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Monthly Contribution Starts At:
 
$130/$405 individual/family

Initial Unshareable Amount (IUA)
$1,000, $2,500, or $5,000 (max 3/year)

Annual Out-of-Pocket Maximum:
$3,000, $7,500, or $15,000

Great For You If:

You want preventive care, 24/7 on demand care, mental health and a low out of pocket cost for major medical. 

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Zion Health Direct-  SUMMARY

Annual Sharing Maximum: None, unless restricted by pre-existing condition.

Lifetime Sharing Maximum: None, unless restricted by pre-existing condition.

Allows HSA: No

Preventative Care: Yes

Primary Care Visit: 24/7 tele-health included, the team can help coordinate care.

Specialist Visit: May count towards (IUA) Initial Unshareable Amount

Maternity: Yes

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Emergency Visit: You are responsible for first $1,000, which counts toward your annual IUA.

Urgent Care Visit: Free through telehealth. You may call member services for assistance in locating an Urgent Care and understanding your self pay rate.

Open Network: You may see any provider or hospital. For annual or preventive care you must use the PHCS network in order for the visit to be $0.

Prescription Coverage: Zion Health RX Share Through OptumRx, Zion Health members can receive discounts on their prescriptions. Additionally, Rx Share gives members access to many generic prescriptions for as low as $5

Maternity: One Initial Unshareable Amounts (or Member Responsibility Amounts) are applied to a single maternity need. Any pre-birth or post birth need of the child will be considered a separate need from the mother’s maternity care.

Mental Health: Yes. Unlimited.

Pre-Existing Conditions: 24-month look-back: no coverage for the first 12 months; $25K 2nd year; $50K 3rd year; $125K 4th year and beyond. (Exceptions for High Blood Pressure, High Cholesterol & Diabetes)

Meets ACA MEC Requirements: No.

Dental: No.

Vision: No.

Plan Highlight

Telehealth-24/7 

Set amount for major medical no surpise bills

What to consider about this plan
  • Out of pocket costs for specialists and doctors are your responsibility
  • Pre-existing conditions go back 24 months, but if medically managed could be eligible for sharing
  • Does not meet the minimum requirements for MEC (Minimal Essential Coverage) or the ACA (Affordable Care Act). New Jersey, Massachusetts, Vermont, California, Rhode Island and the District of Columbia.