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| Program Name | CHS200 | CHS400 | CHS600 |
|---|---|---|---|
| Provider Networks | |||
| Professional and Ancillary services | Multiplan/PHCS Practitioner and Ancillary Network - Sharing of physician and ancillary service expenses is available only for In Network providers. | ||
| Hospital | Sharing of eligible expenses is available for any accredited hospital in the United States. This program does not use a hospital network. | ||
| Non-Sharable Amounts (NSA) | |||
| One Member per Household | $2,000 | $4,000 | $6,000 |
| Two Members per Household | $4,000 | $8,000 | $12,000 |
| 3 or More Members per Household | $6,000 | $12,000 | $18,000 |
| Application Fee and Monthly Membership Dues | |||
| Application Fee (Non-refundable) | $75 | $75 | $75 |
| UHF Monthly Membership Dues per Household | $15 | $15 | $15 |
| Sharing Restrictions and Maximums | |||
| Pre-Existing | Restricted sharing for pre-existing conditions. (Elective cosmetic surgery is never eligible for sharing.) |
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| Sharing Limit per Medical Incident | $400,000 | $300,000 | $200,000 |
| Annual Physical / Well Child Exam and Other Preventive Services | After 30 days, Members are eligible for one Routine Physical (Adults) or Well Child Exam (Children) per year. Sharing for Routine Physical, Well Child Exam and other Preventive Care services combined is limited to $500 per Member per year. | ||
| Visit Maximums per Member | 9 visit maximum for any combination of Primary Care, Specialist and Urgent Care office visits. | ||
| 12 sessions in total for any combination of Chiropractic Visits and Physical Therapy Sessions. | |||
| 10 sessions in total for any combination of Occupational, Speech, Audiological, Optometric/Vision, Respiratory, and Hyperbaric Therapy Sessions. | |||
| 4 visits in total for any Primary Care Physician or appropriate mental health professional visits for the monitoring and management of medications prescribed for mental health conditions such as anxiety, depression, bi-polar disorder, and ADHD. | |||
| 9 pre-natal care visits per pregnancy. | |||
| Annual Sharing Maximum Per Member | $900,000 | $500,000 | $250,000 |
| Consultation Fees | |||
| Telemedicine - Unlimited Use, Available 24/7 (Not Subject to NSA) |
$0 | $0 | $0 |
| Annual Physical / Well Child Exam and Other Preventive Services (Eligible for Sharing Prior to Meeting NSA) |
$0 | $0 | $0 |
| Primary Care and Psychiatric Medication Management Consultation - Office Visits | $25 | $30 | $40 |
| Specialty Care and Psychiatric Medication Management Consultation - Office Visits | $50 | $60 | $80 |
| Urgent Care Visits | $75 | $75 | $100 |
| Emergency Room | $300 | $400 | $500 |
| Additional Program Features | |||
| Health Tools | Included | Included | Included |
| Portion of Expenses Sharable After Meeting NSA | |||
| Hospitalization | 80% | 70% | 60% |
| Surgery | 80% | 70% | 60% |
| Maternity - Labor & Delivery | 80% | 70% | 60% |
| Diagnostic Tests and Imaging Accessed Via Non-Hospital Independent In-Network Facility | 80% | 70% | 60% |
| Pharmacy | |||
| RxSimpleShare | RxSimpleShare shares only for drugs that are on the approved formulary list. There is a $5 co-share payment per prescription and sharing is limited to $500 maximum per month (based on actual cost of medication). A 30 day waiting period applies for new UHS program members. |
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| Please refer to the Sharing Guidelines for definitive rules and guidelines. In case of any discrepancies, the Sharing Guidelines will prevail. | |||
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Or call 888-636-7119
Or call 888-636-7119
If you have a question about a specific member and/or needs request, please call the number on the back of the member’s UHF membership card.
For more general inquiries, call 877-987-1233.