FREQUENTLY ASKED QUESTIONS
FAQs
Here are some answers to Marketing Partner's frequently asked questions. To get answers to the rest of your questions, visit our Help Center or read our Membership Guidelines.
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Impact Insider December
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.
To see details click here.
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.
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. High blood pressure or high cholesterol that is controlled through medication will not be considered a Pre-Existing Medical Condition for purposes of determining eligibility for future vascular or cardiac events.
The Pre-Existing Medical Condition limitations do not apply to members 65 years old and older.
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.
Primary Responsibility Amount (PRA) is the annual amount a Member Household is responsible for before medical bills can be approved for sharing.
Members do not have deductibles. Instead, our members have a Primary Responsibility Amount (PRA).
The PRA options are as follows:
- $1,000 (65 years and older only)
- $2,500
- $5,000
- $7,500
- $10,000
The PRA is the annual amount a Member Household is responsible for before medical bills can be approved for sharing. The PRA applies only to Eligible Medical Bills. After the PRA has been met, and the co-share is applied, all Eligible Medical Bills will be submitted for sharing for the entire household.
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.
Preventive screening as outlined below is subject to PRA and co-share.
• Women: Pap test—one every three years from age 21-65
Mammogram—one every year for ages 45-54,
every two years starting at age 55
• Men: PSA test—one every year, starting at age 45
• All: Colonoscopy—one every 10 years starting at age 45 or one every five years for members at high risk
• As it pertains to eligible preventive care for both men and women, both the test and coordinated office visit will be eligible for sharing.
• Note: Bills are processed in the order they are received to apply allowances and sharing
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
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.
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