HealthPass T€¦ · without any further risk by using a level-funded/fixed-fee self insured plan....

ALIERAHealthcare

TM

www.alierahealthcare.com | 844-834-3456HealthPass-LF-SF_Sell-Sheet_201803-15

URGENT CARE Services are covered at the nearest in-network urgent care center for treatment of an injury or illness. Urgent care handles medical situations that can’t wait or are just a little more complex than what your primary care physician normally performs.

TELEMEDICINE Our U.S. board-certified family practitioners, PCPs, pediatricians and internists, who diagnose, treat, and write prescriptions, when necessary are available 24/7/365 and can resolve most medical concerns via phone or online video consultation, in the convenience of your home or on the go!

LABS & DIAGNOSTICS PCP and Urgent Care labs are included in your monthly membership. Your membership includes over 180 different lab tests to ensure the medical care needed is covered.

PRESCRIPTION DRUG PROGRAM The HealthPass Prescription Savings Card delivers significant discounts in both brand name and generic drugs, saving cardholders an average of 55% on prescription drug purchases.

X-Rays, CT Scans, MRIs X-rays will be available at the nearest in-network urgent care center. CT Scans or MRIs are available depending on the chosen plan.

PREVENTIVE CARE An Aliera MEC Plan covers medical services recommended by the USPSTF and outlined in the ACA for preventive care. There is zero out of pocket expense and no deductible to meet for any scheduled preventive care service or routine in-network checkup, pap smear, flu shot and more. It’s easier to stay healthy with regular preventive care.

EPISODIC PRIMARY CARE Primary care is at the core of a Aliera HealthPass Plan, and we consider it a key step in getting and staying healthy. Our model is based on an innovative approach to care that is truly patient-centered, combining excellent service with a modern approach. This includes medical care needs such as primary care, office visits, basic eye and hearing exams, flu shots, infections, etc.

SPECIALIST Specialist services are available with a referral from the member’s Primary Care Provider (PCP). Services are limited to a number of visits depending on the chosen plan.

HOSPITAL, SURGICAL, AMBULANCE $0 Deductible, 50% coinsurance, limited medical benefit to help offset your out of pocket expenses in the event you need services including hospitalization, surgery, or ambulance. Included in: Advantage and Preferred plans

Level-Funded & Self-Funded Minimum Essential Coverage Plans

Aliera Healthcare in conjunction with First Health, one of the largest PPO networks in the nation with more than 1,000,000 healthcare professionals and more than 6,000 facilities, offers access to quality, affordable health care through TPA’s, carriers, health care plans and Taft-Hartley trusts.

These plans are NOT comprehensive health insurance and do NOT include hospitalization or certain other benefits. These plans meet the individual requirement of the ACA for ‘Minimum Essential Coverage’ when sold through an employer.

(Advantage = $1,000 max benefit | Preferred = $2,500 max benefit)

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LEVEL-FUNDED

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PLAN DETAILS | Level-Funded

Plan Details – Level-Funded / Fixed FeeThe Aliera MEC level-funded solution offers employers the ability and comfort to know they have covered the maximum fee without any further risk by using a level-funded/fixed-fee self insured plan. Review plan details below and select the plan that best fits your group’s needs.

Level-Funded Minimum Essential Coverage* Health PlansBenefits Value Plus Premium

Preventative MEC(Recommended by USPSTF/Outlined by ACA)

All of the ACA mandated preventive services provided in the MEC are listed on the previous page

100% Unlimited No Consult Fee



Rx Discount Program Only covers generic retail drugs. No specialty drugs covered. Receive a Point of Sale discount for Brand Name Drugs.

Included Included Included

Primary Care (PCP) Office Visits Office visit services include, but are not limited to, laboratory services, x-rays, surgery and diagnostic tests performed in the office on the same day as the office visit.

100% Preventative Care Needs*****

3 per Year** $20 Consult Fee


Labs & DiagnosticsOnly Preventative Care,

Labs & Diagnostics Included

Included @ 100% PCP & Urgent Care**

Included @ 100% PCP & Urgent Care**

Urgent Care Urgent Care visit services include, but not limited to, laboratory services, x-rays, surgery and diagnostic tests performed in the office on the same date as the office visit.




Chronic Care (@ In-Network PCP) n/a n/a Included in PCP Allowed Visits

X-Rays*** n/a $75 Consult Fee $50 Consult Fee

CT Scan or MRI n/a n/a n/a

Telemedicine**** 100% Unlimited No Consult Fee



Pediatrics Preventative Care Included Preventative Care Included Primary Care Provider**

OB/GYN All of the ACA mandated preventive services provided in the MEC are listed on the previous page.

Included @ In-Network PCP

Included @ In-Network PCP

Preventative Care at OB/GYN of choice within

network

Specialist n/a n/a n/a

Hospital, Surgical & Ambulance n/a n/a n/a

Enrollment Fixed-Fee Total Anticipated Maximum Total Anticipated

Maximum Total

Employee Only $69 $89 $99

Employee + Spouse $119 $159 $179

Employee + Child(ren) $129 $169 $189

Family $189 $239 $259

Plan Selected

* Minimum essential coverage as defined by the IRS code. “Self-funded employer sponsored plan” ** All members must contact an Aliera telemedicine provider before visiting any provider or lab facility; all appointments are made through the Aliera Concierge Services department, instead of through your provider. Lifestyle lab testing not included. *** $25 Read-fee applies for x-rays at urgent care. **** Telemedicine services not available in some states. ***** Cannot be combined with a visit for other medical needs. Member is responsible for non-preventive cost at the time of visit.

SELF-FUNDED

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PLAN DETAILS | Self-Funded

Plan Details – Self-Funded The Aliera MEC self-funded solution offers employers the ability to add stop loss protection from an ‘A+’ rated underwriter. Employer enjoys the ability to receive monies back in the event claims are lower than anticipated. Review plan details below and select the plan that best fits your group’s needs.

Self-Funded Minimum Essential Coverage* Health PlansBenefits Choice Advantage Preferred

Preventative MEC(Recommended by USPSTF/Outlined by ACA)

All of the ACA mandated preventive services provided in the MEC are listed on the previous page.

100% Unlimited No Co-pay



Rx Discount ProgramOnly covers generic retail drugs. No specialty drugs covered. Receive a Point of Sale discount for Brand Name Drugs.

Included RxValet RxValet

Primary Care (PCP) Office VisitsOffice visit services include, but are not limited to, laboratory services, x-rays, surgery and diagnostic tests performed in the office on the same day as the office visit.

$20 Co-pay** $20 Co-pay** $20 Co-pay**

Independent Laboratory and X-RaysIndependent laboratory services not provided in a physicians office or hospital and non-routine. Does not include MRI, CT Scans and PET Scans or DEXA Scans.

$50 Co-pay** $50 Co-pay** $50 Co-pay**

Urgent CareUrgent Care visit services include, but not limited to, laboratory services, x-rays, surgery and diagnostic tests performed in the office on the same date as the office visit.

2 per Year** $50 Co-pay



Chronic Care (@ In-Network PCP) n/a n/a Included in PCP

Telemedicine*** 100% Unlimited No Co-pay



CT Scan or MRI n/a $400 Co-pay $200 Co-payEmergency Room

Covers all services performed in an emergency room including the hospital facility and physician charges including, but limited to, MRI, surgery, physical therapy or DME.

Not Covered Not Covered $300 Co-pay

Pediatrics Preventative Only Covered (Max 2 visit)

Covered (Max 5 visit)

OB/GYN All of the ACA mandated preventive services provided in the MEC are listed on the previous page.

Preventative Only Covered (Max 1 visit)

Covered (Max 2 visit)

SpecialistReferral office visit services include, but not limited to, laboratory services, x-rays, surgery and diagnostic tests performed in the office on the same day as the office visit.



Unlimited$50 Co-pay

Hospital, Surgical & Ambulance1 n/a $0 Deductible50% Coinsurance

$0 Deductible50% Coinsurance

Enrollment Minimum Anticipated Maximum Total Minimum Anticipated

Maximum Total Minimum Anticipated Maximum Total

Employee Only $83.30 $119 $125.30 $179 $154.20 $220

Employee + Spouse $92.61 $189 $132.94 $289 $165.90 $360

Employee + Child(ren) $99.50 $199 $152.49 $299 $185.10 $370

Family $116.60 $265 $185.71 $379 $188.70 $429

Plan Selected Minimum cost includes the following services PPO network fees* Minimum essential coverage as defined by the IRS code. “Self-funded employer sponsored plan” ** All members must contact an Aliera telemedicine provider before visiting any provider or lab facility; all appointments are made through the Aliera Concierge Services department, instead of through your provider. Lifestyle lab testing not included. Stop-Loss is available at an additional $10 PEPM *** Telemedicine services not available in some states.1. Maximum of $1,000 benefit for Advantage plan or $2,500 benefit for Preferred plan. Benefits paid to provider for medical expenses.Aliera takes 25% of cost savings from claims fund surplus.

www.alierahealthcare.com | 844-834-3456

ALIERAHealthcare

TM

www.alierahealthcare.com

HealthPass T€¦ · without any further risk by using a level-funded/fixed-fee self insured plan....

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