Plan Details

 The HealthShare program pays a fixed amount for each type of service.  For example:

  • Your child has an ear infection and you take him to the doctor.  The doctor’s fee for this service is $75 and will bill the insurance company.  The plan will pay $55 for a doctor’s office visit.  The doctor will send you a bill for the remaining $20.

Doctor's Office Visit, Urgent Care and Outpatient Hospital Benefit
Coverage for visits to a doctor’s office, urgent care or outpatient hospital facility is provided and benefits paid at a preselected fixed dollar amount per visit, up to a calendar year maximum. Routine exams and injections are excluded.

  • Plan pays $55 per visit/$300 per person, per calendar year maximum.

Outpatient Diagnostic X-Ray and Lab (DXL) Benefit
Diagnostic X-ray and lab tests ordered or performed by a doctor are paid at a preselected fixed dollar amount per visit up to a calendar year maximum when a hospital confinement is not required.

  • Plan pays $55 per visit/$300 per person, per calendar year maximum.

Preventive Care Benefit
Coverage for routine exams, medical treatment and well childcare immunizations is provided and benefits paid at a preselected fixed dollar amount per visit up to a calendar year maximum.

  • Plan pays $75 per visit/$150 per person, per calendar year maximum.

Emergency Room Benefit
Covered events that are the result of an illness or accident are paid at a preselected fixed dollar amount per visit up to a calendar year maximum. This benefit will be paid only for procedures received in an emergency room.

  • Plan pays $100 per visit/$300 per person, per calendar year maximum.

Inpatient Hospital Benefit
Coverage for inpatient hospital stays is provided and benefits are paid at a preselected fixed dollar amount per day of confinement up to a maximum number of days per calendar year.

  • Plan pays $500 daily hospital / 30 days maximum per calendar year.
  • Plan pays $500 per day, per person for stays in a substance abuse facility; 30 days maximum per calendar year.
  • Plan pays $1,000 per day, per person for Intensive Care Unit; 30 days maximum per calendar year.
  • Plan pays $250 per day, per person for stays in a mental health facility; 30 days maximum per calendar year, 180 days per lifetime.
  • Plan pays $250 per day, per person for stays in a nursing facility (only if following a covered hospital stay of at least 3 consecutive days and the person is less than age 65); maximum 60 consecutive days per stay.
  • 500 days lifetime maximum for each benefit per person (except for mental illness).
  • Benefits become payable on the first day of coverage confinement (except for nursing facility).
  • Maternity care is covered as any other condition.
  • No deductible
  • No co-payment

Surgical Benefit
Coverage for surgeries performed by a doctor in connection with an illness or injury is provided and benefits paid according to the surgical schedule up to a calendar year maximum.

  • Surgical Schedule A, plan pays $1,000 per person, per calendar year maximum.

Accident Benefit
Covers events that are the result of an injury or accident are paid at a preselected fixed dollar amount per visit up to a calendar year maximum. This benefit will not be paid for visits to an emergency room.

  • Plan pays $50 per visit/$150 per person, per calendar year maximum.

Pharmacy Discount Program
A discount off usual and customary charges may be given to the eligible person when prescriptions are purchased through a contracting pharmacy. There is no additional premium charge for this benefit.

Survivor Benefit
If an employee dies while insured, any covered dependents will be extended benefits (other than dependent life) without premium payments for two years after the employee’s death, as long as the employer’s plan remains in force and the covered dependent meets the coverage requirements in the policy. There is no additional premium charge for this benefit.

For more information on plan benefits click here.

DID YOU KNOW?

  • Wal–Mart offers over 300 generic drugs at only $4 per prescription fill or refill (up to a 30-day supply). The program is available at all Wal–Mart, Sam's Club and Neighborhood Market pharmacies.  For a complete list of $4 prescription drugs click here.
  • Meijer now offers free generic antibiotics.  The program covers leading, oral generic antibiotics with a special focus on the prescriptions most often filled for children. The following are free with your doctor's prescription, regardless of insurance or co-pay:
    Amoxicillin
    Cephalexin
    SMZ-TMP
    Ciprofloxacin
    Ampicillin
    Penicillin VK
    Erythromycin
  • Kroger is now offering over 300 generic prescriptions for $4 each.  Click here for a complete list of prescriptions in the program.