How Does Impact Health Sharing Work?
Impact Health Sharing is a not-for-profit, non-insurance alternative to the high cost of health insurance. The concept has been around for decades and has been proven to work better and feel better than insurance.
How It Works
Impact isn’t insurance, it’s a health care sharing program. It’s a community of individuals, families, and small businesses just like you and me…who share and pay each other’s medical bills.
Impact is a not-for-profit organization and it’s a community that consistently and voluntarily pay each other’s medical bills. Unlike insurance, there is no incentive to not pay a medical bill.
Most families don’t have the means to finance and reserve funds for their own healthcare risk. So, they sell their “risk” to an insurance company in exchange for a contract and promise of payment. You’ll have to pay the insurance company a “premium” to accept your risk.
That’s not the case with health care sharing. You’re not relying on a guarantee, a contract or a “promise to pay” from an insurance company. Like millions of others who participate in health care sharing every day, you’re relying on the voluntary commitment and consistency of the Impact Member community.
Health care sharing is different than insurance in that your money is always going to help another member in need and not some cold and disinterested insurance company. You’ll have full visibility on who you are helping even before funds are transferred from your account. You will even be able to send them a “note of encouragement” or a “prayer.” Finally, you can see how all of the contributions of the Impact community are being used. You’ll never get that kind of transparency and accountability from an insurance company.
A few of our features are:
- Comprehensive Medical.
- Wholesale Rx (PBM direct pricing, no markups).
- Telemedicine (No consult fees or co-pays)
- Preventive & Mental Health (Limited).
- Industry-Leading Technology (VSE).
- Affordable Prices (fits any budget…prices start at $73 for singles and $378 for families).
Key Things to Understand
Primary Responsibility Amount (PRA)
Members choose a Primary Responsibility Amount (PRA), which is similar to an annual deductible. The amount you choose is how much you will have to pay for eligible medical expenses before member sharing kicks in. The size of the PRA you choose will determine your monthly Share. The higher the PRA the lower the Monthly Share Amount.
Let’s say you choose the $10,000 PRA, in case of an emergency, you would handle having to pay $10,000 out of pocket, but would enjoy the savings that the lower monthly Share affords. If your family would struggle with such a high PRA, you could choose a lower one but then will pay more in monthly Share amounts.
As with health insurance, you will pay a provider fee as follows:
- $0 fee for Telehealth.
- $50 for doctor visits.
- $75 for specialists and urgent care.
- $75 for Teletherapy.
- $150 for emergency room care or hospitalizations.
One annual well visit for members six years and older per membership year. Includes a $150 allowance for the following routine labs as ordered by the provider during the annual/well visit.
- No Network or Doctor Limitations
Impact is not contracted with a preferred provider organization. Members are free to seek care from the doctor or provider of choice.
When you need medical care, you will show your Impact Member ID card and pay your provider fee. The provider will bill Impact. The medical bill will be processed and discounted, and then your doctor will bill you for the amount you owe. Once the amount you pay meets your PRA for the year, your Eligible Medical Bills will be approved for Sharing.
After you have met your PRA, eligible bills will be Shared by the members at 90%. You will be responsible for 10%; up to a maximum of $5,000.
It’s important to understand the Preexisting Medical Condition limitations.
Pre-Existing Medical Conditions are conditions in which known signs, symptoms, testing, diagnosis, treatment, or use of medication occurred within 36 months prior to membership (based on medical records).
A known sign is any abnormality indicative of disease, discovered on examination/diagnostic testing before joining membership. A symptom is any subjective evidence of disease. In contrast, a sign is objective. A Pre-Existing Medical Condition is eligible for sharing after the condition has gone 36 consecutive months without known signs, symptoms, testing, diagnosis, treatment, or medication (based on medical records).
If you have been diagnosed with cancer that is in complete remission, and you are only undergoing testing for surveillance purposes, then bills related to those services will not be eligible for sharing for the first 36 months of membership.
If after 36 months you are without signs, symptoms, testing (other than surveillance testing), diagnosis, or treatment (medication), medical expenses related to that cancer diagnosis will be eligible for sharing. The Preexisting Medical Condition limitations do not apply to Members 65 years and older.
Prescription medication expenses may be credited toward the PRA if they are not considered a treatment for chronic conditions that were preexisting when the member joined Impact. After the Member’s PRA has been met, the prescription amount may be shared as follows:
- After the first $25 on a generic drug prescription.
- After the first $50 on brand name prescription when a generic is unavailable.
- Prescription medications* must be purchased using the Impact Member ID card.
- Members pay 100% of the prescription amount at the pharmacy.
- Prescription drugs may be dispensed, injected, or administered.
*Psychotropic medications and birth control expenses are not eligible for Sharing.
The shareable amount is limited to $1200 per member, per membership year after the PRA has been met.
Exceptions may be made in the case of medications for cancer and transplant recipients.
Advantages of Impact
You Can Join Anytime
That’s right! You can apply for Impact and join any time during the year. With Obamacare, you are forced to join within their Open Enrollment period, unless you have a change in status (move, have a baby, etc). You may be reading this during Open Enrollment—understand that you can join Impact anytime throughout the year. And you don’t need one of the special exemptions to make the switch.
Impact does not use a Provider Network; therefore, you can continue to use the doctors and hospitals of your choice, including specialists.
Impact does not use a Provider Network; therefore, you can continue to use the doctors and hospitals of your choice, including specialists.
