What is Family for Health?
Family for Health is personalized, affordable health insurance. Unlike traditional insurance which sits between the patient and the doctor, our members pay for care directly when they get it using an Health payment card. As a result, our members can see any doctor, all coverage is transparent, and members save 40%† or more than comparable traditional plans. Simply put, Family for Health is health insurance the way it should be.
Familyfor Health is the way health insurance should be:
- Affordable: Our members get big discounts‡ by paying doctors when they receive care using the an Health payment card. As a result, our plans save members 40%† or more on monthly insurance costs.
- Personalized: Our members can customize their coverage to fit their needs and budget.
- Transparent: Our members use the Family for Health app or website to see how much their plan will cover for a medical service. Through the app, members can also see what other members have paid for services in their area.
- Simple: Our members can see any doctor they want and pay for medical services using their Health payment card.
What makes Family for Health different from other plans?
Family for Health is different from traditional insurance in that we pay a fixed amount for any eligible, medically necessary service or prescription drug that you buy. That means if your provider charges more than that fixed amount, you pay the difference. And if your provider charges less, you keep the difference. Also, this allows you to know exactly what your coverage is so there won’t be any surprises from your plan. With Family for Health, you are in the driver’s seat.
Enrolling in Family Health Care
Do I have to enroll by a certain date?
You can sign up for a family health care plan at any time, just like you can cancel at any time. Think of us like you would a subscription service.
When will my coverage start once I enroll?
Soon! Your coverage may begin as soon as 14 days from the day you enroll. But check your policy to see exact dates when coverage will begin.
How long will my coverage last?
Most plans last for a year, in some states you have the option to lock in your plan and rate up to three years*. You may cancel any time.
Why do you need to know about my health?
Family health care plans are priced to be as affordable as possible for members, and we can offer low monthly costs by pricing each family by their needs. Your monthly cost is based on the real cost of care, please ensure telling the truth to avoid lapses in coverage.
Are there any requirements I have to meet to enroll in a plan?
Anyone under the age of 65-years-old can enroll in an health care plan, unless you’re less than 18-years-old. You will then need to be enrolled by a parent or guardian.
Using Your Family Health Coverage
How do I use my family health coverage at the doctor’s office, urgent care, or surgery center?
- Call your doctor, the urgent care, or surgery center ahead of your visit, tell them you are paying for the visit as a self-pay patient, and verify what the cost for your medical service will be. If you don’t have a specific doctor in mind, you can use the Family for Health app to find one near you. We also recommend calling a few places to compare prices.
- Use the Estimate care tab in the Family for Health app to see how much your plan will cover. You will be responsible for paying the difference between the Benefit Amount your health care plan will pay toward the visit and what the doctor charges (as a reminder, if the charge is less than the Benefit Amount, you keep the difference).
- If a bill is available in advance, upload a picture of it to the health care provider app or website. Then when ready to pay for your visit, use your health care payment card. If a bill is not available in advance, you can still use your health care payment card to pay up to your card transaction limit. You can always look up your transaction limit in your account.
- When your health care payment card is charged, the company will automatically charge your personal payment method on file for your initial share of the medical service. Since we offer personalized plans, initial shares and benefits may vary. Log in to your account to see the details of your plan.
What do I do after seeing my medical provider?
After you’ve received your care, submit a picture of your itemized bill to the health care provider app or website so we can determine your final Benefit Amount. If this is more than the initial estimated Benefit Amount, we will credit you the difference. If it is less, you will be responsible for the difference. Please note that if an itemized bill is not uploaded within 30 days, we will send you reminders. You must pay the entire amount of your care if you don’t submit your itemized bill by the deadline explained in your policy.
How do I use my health care coverage at a pharmacy?
- Using the health care provider app, go to the Estimate Care tab, select Prescriptions, and search for your prescription.
- Select your prescription and specify the form, dosage, and quantity.
- Compare your estimated out-of-pocket cost at local pharmacies.
- Choose your desired pharmacy and show the discount codes you see in the app to the pharmacist. Without these codes, your medication will still be covered under your plan, but may cost you more out of pocket.
- After you pay using the health care payment card, follow the instructions in the app to upload a picture of your receipt. Check that your receipt includes the drug name, form, strength, and dosage. Alternatively, it can show the National Drug Code (NDC), which is a 10 or 11-digit number shown in 3 segments. The health care provider will review your receipt and notify you when the expense is approved.
Should I submit itemized medical bills, or “medical invoices”, even when I have an outstanding deductible amount?
Yes! If you don’t upload your medical bills, your deductible won’t go down. That’s because as you receive health services, the fixed Benefit Amount of those services that the health care provider normally pay you will be applied towards your deductible instead. Once your deductible has been met, the health care provider will start paying you the fixed Benefit Amount for covered services.
What does a medical invoice need to include?
In order to process your claim, you need to send an itemized medical bill – otherwise known as a “super bill” or “medical invoice”. The itemized bill must include the following five things:
- Patient’s name
- Provider’s name
- Date of service
- Charge amount
- Detailed description of service and/or a medical billing code such as a CPT code.
How do I know how much my plan will pay for covered services I receive?
You can easily find the Benefit Amount of your covered service using the app or website.
Health care providers also share information on doctor and health care provider prices that other members have paid within the health care provider app and website. However, it is important to understand that provider prices can vary, but the fixed Benefit Amounts paid by your plan for the same services will remain the same.
What if my bill is higher than expected?
You should expect to pay anything above the Benefit Amount when getting care. Sometimes a provider will charge more than the Benefit Amount, and sometimes they will charge less. Prices can vary a lot and that is why we always recommend shopping around and comparing prices from health care providers for the services you need BEFORE you get care.
There may be some instances where you are unable to know the cost of your care ahead of time because you don’t know what services you need before seeing a doctor. In this case, we recommend you use the health care provider cost estimator tool to look up the procedures or medical services that your doctor recommends while you’re with your doctor. This way, you’ll always know what your plan pays and you can compare that amount to what your doctor will charge before deciding to get care.
What if my medical bill is lower than what my plan pays?
Congrats! You made a great decision. In this case, you get to keep the difference between the Benefit Amount and what your doctor charges. The difference will be added to your health care providers account and, if unused, will be sent to you when your policy ends or you can request a paper check in the same amount. Your plan pays a fixed amount per service regardless of the cost of your treatment.
Are preventative services covered?
Absolutely. Preventative services are covered the same way as other health care services that you may receive.
Is a referral required to see a specialist?
Of course not. You can see any doctor you want.
What does a health care plan NOT cover?
Your health care plan doesn’t cover anything that is not medically necessary, meaning that things like cosmetic and elective procedures may not be covered.
Here is an overview of what’s not covered, but please look at your policy for specifics. Your policy provides the details of your coverage, including any exclusions and limitations.
- Services and drugs that are experimental or investigational.
- Care provided in rest homes, health resorts, homes for the aged, halfway houses, college infirmaries or places used primarily for living, and extended care in treatment or substance abuse facilities.
- Day care and foster care.
- Personal comfort or beautification cosmetic services and supplies.
- Safety glasses, athletic glasses and sunglasses.
- Eye surgery when the primary purpose is to correct myopia (near-sightedness), hyperopia (far-sightedness) or astigmatism (blurring).
- Cosmetic procedures including but not limited to breast augmentation, liposuction, abdominoplasty and vaginal rejuvenation.
- Any services rendered by an immediate family member, unless allowed per state law.
- Treatment for obesity, including but not limited to prescription or over-the-counter medications, food, diet or exercise programs, surgery, weight management, or nutrition programs. (Prescription medication prescribed by a physician that are medically necessary to treat obesity will be covered under the Outpatient Prescription Drug benefit.)
- Vitamins, food supplements and over-the-counter medicines.
- Wellness benefits such as exercise classes, health club membership or smoking cessation products.
- Diagnostic procedures and treatment related to infertility including, but not limited to, in vitro fertilization, artificial insemination and use of egg donor or surrogate.
- Sterilization or sterilization reversal, including surgical procedures and devices.
- Sexual reassignment surgery and related therapy, whether before or after surgery, including but not limited to treatment of gender dysphoria.
- Body piercing.
- New, or repair or replacement of dentures, bridges, dental implants, dental bands or braces or other dental appliances, crowns, caps, inlays or onlays, fillings or any other treatment of the teeth or gums.
- Treatment of complications of procedures not covered under this Policy.
- Pregnancy, childbirth or well-baby care (except for complications of pregnancy)
- Pre-existing conditions that you didn’t disclose during sign up and certain upcoming procedures that you did disclose
- for elective treatment or elective surgery or complications arising therefrom
- as a result of committing or attempting to commit an assault or felony, or participation in a felony, riot, illegal occupation, insurrection or civil commotion.
- for injury resulting from fighting, except in self-defense.
- for any private duty nursing or skilled nursing services.
- Prescription drugs (if you choose to not elect this coverage)
To see the most up-to-date list of exclusions, be sure to view your policy document.
See the following FAQ about what medically necessary means for more information.
Note: These plans currently do not cover maternity services, including prenatal and postpartum care, labor, and delivery.
What does medically necessary mean?
We cover services prescribed by a doctor for health reasons, but things like cosmetic and elective procedures may not be covered. Whether something is medically necessary is always up to the health care provider. Please refer to your policy for exact details about what procedures and drugs are covered. If you have any questions about whether a service is medically necessary or covered by your policy, please give your Member Care Team a call at 877-653-6440. We’d be happy to help you.
What is a deductible?
A deductible is how much you will pay in covered medical costs before your plan starts paying for any health care expenses. Adding a deductible to your plan will help lower your monthly premium but means you will have to pay more out of pocket before your plan starts covering expenses.
For example, with a $500 deductible, you pay the first $500 of covered services yourself. Only the Benefit Amount for the covered service, found in the health care providers app, will apply toward your deductible. After you pay your deductible, your plan will start to pay for the covered medical care you receive up to the annual max benefit you chose when enrolling.
What does the annual max benefit mean?
Annual max benefit is the amount your plan will pay toward your covered medical expenses within one year. You can choose an annual max benefit between $5,000 and $2 million. For example, if you have an annual max benefit of $25,000, your plan will pay the fixed Benefit Amount for medical care up to $25,000.
As an added feature, if you select $2 million annual max benefit, after your plan has paid $10,000 in benefits, your Benefit Amount for each covered service will increase by 25%, as will be shown in the health care providers app when you look up your Benefit Amount.
For example, say you had an emergency and ended up in the hospital. The hospital charged $20,000 for your stay, which happens to be how much those services should cost per the health care providers app or website. Let’s say you selected a $25,000 annual max benefit, your plan would pay $16,000 and you would be responsible for $4,000. If you had selected a $2 million annual max benefit, you would pay only $2,500 (Calculation: first your plan would pay $10,000 of fixed Benefit Amount. On the remaining $6,000 of fixed Benefit Amount, you get an extra 25%, which is $1,500. So your cost is $20,000 -$10,000 – $6,000 – $1,500 = $2,500).
Do I have any coverage for prescription drugs?
It’s up to you. Prescription coverage is included with all our plans, but you can choose to exclude it when you enroll in coverage. Similar to medical services there is a fixed Benefit Amount for each drug, which you can look up in the health care providers app. The app will also tell you what your portion is depending on where you buy it.
What happens if I become pregnant while on my policy?
Currently, most health care providers do not offer maternity coverage. While they won’t cover maternity related expenses if they arise, your existing coverage on expenses unrelated to maternity will remain the same. We hope to offer maternity coverage in the near future, so stay tuned!
What is monthly cost?
Monthly cost is the monthly premium amount you pay every month for your health care providers coverage. Think about it like every other subscription service.
How do you calculate my monthly cost?
Your monthly cost is based on the plan you choose, and any additional plan features you select. For example, the higher your annual max benefit, the higher your monthly cost will be. It will also be higher if you add the three-year rate lock (which is available in some states)*. Where you live, your age, and how you expect to use your coverage can all impact your monthly cost.
How will you use my credit/debit card or bank account information?
We use your credit/debit card or bank account information to charge you for your health care providers monthly cost, and for your share of any medical costs charged to your health care providers payment card. Your share is based on the difference between how much your doctor charges and your Benefit Amount for any covered service.
Policy Cancellation and Renewals
What is a 3-year rate lock*
A rate lock is an optional feature available in some states that locks in your monthly cost for three years. Note that if you make any changes to your coverage level during this three-year period, your monthly cost may increase or decrease depending on the change in coverage.
What if I need to cancel my policy?
We will cry. But, you can cancel your policy at any time using the health care provider app or website, or by calling your Member Care Team. The cancellation will go into effect on the next billing cycle. For example, if your monthly cost is charged on the 15th of every month and you cancelled on the 20th, you would be covered until the 15th of the following month but would not be charged again.
What is fixed indemnity?
A fixed indemnity insurance plan means that there are pre-set– or fixed- amounts your plan will pay toward medically necessary services regardless of what your medical provider charges. Keep in mind that in all cases, you are responsible for the balance above the Benefit Amount your plan pays. You can think of this as using a retail store gift card. The gift card balance is like your Benefit Amount for a covered service. If the charge is higher than the gift card amount, you must use another method to pay the difference. The same applies using your health care providers payment card.
To see what fixed rates are available, visit the following care plans below
How is my health information protected?
Protecting members’ personal information is extremely important to Family for Health. Your information is not sold. Rather, going above and beyond to ensure that the information you share and entrust with is protected by taking security measures beyond necessary standards.
Does Family for Health offer ACA or Obamacare plans?
Our plans provide members with affordable, highly customizable coverage, some plans may qualify with the Affordable Care Act (ACA)/Obamacare plans though, are not for everyone. If you’d like to explore if an ACA plan is right for you, go to www.healthcare.gov.
What about the tax that requires me to have health coverage?
Beginning in 2019 there are no federal tax penalties associated with not having a qualified plan under the ACA. However, certain states may have other mandates. If you have any questions about this, please consult your tax advisor.
Is Family for Health an insurance company?
Family for Health is not an insurance company, but instead is the exclusive program manager and administrator of the fixed indemnity insurance plans it sells. Basically, Family for Health has partnered with insurance companies to provide insurance plans to health care members. These partnerships make it possible for us to have Family health care members’ backs because our partner has our back. Family for Health is simply authorized to act on the insurance companies’ behalf to create, market, and manage insurance plans which are underwritten by them. So when you have a claim, our insurance partners are responsible for paying your eligibile claims.