| Universal HealthShare Programs | |||
| Program Name | UHS2 | UHS4 | UHS6 |
|---|---|---|---|
| Provider Networks | |||
| Physician and Ancillary services | In Network Only – PHCS / Multiplan Network | ||
| Hospital | Open | ||
| Non-Sharable Amount | |||
| Non-Sharable Amount (NSA) Per Member | $1,500 | $5,000 | $6,000 |
| Non-Sharable Amount (NSA) for 2 Persons | $3,000 | $10,000 | $12,000 |
| Non-Sharable Amount (NSA) for 3 or more | $4,500 | $15,000 | $18,000 |
| Application Fee and Monthly Membership Dues | |||
| Application Fee | $75 | $75 | $75 |
| UHF Monthly Membership Dues | $15 | $15 | $15 |
| Sharing Restrictions and Maximums | |||
| Sharing Program Restrictions | Waiting period of 12 months for maternity and 30-days for all other services. Restricted sharing for pre-existing conditions. Elective cosmetic surgery is not eligible for sharing. | ||
| Sharable Amount Limit (facility & professional) per Medical Incident | $350,000 | $200,000 | $100,000 |
| Visit Maximums per Member | Nine (9) visit maximum for any combination of Primary Care, Specialist and Urgent Care. Nine (9) visit maximum for pre-natal care. | ||
| Annual Sharing Maximum Per Member | $700,000 | $400,000 | $200,000 |
| Eligible Services - Prior to Meeting NSA | |||
| Telemedicine - Unlimited per Member, available 24/7 | $0 Consultation Fee |
$0 Consultation Fee |
$0 Consultation Fee |
| Annual Physical / Wellness Exam and Preventive Services | Members are eligible for one (1) Routine Physical/Wellness Exam per year after 30-days of continuous membership. Limit of Sharing Amount for Routine Physical, Wellness Exam and Preventive Care services combined is $500 per member per year. | ||
| Primary Care - Office Visit | $25 Consult Fee |
$25 Consult Fee |
$35 Consult Fee |
| Specialty Care - Office Visit | $50 Consult Fee |
$50 Consult Fee |
$70 Consult Fee |
| Urgent Care | $75 Consult Fee |
$75 Consult Fee |
$100 Consult Fee |
| Physician Services - After Meeting NSA | |||
| Emergency Room | $300 Consult Fee |
$300 Consult Fee |
$400 Consult Fee |
| Therapy - Physical, Occupational, Speech, Chiropractic | $25 Consult Fee |
$25 Consult Fee |
$25 Consult Fee |
| Inpatient/Outpatient Hospital Services (except for Maternity) have a 30-day waiting period | |||
| Hospitalization | 80% After NSA |
70% After NSA |
60% After NSA |
| Surgery | 80% After NSA |
70% After NSA |
60% After NSA |
| Maternity - Labor & Delivery | 80% After NSA |
70% After NSA |
60% After NSA |
| Pharmacy | |||
| Pharmaceuticals | Prescription drugs are only eligible for sharing when provided by a hospital as part of inpatient treatment or provided by a facility during an outpatient surgical procedure. | ||
| Diagnostics and Tests | |||
| Diagnostics Accessed Via Non-Hospital Only | 80% After NSA |
70% After NSA |
60% After NSA |
| 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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