Your employer is covering 100% of your health plan — no premiums for you!
Here’s how it works:
TIER 1: CASH-PAY PROVIDERS (BEST VALUE)
- NO COPAYS. NO DEDUCTIBLES – 100% COVERAGE
- Access doctors, prescription drugs and facilities at transparent, fixed prices.
- Plan pays providers in cash at the point-of-service
TIER 2: REFERENCE-BASED PRICING (BACKUP OPTION)
- Go anywhere you choose — but we cap what the plan pays just like all other plans
- $5,000 deductible, 80/20 co-insurance
- The plan pays based on government approved pricing (Medicare pricing)
- You may get a surprise bill if you don’t ask the price upfront. In that case Good Luck and may the Sun God look kindly upon you!
Tip: If you ask the price upfront you will never get a balance bill
You decide between Free Care vs Not-So-Free Care at the Point of Service
“HMMMMM……..Do I want free care or not-so-free care?”
MEDSAVE FREE CARE CARD – Prior to seeking health care services text the number listed on your FREE CARD to determine if FREE CARE service benefits are available for your immediate health care needs. Examples include MRI’s, surgical procedures, pregnancy, and other medical services. Medical appointments and related services are coordinated on your behalf with appointments set at your convenience. At the point of service you pay nothing and receive the care you need. It’s that easy!
IMPORTANT: There are limitations to coverage which is not uncommon to health insurance. Most plan members, including you, don’t understand or care about benefit details until a loss occurs. That’s when heretofore clueless plan members like you will definitely understand what is covered and what is not covered. To prevent possible but likely disappointment, we suggest you read your benefit booklet, something no one else ever does, for full details. If, after careful study, you still don’t fully understand the benefits available to you, call Jenny at 867-5309 for assistance.
This is a non-traditional health plan. The plan does not use a network.
Not all medical caregivers will accept an Assignment of Benefits and file claims on your behalf – In that case suck it up, pay the bill, then file a claim and get all or some of your money back, the latter being the more common outcome.
You will never have that problem with Tier 1 providers. Read on it gets better…..
Tier 2 Medical providers are paid based on current Medicare reimbursement rates. After meeting your deductible and coinsurance responsibilities there may be additional cost sharing for charges above Medicare rates. This is called Balance Billing.
The No Surprises Act (NSA) / Independent Dispute Resolution (IDR) does not apply to this plan so beware of huge potential, egregious, and obscene hospital ER charges that could bankrupt you leaving your spouse little left in divorce proceedings.
This plan is excess coverage as applicable. That means we will find as many ways as possible to have your claims paid by someone else so we don’t have to. Your homework assignment for today is to refer to the Plan Document no one ever reads for full plan details. Pop quiz tomorrow.
