Resources

FAQ / Glossary

Keep reading to find answers to questions about your plan, enrolling, how it works, or to learn some important definitions.

Glossary

Initial Unshareable Amount (IUA)

The specified financial amount that members are required to bear on their own prior to any amount that may be eligible for sharing.

Dependent

The head of the household’s spouse or unmarried child(ren) under the age of 26, who are the head of household’s dependent by birth, legal adoption, or marriage, and who are participating under the same combined membership. Unmarried children under 26 years of age may participate in the membership as a dependent.

Effective Date

The date a person’s membership begins.

Healthcare Sharing

A membership-based, non-insurance arrangement established for the purpose of sharing legitimate healthcare expenses between members.

Licensed Medical Professional

An individual who has successfully completed a prescribed program of study in a variety of health fields and who has obtained a license or certificate indicating his or her competence to practice in that field (MD, DO, ND, NP, PT, PA, Chiropractor etc.)

Minimum Essential Coverage (MEC)

Minimum essential coverage is the minimum amount of coverage that is considered essential by the Affordable Care Act. Things that are not considered minimum essential coverage include only supplemental plans, coverage for only a specific condition, and worker’s compensation.

Frequently Asked Questions

Enrollment

At the age of 18, an individual is eligible to enroll in their own individual plan. However, they can stay on a parents plan until the age of 26. At the age of 26, or when they get married, they must enroll in their own plan. If someone is 65 or older, they are not eligible to be on the Clearwater plans.

You will keep your healthcare plan for one year based on your effective date. If there is a qualifying event, you may be eligible to update or cancel your plan.

Clearwater plans are currently available in every state with the exception of Washington State.

Given that all eligibility requirements are met, you can enroll in a Clearwater plan at any time.

Yes, as long as the primary member has a U.S. address.

Yes, the plans can be used between states, but cannot be used outside of the U.S. You must have a U.S. address in order to enroll in the Clearwater plans.

No, you do not need a medical checkup to enroll, but you will be asked specific questions around your medical history in the enrollment form.

Yes! Click here to read more. If you are pregnant prior to membership, or within 60 days of your plan going into effect, the membership will not share in your maternity expenses.

If your enrollment date is on or before the 15th of the month, your start date is the first of the same month. If your enrollment date is after the 15th of the month, your plan start date will be the first of the next month.

After enrollment, it may take up to 10 business days for you to receive your physical card. You will also get a digital copy in the welcome email, which typically arrives within 2 business days.

Other Questions

Clearwater Benefits is a healthcare vendor. Clearwater offers a wide variety of high quality, highly affordable healthcare solutions tailored to meet individuals’ unique needs via traditional insurance plans, healthshare-based solutions and supplemental insurance offerings.

Clearwater plans are innovative solutions customized for 1099s (or self-employed) that are a blend of a MEC (Minimum Essential Coverage) and healthshare. The Clearwater Basic plan is an HSA (this portion is a MEC that is used for day-to-day services) + Healthshare plan (used for accidents and expensive procedures), and the Advanced plan is a Copay plan that is a MEC (used for day-to-day services) + Healthshare plan (used for accidents and major procedures). We also have traditional insurance and other supplemental options available as well.

A copay is a fixed amount you pay for your day-to-day medical care, usually at the time of the service. Our copay plan offers affordable copays for things like:

  • Primary Care Practitioner visits ($20 copay)
  • Specialist Practitioner visits ($50 copay)
  • Generic Prescription Drugs ($10 copay)
  • Brand Name Drugs ($25 copay)
  • X-Rays ($50 copay)
  • Complex Imaging – MRI, PET and CAT scans ($200 copay)
  • Lab Work/Screenings ($10 copay)

A Health Savings Account (HSA) is a tax-advantaged savings account you can use to pay for qualified medical expenses. Members who select our HSA Plan use their personal health savings account to pay for day-to-day needs like doctors, prescriptions, and diagnostics.

Medical cost sharing is a nonprofit program that provides an organized structure for a community of members to contribute toward each other’s medical costs. It is a proven and effective alternative to health insurance.

No, it is not. Membership is available to anyone regardless of their religious beliefs.

Clearwater Plans do not have a max out-of-pocket, but instead an IUA. The IUA is the amount a member will pay before Zion Health shares in the medical expenses. The IUA is also known as your “personal responsibility”. You are only responsible for a maximum of three IUAs in a rolling 12 month period. There are three levels of personal responsibility – $1000, $2500, and $5000 – depending on the plan you choose. The lower your personal responsibility (IUA), the higher your monthly payment will be. The IUA is used for expensive services such as major procedures, accidents, surgeries, and ER visits. Day-to-day coverage is handled through the MEC portion of your plan, whether it be the HSA or Copay option you selected.

Yes, because part of all Clearwater plans include Minimum Essential Coverage (MEC), they meet the individual mandate requirement.

Plan Information

You can use your existing HSA account, or roll it over into a new HSA account through our preferred provider, Optum Bank. For help with this, contact planhelp@clearwatersavings.com.

No, a referral is not needed. However, we do recommend making sure your provider is in-network.

Yes! Preventive services are included in our HSA and Copay plans. To learn about the services covered within your specific plan, visit https://www.healthcare.gov/coverage/preventive-care-benefits/

Conditions that existed prior to membership are only shareable if the condition was regarded as cured and did not require treatment or present symptoms for 24 months prior to the effective date of membership. Any illness or injury for which a person has been examined, taken medication, had symptoms, had a routine visit, or received medical treatment within 24 months prior to the effective date of membership is considered a pre-existing condition.

If you think you may have a pre-existing condition we encourage you to book a call with one of our Expert Benefit Consultants who can help assist you in recommending the best plan based on your needs. Just because you have a pre-existing condition doesn’t mean you can’t enroll in the Clearwater plans, but further information will be needed to determine if the plan is a good fit for you. Pick a date and time that is most convenient for you, and book a call to speak with someone directly.

If you think you have a pre-existing condition, we recommend scheduling a one-on-one consultation with one of our Benefit Experts.

Pre-existing conditions have a phase-in period wherein sharing is limited. Starting from the initial enrollment date, members have a one-year waiting period before pre-existing conditions are shareable. After the first year, pre-existing needs are eligible for sharing on a limited basis, with the amount increasing each membership year.

Shareable amount for pre-existing conditions:

  • Year One: $0 (waiting period)
  • Year Two: $25,000 maximum per need
  • Year Three: $50,000 maximum per need
  • Year Four: $125,000 maximum per need

Absolutely! Formularies are through OptumRx.

The healthshare part of your plan handles major accidents, procedures, and ER visits. If you have a major procedure you are going to schedule, we recommend getting in touch with Zion Health so they can help you through this process. For any accident or ER visits, you will want to save your bills and open a needs request through Zion Health directly. You have 60 days to open a needs request from the original date of service. If you have questions and/or need immediate assistance contact Zion Health at 1-888-920-9466 or planhelp@clearwatersavings.com.

When enrolling in a Clearwater plan, you have the option to add vision and/or dental coverage. However, if you only need vision and/or dental coverage without a Clearwater plan, you can do so through our partner, Ameritas.

Support

You can switch plans at the one-year renewal date. To switch before then, there would need to be a qualifying event to be able to do so.

To find a list of providers in your area you can go to the PHCS Network website.

  1. Click on “Change Network”
  2. Click on “PHCS”
  3. Click on “Specific Services”
  4. Search for a provider

When selecting a provider, contact the provider’s office to verify that they are still in-network with PHCS and that the provider’s billing NPI# is contracted through the PHCS/Multiplan network.

If you need further assistance please contact member@planstin.com or call 435-631-2014.

If you make a mistake on your enrollment for, contact planhelp@clearwatersavings.com. Our concierge team would be happy to help you with any concern or issue you may be experiencing.

To cancel your plan, contact planhelp@clearwatersavings.com. A qualifying event is needed to cancel your plan. We ask for a 30-day notice prior to the cancellation date. Plans are paid for a month in advance and therefore refunds or prorated amounts are not applicable unless it is a billing error on our end.

Your Member ID card is a resource that will provide you with a variety of contact numbers for your plan. Additionally, you can always reach out to planhelp@clearwatersavings.com or call 1-856-205-4365 for assistance.

For day to day coverage, claims are submitted through your provider. If your provider cannot, or will not, submit a claim directly to us, then you may submit your claim by fax, mail, or email. If you have an ER visit, major procedure, or accident, you will need to open a needs request through Zion Health and submit your bills.

Claims Contact Information:
EDI Payer ID: 65241
Address: P.O. Box 21747, Eagan, MN 55121
Email: claims@planstin.com
Fax: 435-631-9478

The healthshare part of your plan handles major accidents, procedures, and ER visits. If you have a major procedure you are going to schedule, we recommend getting in touch with Zion Health so they can help you through this process. For any accident or ER visits, you will want to save your bills and open a needs request through Zion Health directly. You have 60 days to open a needs request from the original date of service. If you have questions and/or need immediate assistance contact Zion Health at 1-888-920-9466 or planhelp@clearwatersavings.com.