FAQ &
Welcome to the FAQ Page!
You will find answers to common questions to help you understand SimpleNext’s healthcare programs
Welcome to the FAQ Page!
You will find answers to common questions to help you understand SimpleNext’s healthcare programs
The Healthy PPO Plan is compliant with Part A of the Affordable Care Act and the Bronze PPO MVP is compliant with Part A and B of the Affordable Care Act.
There is no “open enrollment” since these are month to month programs. If you enroll by the 20th, you will be eligible for benefits the 1st of the following month.
Yes. Our members can get support via the help desk in the member portal or by calling your care navigator.
Termination can be done at anytime up till the 20th of the month at midnight just like enrollment.
Our member-focused affordable healthcare plans are an excellent alternative to traditional insurance.
The Healthy PPO is available to individuals and families.
We currently have Dental and Vision plans available for members. They must be coupled with a SimpleNext Health Plan.
Our programs do not accept members 65+.
Yes. Healthy PPO Plan meets the Part A Tax requirements.
Yes. The Healthy PPO Plan is available to independent contractors and individuals. The Bronze MVP is only for large organizations.
Yes. Align also offers the Bronze PPO MVP Plan which meets the Part B Tax requirements of the Affordable Care Act (ACA).
Plans provide 100% coverage for preventative services as outlined by the Affordable Care Act.
Yes. Plans include telemedicine membership with access to a physician 24/7.
Yes. There is a large provider network for preventive care by First Health Aetna PPO Network. To locate a provider visit https://www.firsthealthlbp.com. ShareWell is network free.
Similar to a deductible, the Unshared Amount, or UA, is the amount a member will pay per incident before the ShareWELL shares in medical expenses. The lower your UA, the higher your monthly contribution will be.
After the UA is met, additional eligible medical expenses are provided for. If you chose an UA of $1,500 and are hospitalized with a heart attack, you pay the UA. That’s it!
Members do not pay for the same Sharing Request within 12 months of the last treatment date. Additionally, members will not be responsible for more than two UAs in a rolling 12-month period.
No. This is not an insurance plan.
No. The Health Share is only one component of the Healthy PPO Plan. This plan is bundled with ACA compliant Preventive Care, Virtual Care, Health Benefits App, Pharmacy, and more.
imilar to a deductible, the Unshared Amount, or UA, is the amount a member will pay per incident before the ShareWELL shares in medical expenses. The lower your UA, the higher your monthly contribution will be.
After the UA is met, additional eligible medical expenses are provided for. If you chose an UA of $1,500 and are hospitalized with a heart attack, you pay the UA. That’s it!
Members do not pay for the same Sharing Request within 12 months of the last treatment date.
Additionally, members will not be responsible for more than two UAs in a rolling 12-month period.
Members may choose to change their IUA once per membership year. If it’s decreased, a 60-day waiting period will apply to all Sharing Requests other than those resulting from an accident.
Generally, medical events exceeding a member’s Unshared Amount related to a new injury, illness, or pregnancy are eligible for sharing. Sharing is not available for conditions that existed before joining in the first year of membership. We have also expanded sharing for the to include alternative and holistic approaches to treatment and care.
Pre-membership conditions may have a waiting or phase in period. We attempt to negotiate all medical bills received and many membership types include assist with pre-negotiated medical expenses. See plan details for more information.
Sharing requests should be submitted through the Member Portal or HealthWallet. Sharing requests should be submitted as soon as possible but no later than six months of the date of service. Most non-emergency sharing requests, such as surgical procedures, should be submitted prior to the date of service. For any help with this process, members may contact ShareWell HealthShare directly during business hours.
Yes, in fact many of our members will spend a fraction of what is typically owed for those using traditional methods to cover their care. Our maternity program includes prenatal, delivery, postnatal, homebirth, midwives, and doulas. Members who keep the cost down for the The community may be eligible to have part of their UA responsibility waived. Members are able to use a wide variety of prenatal and postnatal services that are not often covered by traditional plans.
Pregnancy is considered not shareable if conception occurs before the membership start date. Maternity sharing requests must be submitted no later than 6 months after pregnancy confirmation at your initial provider visit.
Member households that experience multiple sharing requests will be responsible for up to three UAs within a rolling 12-month period. After a member has paid three UAs in a twelve-month period.
No. There are no lifetime maximums, monthly caps, or other limitations on how much funding can be shared for eligible medical expenses. Certain care may have a sharing allowance that will be clearly outlined in the member guidelines. The allowances are designed to give personal responsibility back to the patient.
When asked for your insurance or ID card, let them know you are a self-pay patient. Request any available discounts. You can pay up to your UA amount directly to the provider while you are at the visit or after they send your bill in the mail. Open a Sharing Request as soon as its convenient and send the bills as you receive them.
Yes! Sharing Requests for alternative treatments is done on an equitable basis compared to the equivalent traditional treatment. If a member chooses an alternative treatment and returns to conventional care, their sharing will be limited equitably by the expenses shared towards the alternative treatment.
Alternative Sharing Requests with nontraditional providers other than MD, DO, NP, RN, DC, APRN, Ophthalmologist, or DPM require written approval in advance.
Interested in SimpleNext Healthcare Plans for your business or trade organization? Tell us a little more about you and we will get in touch with you as soon as possible.