| Basic | Enhanced | Crown | |
|---|---|---|---|
| Eligible for Sharing Review Membership Guidelines for full details: Waiting Periods, Pre-Existing Limitations, service-specific limits, ISA, and Visit Fees for all Eligible Expenses. All ISAs, fees, Per Incident Limits and Lifetime Maximums are per Member. |
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| Individual Sharing Amount (ISA) | $5,000 / $7,500 / $10,000 | $5,000 / $7,500 / $10,000 | $5,000 / $7,500 / $10,000 |
| Maximum Limit Per Incident | $150,000 | $250,000 | $500,000 |
| Lifetime Sharing Maximum | $1,000,000 | $1,000,000 | $1,000,000 |
| Physician Visits OneShare Members have access to a broad range of Providers through the First Health Network. Choosing an in-network Provider will result in faster sharing request processing and ensure that Members do not face additional sharing responsibility for Eligible expenses. |
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| Smart Virtual Care (Telemedicine) Smart Virtual Care is immediately available. It is not owned or operated by OneShare Health, LLC. but is made available by Clever HealthTM. |
$0 Visit Fee / 100% Shared | $0 Visit Fee / 100% Shared | $0 Visit Fee / 100% Shared |
| Preventive Services and 1 Wellness Visit Preventive Services and 1 Wellness Visit are Eligible after a 180-day waiting period. |
100% Shared Up to $1,000 Per Program Year | 100% Shared Up to $1,000 Per Program Year | 100% Shared Up to $1,000 Per Program Year |
| Primary Care Physician | 1 Per Program Year $40 Visit Fee |
3 Per Program Year $40 Visit Fee |
5 Per Program Year $40 Visit Fee |
| Specialist | Not Eligible | Not Eligible | $75 Visit Fee |
| Facility Services | |||
| Urgent Care Facility | 1 Per Program Year $75 Visit Fee |
1 Per Program Year $75 Visit Fee |
2 Per Program Year $75 Visit Fee |
| Emergency Room After the Visit Fee, Emergency Room services are Eligible for Sharing up to $10,000 then ISA applies. |
$500 Visit Fee - up to $10,000 | $500 Visit Fee - up to $10,000 | $500 Visit Fee - up to $10,000 |
| All Other Services | |||
| X-rays / Labs / Diagnostic |
Eligible | Eligible | Eligible |
| In/Outpatient Surgery Eligible after ISA is met up to Maximum Limit Per Incident. |
Eligible after ISA | Eligible after ISA | Eligible after ISA |
| Maternity All aggregate prenatal and delivery expenses related to an Eligible pregnancy are subject to the following limits based on the method of delivery - Natural Delivery: $5,000; C-Section: $8,000; Complications of delivery: $50,000. |
Not Eligible | Not Eligible | Eligible after ISA |
| Hospitalization After ISA is met, Eligible up to Maximum Limit Per Incident. Outpatient, Pre and Post Admission for Hospitalization/Outpatient Surgery. |
Eligible after ISA | Eligible after ISA | Eligible after ISA |
| Membership Services | |||
| Prescription, Health, Wellness,
and Entertainment Discounts Discount Programs will vary by state and are not owned or operated by OneShare Health, LLC. Members in Washington state are eligible for the state’s
WPDP Discount Card through the Washington State HCA. |
Included | Included | Included |
| Mental Health Support Mental Health Support is not owned or operated by OneShare Health. |
24/7 Intuitive Mental Health Chatbot from Clever HealthTM |
24/7 Intuitive Mental Health Chatbot from Clever HealthTM |
24/7 Intuitive Mental Health Chatbot from Clever HealthTM |
