Card through the Washington State HCA. |
Included | Included | Included |
| 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 |
