Self - Directed Healthcare
Designed for the Self-Pay Patient with a Back-up Plan
A Totally Self-Directed Plan that combines Wellness services, SOME Preventive
Care services, AND Medical Cost Sharing using an Open Access network of care providers.
Self Directed Healthcare
Self Directed Healthcare
Plan Specifications
  • PREVENTIVE CARE SERVICES—Colonoscopies for members 50 and over, mammograms for members 40 and over, and childhood immunizations (excluding flu shots) and vaccinations are shareable at no cost (i.e. with no Individual Unshareable Amount) under the Medical Cost Sharing portion of the program. No other preventive care services mandated by the Affordable Care Act are covered
  • NETWORK—Open Access network; can use any provider who accepts cash payment for any service under the program, including shareable preventive care services mentioned above and large medical expenses mentioned below
  • 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
Large Medical Expenses
  • Contain Unforeseen Incidents With Medical Cost Sharing
  • 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 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.