Traditional and Innovative Health Insurance Plans
Planstin Preventive MEC Plan Pairing with Zion HealthShare means no deductible to meet, rather for any qualifying expense (see Zion HealthShare member guidelines), you pay the first $1,250 (known as your Initial Unshareable Amount or IUA) of qualifying medical events and the HealthShare pays the rest. After you pay 3 IUAs, in a 12 month period, any other major event over $500 is paid by Zion HealthShare w/o requiring another $1,250 IUA. More money can go into your Health Savings Account if the HSA Plan is selected or choose the Copay plan if you prefer a copay instead of receiving HSA dollars. All Preventive care 100% covered. Rx Discounts.
See Member Guidelines and talk to an HCap Insurance Agent to learn how Pre-Membership Conditions are handled on this plan.
With these plans you present yourself as a “Self-Pay” Patient for anything that is not preventive coverage and pay at time of service or when billed. Your responsibility is for first $1,250 IUA using your HSA (if applicable). You have responsibility to learn the Zion HealthShare Member Guidelines. Your employer will also contribute to your Health Savings Account Plan.
Note: High blood pressure, high cholesterol, and diabetes (types 1 & 2) are not considered pre-membership medical conditions as long as 1. no hospitalization for the condition in 12 months prior to joining and 2. the member is able to control the condition through medication or diet.
A Sterling Urgent Care Membership can be combined with a Zion HealthShare Membership as a powerful way to control costs on medical expenses and be a comprehensive health strategy.
You can visit a Sterling Urgent Care facility for allergies, fever and illness, flu shots, lacerations, physicals (annual and sports), primary care, sprains, broken bones and much more. Most care is included at no additional charge to you with a low cost of $15 for X-Rays, $10 Rx and $15 Lab Work. Some Rx is also available at Sterling Medical Clinics
For larger claims that can’t be treated at a Sterling Urgent Clinic or for Maternity, a Zion HealthShare Membership is also included to provide comprehensive coverage. Pre-Membership conditions do have a phase in period per the Zion HealthShare Member Guidelines on this plan.
Plans that included Planstin, are actual insurance products and include preventive services defined by healthcare.gov covered at zero cost. Many of these preventive services can be received with your Sterling Urgent Care membership as these clinics also do primary care also at no cost. However, with this membership only plan, the cost for colonoscopies and mammograms (to name the two most common, but not limited to just these two) will need to be paid for by the employee as they are not covered in this membership only option. While many medications are available at Sterling, this membership only plan is not recommended for those needing specialty medications.
Where 96% of All Medical Claims Are Treated
Open Market Plans are traditional insurance plans that are similar to other group insurance offerings. The plan you choose will determine your monthly premium, deductible, max out of pocket and other plan benefits. Copay or HSA plans are available.
These plans are especially excellent when pre-existing conditions are a consideration regardless of income. However, depending on the household income, a government subsidy may be available. In addition, your company offers a taxable stipend to you (see above) if you choose to receive your health insurance on the open market. You will pay for the monthly premium for these plans using your own personal credit or debit card rather than through payroll.
Cons: Significantly less money will be contributed by your company into your HSA with these plans. If a major medical event occurs you likely will be paying towards a much higher deductible than the $1K IUA with Zion Healthshare.
Your HCap representative can help you navigate to the plan that is the best fit for your circumstances. Call us at (435) 239-3154
Planstin Contact Info
Member Services 888-920-7526 or
member@planstin.com
Claims Fax 435-631-9478 or
claims@planstin.com
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Your plan may include a Health Savings Account. Contributions can be made to this account per the chart below. Some contributions may be included in your health plan. Some contributions may be included due to your healthy behaviors through Doable Wellness. You can take full advantage of your HSA by adding additional contributions per the limits below. All HSA Contributions are tax free and can be used for any qualified medical expenses (click below).
Health Equity Bank Contact Info
Member Services 1 (866) 346-5800 or www.healthequity.com