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 | 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) Telemedicine services are not owned or operated by OneShare Health LLC., but made available to OneShare Members by Clever Health™ and Teladoc® in MA. |
Consult Fee 100% Shared | Consult Fee 100% Shared | Consult Fee 100% Shared |
| Additional Member Services Available | |||
| Prescription Discount Program The Prescription Discount and Membership Discount Programs are not sharing services and are not owned or operated by OneShare Health, LLC. These are made available to OneShare Members by Careington and Clever HealthTM , or NBI depending on the Program or state in which the Member is enrolled.
|
Elixir (Formerly EnvisionRX) | Elixir (Formerly EnvisionRX) | Elixir (Formerly EnvisionRX) |
| Membership Discount Program The Prescription Discount and Membership Discount Programs are not sharing services and are not owned or operated by OneShare Health, LLC. These are made available to OneShare Members by Careington and Clever HealthTM , or NBI depending on the Program or state in which the Member is enrolled.
|
Included (see below) |
Included (see below) |
Included (see below) |
| Behavioral Health / Member Assistance Program (MAP) Behavioral Health / Member Assistance Program (MAP) is not owned or operated by OneShare Health, LLC but is provided by IBH. |
24/7 Crisis Management 4 Counseling Sessions |
24/7 Crisis Management 4 Counseling Sessions |
24/7 Crisis Management 4 Counseling Sessions |
