DPC Direct Primary Healthcare
Designed to complement the services of your Direct Primary Care Doctor with Preventive Care and a Back-up Plan
This plan complements the services of your Direct Primary Care Doctor with limited expensive Preventive Care. Includes Medical Cost Sharing for large expenses using an Open Access network of care providers.
DPC Direct Primary Healthcare
DPC Direct Primary Healthcare
Plan Specifications
  • COORDINATED CARE—The principle of Direct Primary Care is that your primary care doctor is your first point of contact and focal point for services and coordinates all care. He or she provides most preventive care [colonoscopies for members 50+, mammograms for members 40+, and childhood immunizations (excluding flu shots) and vaccinations are fully shareable under the Medical Cost Sharing portion of the program (see below)]
  • SMALL MEDICAL EXPENSES—Mitigate using your DPC doctor, My AHE Pharmacy Programs, My AHE Member and Concierge Services, TelaDoc™ (telemedicine), the 2nd Opinion Program (2nd MD™), and Counseling services
Large Medical Expenses
  • Contain Unforeseen Incidents With Medical Cost Sharing
  • Medical Cost Sharing Network—Open Access network; can use any provider who accepts cash payment
  • Initial Unshared Amount (IUA) Options—Select IUA of your choice: $500, $1000, $1500, $2500, or $5000
  • Maximum Number Of IUA’s Annually—3 per individual/5 per membership unit
  • Prescription Drugs—normal sharing rules apply for curative medications; 120 days for maintenance medications (blood pressure, cholesterol, etc.)
  • Pre-Existing Conditions—36 month look-back: no coverage for 1st 12 months; $15K 2nd year; $30K 3rd year; unlimited thereafter
  • Maternity Benefits—$5K IUA for normal deliveries and $7.5K for non-emergency/elective C-sections; conception must have occurred after membership per section 9 of the Guidelines
  • Therapies And TMJ—range from $1.5K to $2.5K/Need under Section 8 of the Guidelines
  • Psychiatric And Behavioral Health—$5K inpatient maximum/Need; $1.5K outpatient/Need under Section 8 of the Guidelines
  • Tobacco Use—$75 surcharge per membership unit. If age 50 or over, $25K sharing restriction for cancer, stroke, heart conditions and COPD
  • Sharing Limits—No annual or lifetime limits unless restricted by Sections 8 or 9 of the Guidelines
Is the DPC Direct Primary Plan the right one for you?

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Call Healthy Care Strategist Charles Frohman (202) 258-8027

Medical Cost Sharing Guide

** This is NOT insurance. Medical Cost Sharing Plans are ACA compliant.