Frequently Asked Questions
A cost-share doesn’t function like traditional insurance plans, instead of a premium and deductible you become a member of the “community” that shares the cost of medical needs.
Each plan can function a little differently and may offer different services, but the goal is the same: they have a team to help you navigate the massive healthcare industry and set transparent pricing if a major medical need occurs.
indipop is a marketplace for finding the right cost-sharing plan. Its dedicated team provides support in understanding how cost-sharing plans work and which ones are right for you.
indipop has also created bespoke plans, in partnership with the cost-sharing services, to create even more attractive and powerful coverage for the independent population.
And indipop is a partner in your health. Its mission is to get your healthcare right, for the right price.
Unlike traditional healthcare, enrollment is all year long. We never want you to have to go without coverage.
Coverage begins on the first of the month after you enroll.
IUA stands for Initial Unsharable Amount. – This is the amount paid by the Member before the cost-share shares in the medical expenses on a per condition or need basis. Typically, it is a $1000 fee. Example: for an appendix removal the member would be responsible for a $1000 payment for the entire medical need no matter what hospital, surgeon, or anesthesiologist is on call. And, if in the next month, you break your leg, that is a new medical need and your responsibility would be capped at another $1000. Typically, with a treatment plan for a broken limb you would need physical therapy and post-op care, this counts as part of your IUA.
Cancer, injured in a car accident, or a brain aneurysm, these are scary major medical occurrences that can also be expensive. Depending on your plan, you will be responsible for the (MRA) Member Responsibility Amount. The remainder will be shared with the community. There are no annual or lifetime limits with the indipop selected plans.
A condition is considered pre-existing for you or a dependent if symptoms or treatment have occurred within the 12-24 months (depending on the plan) prior to joining the cost-share.
- First 12 months it is Not Shareable
- Months 13-24 Shareable to $25,000
- Months 25-36 Shareable to $50,000
- Month 37 and after Shareable to $125,000
Pre-existing conditions not subjected to pre-existing limitations if medically managed and stable with generic medications:
- Controlled Diabetes
- High blood pressure
- Seasonal Allergy
- Intermittent Asthma
- High cholesterol
The indipop health plans will accept members, if you are unsure about a pre-existing condition it is best to read the guidelines and contact the healthcare plan or indipop to double check.
Yes, the health plan networks are not PPO’s or HMO’s, you may choose a provider or keep the one you have.
First get stable. Once you or your family member have a moment, alert the cost-share.
Good question. Here’s a short list.
You want to investigate any specific questions before joining, but this will get you started:
- Discounted or inclusive primary care visits
- Discounted prescriptions – some prescriptions can be free based on usage and need
- Mental and behavioral health support
- Pediatric care and women’s wellness discounts
- HSA Health Savings Account
- Discounts and perks on wellness services
- Chiropractic Care
- Electronic vault for medical records
- Lifecare Program including mental health and experts to help in all areas of your life
- End of life benefits
- Concierge care without the VIP sticker shock, a team to help guide and navigate care ensuring you are treated like a human and not an ID card. They help get you well by also saving you time not waiting in congested urgent cares or trying to find a provider in the middle of the night to inquire about your child’s rash. You get quality care right from your own couch.
- Large or open network.
- Transparent fair medical pricing, from Tulsa to Brooklyn you will have access to the fair medical rate not the inflated insurance costs.
- Portable, the plans have identical benefits state to state. Perfect for professionals that travel frequently, kids in college and if you are vacationing outside of your town.
- Flexible- enroll all year long on your timeline.
- Affordable- 20-70% savings.
- No lifetime or annual caps on the indipop health plans.
- Thinking about growing your family? Maternity is included for post and pre-natal care.
If you are visiting a country and not living there you may still use your plan.
With monthly rates lower than traditional insurance (an average savings of 20%-70%) plus with set transparent rates for medical care, we’ve heard people say “it is too good to be true.”
This type of healthcare is not mainstream, but yet it is rising in popularity due to the proactive nature of the concierge teams, fair medical pricing and open networks.
Not everyone is a fit and therefore it is not a one size fits all. If you have recently been diagnosed or being treated for a chronic condition this is probably not the best option for you. The reason is the plan will look back at your medical history 1 -2 years and for the first year the “condition” is not shareable. That means you would be responsible for the medical bill for that specific condition if treatment or surgery is needed.
Example: 6 months ago you had ACL surgery, you are finished with rehab and doing great. You’d like to join one of the indipop health plans, the plans will look back 1-2 years (depending on the plan) and since you have not gone a full year since your surgery it would be considered pre-existing. If the ACL needed further repair after you join a health plan, this is considered a pre-existing condition and therefore will not be eligible for the $1,000 IUA. You would be responsible for the medical bill. If you broke your leg while on the plan or needed your tonsils out, that has nothing to do with your ACL and therefore those conditions would be sharable for the $1,000 IUA.
Forget the days of trying to get a human being from a traditional health insurance company to pick up the phone. With concierge care, you get a team dedicated to serve you. They find providers, negotiate rates, coordinate care for procedures and hospitalization. You are no longer alone in trying to navigate a massive healthcare system.
Whether by phone, text, or through a streamlined app, there’s always someone there for you.
No, indipop plans do not have a statement of faith or tied to a specific religion.
Each indipop plan has different benefits, they all include concierge care, major medical/hospitalization, Rx discount plan and mental health. One of the plans has Health Savings Account, compatibility, an electronic vault for medical records, end of life beneficiary and discounts to acupuncturists, sports massage, chiropractors, etc. Another option has in person and virtual unlimited primary care for adults and children and 12 chiropractic visits!
Each plan ensures you are receiving the care you need at the fair medical cost many times it is $0.
On a healthshare you have shareable and unshareable medical needs. The guidelines for each plan just like for conventional insurance provides detailed information about shareable medical needs.
Yes! Each plan offers mental health, see the plan details to learn more about what is offered.
The best way to know if a cost-share is a good alternative to traditional health insurance is by asking yourself the following questions:
- What are your typical healthcare bills per year?
- What’s your typical premium?
- What’s your annual deductible?
- What are your regular out-of-pocket expenses?
- Are you open to telemedicine and virtual doctors?
- Are you primarily interested in major medical and hospitalization care?
Once you add it all up. This is your starting point. Then, start your quote to explore what an indipop membership would cost. If the savings are there, a plan with indipop may make smarter financial sense versus your traditional insurance.
The most significant difference between health insurance and cost-share are that these plans aren’t governed by the Affordable Care Act (ACA.) (though there are indipop plans that meet the ACA criteria)
Because of that, the terms a cost-share uses are different than insurance.
So, a “premium” becomes a “contribution” or “membership.”
A “deductible” becomes a “member responsibility or unshareable amount.”
A “covered” medical expense becomes a “shared expense” with the community.
And a “claim” becomes a “need.”
Where the difference really matters is in what “needs” can be “shared” with the community vs. what is “covered” by an insurance company. The ACA mandates health insurance companies to cover all kinds of things that not everyone needs. That means that you often wind up paying for things you never use.
Cost-sharing is different. Because they aren’t insurance and aren’t regulated by the ACA, they are free to tailor their plans to meet members’ needs.
Here’s a great example: let’s say you have seasonal allergies and you need a prescription once a year so you can get some relief. With an insurance plan, you’ll go into an office, speak with a receptionist, who will then put you in an exam room so you can see a medical assistant, and then, finally, your physician.
Your cost-share will connect you with a provider either by phone or virtually. You won’t pay for the office, receptionist, exam room or nurse. You’ll only see the provider– who will write you the same prescription.
Practices like these dramatically reduce the cost of “everyday” medical care. That means there’s a lot leftover in the pool for major medical expenses and emergencies. So, your monthly contribution remains small and affordable.
Another major difference is set rates. This means no surprise bills in a medical emergency and you do not have to stress about networks because you will owe one set fee for care.
Traditional health insurance charges annual deductibles that renew each year. That hurts patients. For example, if you break you leg in December, you’ll probably need post-op care in January. With traditional insurance you’re stuck with paying two deductibles for the same medical event.
Cost-sharing plans don’t work that way. Out-of-pocket maximums are tied to specific medical events. If you break your leg, you shouldn’t have to pay for it twice.
ACA-compliant – individual and small-group policies must include coverage for the ten essential health benefits with no annual or lifetime coverage maximums.
If a plan provides Minimum Essential Coverage, it means that it covers the following 10 Essential Health Benefits:
- Outpatient care—the kind you get without being admitted to a hospital
- Trips to the emergency room
- Treatment in the hospital for inpatient care
- Care before and after your baby is born
- Mental health and substance use disorder services: This includes behavioral health treatment, counseling, and psychotherapy
- Your prescription drugs
- Services and devices to help you recover if you are injured, or have a disability or chronic condition. This includes physical and occupational therapy, speech-language pathology, psychiatric rehabilitation, and more.
- Your lab tests
- Preventive services including; counseling, screenings, and vaccines to keep you healthy and care for managing a chronic disease.
- Pediatric services: This includes dental care and vision care for kids
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