Mikey P
Administrator
Im getting kicked off the SCruz company plan so Im shopping...
Anyone familiar with this?
Anyone familiar with this?
ALTRUA HEALTHSHARE ENHANCED MEMBERSHIP MRA = MEMBER RESPONSIBILITY AMOUNT | |
1st MRA* | $1,500 per member per calendar year |
2nd MRA* 70/30 CO-INSURANCE, MAX OOP IS $4,000 | 25% of next $10,000 per member ($2,500 max) with an affiliated provider/facility or Maximum of $5,000 if Medicare Plus 25% isn’t accepted and/or the licensed medical professional/ facility is non-affiliated. The membership shares in eligible needs at 100% after the 1st, then 2nd MRAs are met, and simultaneously, as the 2nd MRA is being met.1 |
Annual Maximum Limit | $250,000 per member |
Lifetime Maximum Limit | $1,000,000 per member |
Office, Urgent Care & Specialist Visits (30-day waiting period) | Primary Care Physician MRA: $35 per member, per visit (not applied to the 1st or 2nd MRAs) Specialist MRA: $50 per member, per visit (not applied to the 1st or 2nd MRAs) Maximum Visits:
For female members age 40 and over, for a mammogram visit, the membership will share up to $500 with the $35 office visit MRA |
Wellness/Preventative Visit |
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Flu Shot |
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Laboratory Services |
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Emergency Room |
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Cancer Treatment |
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WAITING PERIODS | |
Eligible 30 days from the membership effective date |
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Eligible 90 days from the membership effective date |
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Eligible 12 months from the membership effective date |
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IMPORTANT INFORMATION |
*Applies to practitioners and facilities. ¹ Limitations apply. See Membership Guidelines for more information. (5.5 Medical Needs that are Not Eligible for Sharing) ² Not applied to the 1st or 2nd MRA ³ Laboratory services must be obtained through an in-network facility to be eligible for sharing. Dependent children are accepted up to age 22. Children 23 years old and older must apply for their own membership. |
PHCS PROVIDER NETWORK |
Altrua HealthShare includes the PHCS Network through MultiPlan, Inc. Members have access to a premier national network that includes access to 223,113 Primary Care Providers, 89,444 Ancillary providers and 660,047 Specialists. MultiPlan negotiates discounts that result in significant cost savings when members visit in-network providers, helping to maximize their health services. A PHCS logo on the ID card tells both the Member and the Provider that a PHCS discount applies. Members can find participating doctors or facilities near them by going to www.multiplan.com and following the instructions below or by calling (888) 244-3839. Home page 1 - Click on "Find a Provider" Find a doctor or facility page 2 - Click on the "Select Network" button and choose "PHCS" 3 - Click on "Extended PPO" 4 - Type in the search criteria and location It is the Members’ responsibility to confirm the provider or facility’s continued participation in the PHCS Network and accessibility under the shared services program. When scheduling an appointment, Members need to specify that they have access to the PHCS Extended PPO Network, confirm the provider’s current participation in the PHCS Network, their address and that they are accepting new patients. In addition, to ensure proper handling of their bills, Members should always present their Altrua HealthShare ID card upon arrival at your appointment. Please note: MultiPlan, Inc. and its subsidiaries are not insurance companies, do not pay claims and do not guarantee health benefit coverage. Click Here to Search for Providers |