Partially Self-Directed Healthcare

Designed for the Self-Pay Patient Who Wants Full Preventive Care Services with a Back-up Plan
Partially Self-Directed Plan that combines all Wellness Services, Preventive Care using the PHCS Network, AND Medical Cost Sharing using an Open Access Network of care providers. Includes the ability to establish a tax-advantaged Health Savings Account.
Partially Self Directed Healthcare
Partially Self Directed Healthcare
Plan Specifications
  • NO AFFORDABLE CARE ACT TAX PENALTY
  • PREVENTIVE CARE NETWORK AND SERVICES—Requires use of PHCS network for all services. No cost for preventive services mandated by the Affordable Care Act
  • SMALL MEDICAL EXPENSES—Mitigate using My AHE Pharmacy Programs, My AHE Member and Concierge Services, TelaDoc™, the 2nd Opinion Program (2nd MD™), and Counseling services. Manage with a voluntary Health Savings Account
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 Partially Self-Directed 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. Most Medical Cost Sharing Plans are ACA compliant.