FREQUENTLY ASKED QUESTIONS
COVID-19 is no different than any other symptom-related illness that our members may experience from time to time. This means that bills related to treatment and testing for COVID-19 can be submitted for sharing, including labs, emergency room, hospital admissions, prescriptions, etc.
Our membership is made up of like-minded individuals, families, and small businesses who agree with the Statement of Shared Beliefs & Ethics. There are no restrictions based on race, color, religion, or creed.
There is no limit on when you can apply. You can choose which month you want your membership to begin.
The monthly cost is based on the age of the oldest person in your household, the number of people applying, and the Primary Responsibility Amount that you choose.
Visit https://www.impacthealthsharing.com/pricing to see your options.
There are dramatic savings over ACA Plans (Obamacare) and greater value than other health sharing programs. Prices start at $73/mo. for singles and $378/mo. for families.
See the Guidelines for complete details.
Prescription medication expenses may be credited toward the PRA if they are not considered 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 generic drug prescription.
- After the first $50 on brand name prescription when a generic is unavailable.
- Prescription medications must be purchased using the member ID card (see Rx information on the card).
- Members pay 100% of the prescription amount at the pharmacy.
- Prescription drugs that may be dispensed, injected, or administered.
Psychotropic medication and birth control expenses are not eligible for sharing.
The sharable amount is limited to $1200 per member, per membership year after the PRA has been met. For more info. on how it works click here.
Pre-Existing Medical Conditions are conditions in which 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. 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.
- Care or services
- Diagnostic measures
- Prescribed drugs or medications
The Preexisting Medical Condition limitations do not apply to members 65 years and older.
Watch this video for information on using Impact at any provider, and read through these simple steps.
When you need to go to the doctor, using your Impact Health Sharing membership is easy.
Step 1. Choose your medical provider. No network limitations. Just see your preferred provider.
Step 2. Show your member ID card. If you have used health insurance in the past, using Impact Health Sharing won't feel a whole lot different.
Present your Impact member ID card to the staff and ask the provider to bill Impact using the information on the back of your card. All of the information that their billing specialist will need is on the card.
Our phone number is also included on the card if they have any questions. If they ask what network Impact participates in, let them know that you are free to see any provider you choose.
Keep in mind, there are hundreds of healthcare options these days. If your provider hasn’t seen a patient with Impact before you, they may have to add Impact to their Payer ID system. It is best to ask the provider to call if they run into any problems.
Step 3. Pay your provider fee.
For non-emergency care, consider using a Telehealth provider.
Pay the provider fee as follows:
- $0 for Telehealth
- $50 for primary care
- $75 for specialist or outpatient services
- $75 for urgent care
- $150 Emergency Room or inpatient hospitalization
- $0 for Impact Seniors
At each visit only pay your provider fee. You should never be asked to pay for services out of pocket or upfront. If so, please ask the provider to call Impact at 855-378-6777.
Step 4. Receive the care you need when and where you need it.
Step 5. Pre-notification is required. Sometimes it takes more than one visit to get you back on your feet. Be sure to direct providers to pre-notify Impact for any of the following treatments to be eligible for sharing:
- Cancer treatments
- Elective cardiac procedures
- Inpatient hospitalizations
- Non-Emergency surgery
- Organ/Tissue transplant services
Providers must pre-notify by calling 855-378-6777. In the event of emergency/urgent care, the member or provider is required to provide notification within 72 hours after treatment.
Pre-notification of medical bills does not guarantee eligibility or sharing.
Since Impact Health Sharing isn't insurance, there isn't a per person deductible; rather there is a Primary Responsibility Amount (PRA) per household.
The PRA is the annual household amount that you pay, before your eligible medical bills are published for sharing.
There are five options to choose from: $1,000 (65 years and older only), $2,500, $5,000, $7,500, and $10,000.
Once the Primary Responsibility Amount is met, the member pays 10% (the Co-Share amount) of all eligible medical bills.
The remaining 90% is published for sharing to the Impact membership.
There is a Co-Share limit of $5,000 per year, per household. In other words, after a member pays a total of $5,000 in Co-Shares, they will not be subject to a Co-Share until the amount resets on their Membership Date.
A provider fee is the amount paid by the member to the medical provider for each visit.
The provider fee is not eligible to be applied to the PRA and is paid even after the PRA is met.
The provider fee is:
- $0 for Telehealth
- $50 for each primary care visit
- $75 per specialist visit or outpatient services
- $100 for urgent care
- $150 for Emergency Room or inpatient hospitalization.
- $0 for Impact Seniors
One annual/well visit per membership year.
Includes $150 allowance for routine labs.
Impact follows the American Cancer Society recommendations when it comes to sharing in preventative care, which includes the following:
Pap test – once every three years from 21-65 yrs.
Mammogram – Age 45-54 yearly, every two years starting at age 55.
PSA test – one every year, starting at age 45.
- All: Colonoscopy – one every 10 years starting at age 50, or one every five years for members at high risk.
Impact for Seniors simplifies the healthcare experience.
- No Provider fees.
- No Co-share.
- No Pre-existing limitations.
Here are a few things to know:
1.If you are 65 or older, you are required to have Medicare Parts A & B to join Impact.
2. Impact is always secondary to Medicare Parts A & B. One great thing about this is that there are no preexisting condition restrictions or provider fees for Impact members with Medicare.
3. You are welcome to use your member card to access the pass-through direct pricing on prescriptions. One thing to note, for prescription costs to be eligible for sharing, members must have Medicare Part D as well.
4. All sharing will be secondary to Medicare. There is only one PRA level available to these senior adults (see pricing calculator at https://www.impacthealthsharing.com/pricing). This program is available only on an individual membership basis.
5. The PRA for senior adults is $1000 with no provider fees, no co-share, and no preexisting limitations.
Impact does not use a Provider Network; therefore; you can continue to use the doctors and hospitals of your choice, including specialists.
Watch this video for more information on how to use Impact Health Sharing at any provider.
The ACA requires employers to offer MEC (Minimum Essential Coverage) to their employees if they have at least 50 full-time employees; this is known as the "employer mandate" and remains in effect today.
As a healthcare sharing organization, Impact DOES NOT meet the standard for MEC (Minimum Essential Coverage).
Therefore, organizations with 50 or more employees offering Impact Health Sharing must also offer a MEC program alongside Impact.
IMPACT’S STATEMENT REGARDING ACA COMPLIANCE FOR HEALTHCARE SHARING ORGANIZATIONS. Read Here.