Heathcare For You And Me

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Frequently Asked Questions

 Who is the targeted demographic? Who are these programs good for?

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• Individuals
o Not eligible for healthcare subsidies
o Spouse not eligible for Medicare
o Underemployed
o Unemployed

• ALSO

o Small Businesses & Nonproifts (3-49 employees)

o Associations & Affinity Groups (unlimited member enrollment)

• Self Employed

• Independent Contractors

• Part-time Employees

• Dependents Eligible for their own membership

o Individuals not in school ages 20-27

o Dependents aging off parent’s program at 27


ENROLLMENT PROCESS

When does the enrollment period close? Enrollment is 365 days a year. We also provide next day, effective day sharing services.

How are Post/Effective Dates determined?
The Member can choose their Post Date and Effective Date. They can have next day activation if the date is between the 1st-28th of the month. Members can be enrolled up to 60 days in advance. Note: The Post Date must occur prior to the Effective Date.

Are there separate child only policies?
No not currently. The Primary Member must be at least 18 years of age.

Do we offer group benefits? yes! on a post-tax benefit.


PHCS (PPO) NETWORKS

How does a Member check if their physician or specialist is in-network?

A member can check if their physician or specialist is in network by visiting https://www.multiplan.com/

Note: Members should always reference PHCS when making an appointment or speaking with a doctor.

• Hospital Only = Catastrophic Program

• Specific Services = Classic Basic Program

• Limited Benefit Plan = Classic Enhanced/Crown Program

• Full Network = Complete Program

Are there discount eligible charges from PHCS providers?

When a member submits a sharing request and has utilized a PHCS provider, charges could be eligible to be discounted. However, if the service provided is not covered by the program, the discount will not be applied.

What if the physician, specialist or facility is Out of Network?

On the Complete Program only, Out-of-Network sharing services are available. If a life threatening situation, services rendered would be eligible for sharing up to the maximum limit per incident.


PRICING

Is pricing set for the program year? Yes. However, there are three variables that can affect pricing.

• If a member changes programs/tier.

• For families of 6 or more, $45 per additional member per month will be applied.

Does program pricing vary by state? No, pricing is the same nationwide.

What are the age bands for the Programs? Our pricing is based on age bands which range from 18-64 years old. The oldest person on the program will be considered the Primary Member.


PROGRAM CHANGES

Are Members allowed to change programs at any time?

Yes, one program change is allowed per program year, with no application fee. Any additional program change within the program year will include an application fee. The Producer or Member must submit a Program Change Form. Upon approval, this will result in a new Effective Date with all sharing services starting over. Note: ISA/Out of Pocket Maximums, Per Incident/Lifetime Sharing Maximums, and ALL Waiting Periods


CANCELLATIONS AND REFUNDS

Can Members cancel at any time? Yes, Members can cancel at any time. Within the first 30 days of a new Member’s Effective Date, the Member is entitled to a full refund, including the one-time application fee. After the first 30 days, a refund for the most recently paid period may be processed if the request is submitted within 10 days of their scheduled billing date. Refunds will be processed as a credit to the same card or account provided for billing. Requests involving refunds payable by check may take up to 30 business days.


Have more questions? Please give us a call: 773.832.7798