Keep reading to find answers to questions about your plan, enrolling, how it works, or to learn some important definitions.
The annual maximum is the amount that a member will pay before the ClearShare community shares in medical expenses. The annual maximum is also known as your personal responsibility. ClearShare has three primary levels of personal responsibility: $1000, $2500, and $5000. The lower your personal responsibility, the higher your monthly contribution will be.
All qualifying medical expenses submitted after the Annual Maximum is met are shareable with the ClearShare community at one hundred percent. You are only responsible for the annual maximum once each plan year based on your effective date. There is no annual or lifetime limit.
Service copays are not included in the annual maximum. Members who are also part of an HSA MEC, service related costs that apply to the member’s deductible are not part of the annual maximum.
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.
The date a person’s membership begins.
A membership-based, non-insurance arrangement established for the purpose of sharing legitimate healthcare expenses between members.
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 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.
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 Clearwater.
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.
Yes, Clearwater is available in all 50 states.
Given that all eligibility requirements are met, you can enroll in Clearwater at any time.
Members must have a Social Security Number in order to enroll.
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 Clearwater.
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, if you are pregnant at least 60 days after your plan goes into effect, maternity is 100% shareable with ClearShare.
If you are pregnant within 60 days of your plan going into effect, maternity is shareable up to $50,000.
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.
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 offers innovative solutions customized to those who are self-employed on 1099s. Our plans are a combination of a MEC (Minimum Essential Coverage – used for day-to-day services) and healthshare (used for accidents and major procedures).
The Advanced + ClearShare plan features low copays for the widest variety of services, including doctor visits, prescriptions, and labs and imaging services. ClearShare, a healthshare, handles accidents and major procedures.
The Basic + ClearShare plan features low copays for in-network doctor visits and prescriptions. ClearShare, a healthshare, handles accidents and major procedures.
The HSA + ClearShare plan provides members with a tax-advantaged Health Savings Account (HSA) which they can make contributions to and pay for medical expenses with. ClearShare, a healthshare, handles accidents and major procedures. Members with HSAs will still need to be in-network with PHCS to receive free preventative services.
We also offer ClearShare memberships, a healthshare-only plan that does not include a MEC portion, which provides members a safeguard against high medical expenses including accidents or illnesses. It does not provide any day-to-day coverage such as preventative or primary care doctor visits, diagnostics, and drugs.
A copay is a fixed amount you pay for your day-to-day medical care, usually at the time of the service. Advanced + ClearShare and Basic + ClearShare plans offer affordable copays for services including, but not limited to, doctor and specialist visits.
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.
ClearShare is a membership-based community of individuals established for the purpose of sharing eligible healthcare expenses between Members as described in the Member Guidelines. ClearShare is not insurance. ClearShare covers most emergency and hospital services. These medical services may include, but are not limited to major procedures, accidents, surgeries, and ER visits.
The annual maximum is the amount that a member will pay before the ClearShare community shares in medical expenses. Your annual maximum is also known as your personal responsibility. ClearShare has three primary levels of personal responsibility: $1000, $2500, and $5000. The lower your personal responsibility, the higher your monthly contribution will be.
All qualifying medical expenses submitted after the annual maximum is met are shareable with the ClearShare community at one hundred percent. You are only responsible for the annual maximum once each plan year based on your effective date. There is no annual or lifetime limit.
Service copays are not included in the annual maximum. For members who are also part of an HSA MEC, service-related costs that apply to the member’s deductible are not part of the annual maximum.
Advanced + ClearShare, Basic + ClearShare, and HSA + ClearShare plans all include minimum essential coverage (MEC) and meet the individual mandate requirement.
ClearShare-only memberships do not contain a MEC, are not insurance, and do not meet the individual mandate requirement.
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 firstname.lastname@example.org.
No, a referral is not needed. However, we do recommend making sure your provider is in-network.
Yes! Preventive services are covered on our Advanced + ClearShare, Basic + ClearShare, and HSA + ClearShare plans. To learn about the services covered within your specific plan, visit this website.
Needs that arise from conditions that existed prior to membership are only shareable if the condition was regarded as cured and did not require treatment for 12 months prior to the effective date of membership. Any illness or injury for which a person has been examined, taken medication, had a diagnostic test performed or ordered by a physician, or received medical treatment is considered a pre-membership medical condition.
High blood pressure, high cholesterol, and diabetes (types 1 and 2) will not be considered pre-membership medical conditions as long as the member has not been hospitalized for the condition in the 12 months prior to enrollment and is able to control it through medication and/or diet.
Cancer, Heart Disease, Stroke, and COPD are only shareable if the condition was regarded as cured and did not require treatment for 5 years prior to the effective date of membership.
If you think you may have a pre-membership medical condition, we encourage you to schedule 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-membership condition doesn’t mean you can’t enroll in Clearwater, but further information will be required to determine whether a plan is a good fit for you.
If you think you have a pre-membership medical condition, we recommend booking a 1:1 consultation with one of our Expert Benefit Consultants.
Pre-membership medical 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-membership medical conditions are shareable. After the first year, pre-membership medical condition needs are eligible for sharing on a limited basis, with the amount increasing each membership year.
Shareable amount for pre-membership medical conditions:
After year four of membership, expenses related to pre-membership medical conditions will remain shareable at a maximum of $125,000 in a 12-month rolling period and resetting each membership year.
The healthshare part of your plan handles major accidents, procedures, or ER visits. If you have a major procedure you are going to schedule, please contact us at email@example.com or (877) 405-2926. For any accident or ER visits you will want to save your bills and open a needs request through ClearShare. You have 60 days to open a needs request from the original date of service.
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.
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 to find a provider outside of the PHCS Specific Services network, go to the PNOAe network website. Select the “PNOAe (Exclusive) Network” option.
If you make a mistake on your enrollment for, contact firstname.lastname@example.org. Our concierge team would be happy to help you with any concern or issue you may be experiencing.
To cancel your plan, contact email@example.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.
For day to day coverage, claims are submitted through your provider. If your provider cannot, or will not, submit a claim directly to us, please contact firstname.lastname@example.org.
If you have an ER visit, major procedure, or accident you will need to open a needs request through ClearShare and submit your bills.