The very concept for and purpose of insurance is to protect one against unpredictable and large expenses, such as damage to your vehicle from an accident, or to your home from a hurricane. In health care where there is virtually no transparency, most health care costs are purposedly unknown, falsely creating a need for insurance for even routine care. Charges are frequently inflated, and “discounts” off these inflated charges by health care facilities are advertised by insurance companies as evidence that they are working on your behalf to get your value and savings for your insurance plan.
The Direct Primary Care (DPC) memberhsip model absolves the need for insurance for non-emergency care, from physician consultations to ancillary services, such as laboratory and radiology services. All costs are transparent, affordable and predictable with the all-inclusive monthly membership. Various private surgical groups are now publishing all-inclusive non-emergency surgical procedures so insurance is even not needed for them.
The DPC model allows members to purchase insurance or other plans purely for catastrophic needs at a much lower cost by forgoing inclusion of routine care in their plans. Unless you have chronic medical conditions that truly require the care of a specialist physician and expensive medications (about 15% of you), a health cost sharing plan may be just what you need. These programs dovetail with a DPC membership perfectly, at a combined cost that is usually half of traditional insurance offerings.
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Please refer to Sedera Health’s website for full information.
The following applies to Sedera Health Access+ Program only. Other programs may differ.
- Pre-existing conditions: Eligible for sharing at up to $15,000 in the 2nd year, $30,000 in the 3rd year of membership, then NO restrictions afterwards, subject to Guidelines
- Tobacco: Additional $75/mo per household + Limits on benefits for tobacco users age 50+: $25,000 for Cancer, Heart conditions, Stroke, Oral/Esophageal/Gastric/Duodenal/Lung diseases (until 12-month tobacco free)
- Maternity IUA of $5,000 for normal or $7,500 C-section deliveries applies regardless of routine IUA plan chosen (IUA reduced by 50% for using a birthing center) for delivery date beyond first 12 months of membership
- Mental Health: Pscyhological services shareable up to $750/need, and $750/year
Please refer to Zion Health’s website for full information.
The following applies only to the Zion Health DPC Program. Other programs may differ.
- Pre-existing conditions: May be shareable under Additional Giving Fund in 1st year, up to $25,000 in 2nd year, $50,000 in 3rd year, and $125,000 in 4th year onward
- Exemptions: Diabetes (types 1 and 2), High blood pressure, High cholesterol, and Fully cured conditions NOT requiring treatments in the prior 24 months
- Tobacco: Additional $50/mo per household + Limits on benefits for tobacco users age 50+: $50,000 for Cancer, Heart conditions, Stroke, COPD
- Sharing for colonoscopies and other preventive services requires 12 months of Direct Membership or 6 months if having Connect Add-on.
- Maternity: 1xIUA may be waived for home births | Pregnancy 60 days prior to start of membership not shareable | Premature birth shareable
- Death benefits require 2 years of uninterrupted membership: $10,000 primary member or spouse, $2,500 dependent child
- Connected add-on: colonoscopies, mammograms and youth (ages 0-16) immunizations (IUA waived)
Please refer to Altrua Healthshare’s website for full information.
- Doctor’s Office Visits: Maximum $300/visit can be counted towards 1st MRA, then 2nd MRA
- Maternity: Only for Emerald or Diamond Membership plans, with a 90-day waiting period, $5,000 Maternity MRA, with maximum of $12,000 in the first year, and $25,000 from the 2nd year onward.
Max $4,000 normal delivery, $6,000 non-elective C-section, and after 10 months of a Couple Membership - Colonoscopy: Not shareable in the first year; Maximum 1 per year, 3 per lifetime, unless having genetic diseases
- Lifetime and 5-year restrictions on several pre-existing conditions
Please refer to Samaritan Ministries’ website for full information.
- Pre-existing conditions: shareable after 5 years of no symptoms or treatment, or 3 years for genetic defects, hereditary diseases, cases of related cancers, back programs, implants, and heart conditions
Exemptions from Pre-existing conditions limitations: Diabetes, Hypertension, Cholesterol. Pre-existing is considered any conditions that requires medical attention within the prior 12 months. - $50 Additional monthly for each family member for families over five (5) people
- Classic/Basic Programs: DPC Memberships are eligible for sharing at up to $100 for the month in which a physician is consulted, makes a referral, or charges for services related to a shareable need.
- Sharing after IUA is 90% for Samaritan Basic, 100% for Samaritan Classic.
- Maternity: Due date must be 260 days or more from membership start date; Individual Membership not eligible;
Basic/Classic: $1,500 + 10% Co-share + Sharing limit of $5,000, then no sharing until cost exceeds $13,500, and then max $236,500; Given: per plan limitations.
Home Birth + VBAC: $1,500 IUA waived
Please refer to Christian Care Ministry’s website for full information.
- Monthly Amount depends on age, family size, and selection of AHP amount. Opting into Co-Share option allows for lower monthly premium.
- Cost might be higher when not using PHCS, such as a co-liability of 20% at non-PPO hospitals.
- The $35 and $200 co-payments are required even after the member has met the AHP amount.
- Pre-existing conditions: shareable only after 36 months of membership, up to $100,000/year if no symptoms in the last 36 months, or $500,000/year if in the last 60 months.
Exceptions: High blood pressure, Cholesterolterol - DME: No sharing of motorized locomotion equipment (such as motorized wheelchairs, scooters), exercise equipment, or home modifications
- Maternity: Conception has to be after joining, with maximum amount shared at $125,000.
- Mental health: Short-term counseling available through telemental health service
Please refer to Christian Healthcare Ministries’ website for full information.
- Pre-existing conditions: Conditions requiring no treatment for 1 year, except for cancer (when it is 5 years)
- Gold members: Eligible for sharing at up to $15,000 in the 1st, additional $10,000 in the 2nd, additional $25,000 in the 3rd years, and NO more restrictions after 3rd year, subject to Guidelines
- A unit can be an adult, or all dependent children of an adult: One unit: 1 adult | Two units: 2 adults, or 1 adult + children | Three units: 2 adults + children
- Extended Coverage with Brothers’ Keeper Program: Annual fee $40 per year, plus $45 per quarter per unit
- For Bronze and Silver, amount is increased by $100,000 per year of renewal up to $1 million maximum. For Gold, it is unlimited.
- Maternity: Gold members only, and due date must be 300 days from start of membership
- DPC Membership: Shareable only on highest AHP plan of $12,000
Please refer to Liberty Healthshare’ website for full information.
- Most sharing requests have restrictions, and may require pre-approval. Enrollment requires completion of a health questionnaire.
- Pre-existing conditions: Eligible for sharing at up to $50,000 for in the 2nd and 3rd year of membership combined; No restrictions afterwards, subject to Guidelines
- Maternity: Conception has to be after joining
- Direct Primary Care (DPC) Membership often include office visits in the monthly membership fee at no additional cost.
- DPC Membership fees can be reimbursed at up to 75%, subject to change by Liberty.
Please refer to Solidarity Healthshare’ website for full information.
- Pre-existing conditions = Existed in 24 months prior, Cancer requiring care in 60 months prior, or Conditions requiring lifetime care
- No sharing in 1st year, max $25,000 for in the 2nd and 3rd year of membership; No restrictions afterwards, subject to Guidelines
Please refer to United Refuah Healthshare’ website for full information.
- Pre-existing conditions: No sharing in 1st year, max $25,000 for in the 2nd and 3rd year of membership; No restrictions afterwards, subject to Guidelines
- Pre-existing conditions also include a lifetime chronic condition or a condition that requires lifetime monitoring, even if asymptomatic at the time of enrollment.
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