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Your monthly cost is the amount you pay for healthcare benefits each month.
This is the most you'll have to pay for expensive healthcare services during your plan year.
All qualifying medical expenses submitted after the Annual Maximum is met are shareable with the ClearShare community at 100%. There is no annual or lifetime limit. You will not need to pay the Annual Maximum again until the new plan year begins. Additionally, you are only responsible for the Annual Maximum once each plan year.
Family Annual Maximum
If you have family members on the plan, they have to meet their own Annual Max until the overall Family Annual Max has been met. Once the household has paid up to its Family Annual Max, the ClearShare community will share in eligible medical expenses at 100%.
Member + Spouse: $7500
Member + Children: $7500
Member + Family: $10000
Note: Monthly member fees and member responsibility costs for office visits, labs, and other tests do not count towards your Annual Max.
This type of network is designed to give you the widest number of options for medical providers.
To find a list of providers, 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.
For expensive and emergency services, members have no network restrictions and can receive care anywhere. This includes major procedures, accidents, surgeries, ER, and hospital visits.
You can get a policy that pays you a fixed amount in the event of a Critical Illness, regardless of what your medical bills are. This will help with your Annual Maximum payment and other non-medical costs due to this Critical Illness including loss of work, extra child care or anything you want to use it for.
You can get a policy that pays you a fixed amount in the case of an accident to help pay your Annual Max or other costs related to an accident. This fixed amount varies by the medical service you receive related to the accident. You may use this amount for any use you deem appropriate.
Members who select our HSA Plan use their personal health savings account to pay for day-to-day needs like doctors. For preventive care visits, such as annual checkups, visits are free.
In Network
Out of Network
There are dozens of preventive care services available for free with every plan, including check-ups, counseling, screenings, and immunizations. These services are government mandated. To learn more, scroll down to the Free Preventive Care section below.
Primary care visits are appointments with your primary care provider to look at symptoms, sickness, or injuries. This is different from preventive care visits - regular checkups or screenings are always free.
*After you hit your plan deductible ($3,000 for individuals and $6,000 for families), then there is a $35 copay.
A specialist is a medical professional who specializes in a condition or area of the body. For example, a dermatologist (skin), cardiologist (heart), neurologist (brain), or oncologist (cancer).
Referrals are not needed to see specialists.
*After you hit your plan deductible ($3,000 for individuals and $6,000 for families), then there is a $60 copay.
An urgent care center can be a convenient option if you have a non-life-threatening injury and your doctor is not available.
Urgent care is usually less expensive than going to the Emergency Room, and will usually have shorter wait times for non-life-threatening injuries.
Prescription coverage is based on which category a drug falls into. Members who select our HSA Plan use their personal health savings account to pay for prescriptions. To see how this plan categorizes prescriptions, browse its drug formulary.
In Network
Out of Network
A generic drug is identical to the brand name drug in form, safety, strength, quality and intended use. Although identical, generic drugs are substantially cheaper than their brand name counterparts.
Brand drugs are more expensive than generic drugs. Not every brand drug has a generic equivalent.
Generally these are higher-cost drug that have recently come on the market. In most cases, an alternative preferred drug is available.
A specialty drug is a high-cost medication used to treat a chronic or complex health condition.
These are tests your doctor may run when diagnosing a condition. Members who select our HSA Plan use their personal health savings account to pay for diagnostics.
In Network
Out of Network
This includes the use of X-rays to diagnose a condition.
Imaging includes diagnostic services such at CT scans, PET scans, and MRIs.
Blood tests are often used to help diagnose a condition, or check levels such as cholesterol or blood sugar.
*After you hit your plan deductible ($3,000 for individuals and $6,000 for families), then there is a $10 copay.
ClearShare shares in eligible emergency & hospital services. These medical services may include, but are not limited to major procedures, accidents, surgeries, ER, and hospital visits. For details about eligible medical expenses and limitations that may apply, please review the ClearShare Member Guidelines.
In Network
Out of Network
This includes services to check for an emergency medical condition* and treatment to keep it from getting worse. These emergency services may be provided in any licensed hospital’s emergency room or another place that provides care for emergency medical conditions.
*An emergency medical condition is defined as an illness, injury, symptom (including severe pain), or condition severe enough to risk serious danger to your health if you didn't get medical attention right away.
This covers emergency transportation and off-site treatment for emergency medical conditions* and may also cover non-emergency transportation between hospitals.
*An emergency medical condition is defined as an illness, injury, symptom (including severe pain), or condition severe enough to risk serious danger to your health if you didn't get medical attention right away.
This is the amount you’re responsible for when using the facilities and equipment at a hospital.
This is the amount you’re responsible for when receiving services provided by a physician, surgeon, medical doctor, or other specialists.
This is the amount you’re responsible for when using the equipment and facilities at a hospital.
Specifically, during a procedure that does not require overnight hospitalization.
This includes physical, occupational, and speech therapies.
Physical and occupational therapy are shareable for inpatient treatment and up to 35 outpatient sessions per need, up to $7,500 each. Physical and occupational therapy must be prescribed by a licensed medical provider to be shareable.
Speech therapy in relation to a shareable illness, injury, or accident is shareable for 35 outpatient visits per condition, up to $3,000. Speech therapy for conditions such as speech delays or learning impairments not caused by injury or accident is not shareable. Speech therapy must be prescribed by a licensed medical provider to be shareable.
We partner with Talkspace to offer private and convenient mental health support. With Talkspace, you can receive counseling, therapy, and medication services from the convenience of your device (iOS, Android, and Web).
Talkspace is a digital space for private and convenient mental health support. With Talkspace, you are matched with a recommended, licensed provider based on your preferences and can receive support day and night from the convenience of your device (iOS, Android, and Web). You will continue to work with the same therapist throughout your journey. However, you’re always welcome to switch providers so you can find the perfect fit.
Talkspace Therapy is available to members ages 13+.
With Talkspace Psychiatry, get private and personalized care from a prescriber who specializes in mental health care and prescription management. Get matched with a prescriber in your state, and schedule Live Video sessions for everything from initial evaluation to ongoing prescription management.
Talkspace Psychiatry is available to members ages 18+.
Members can begin to exchange unlimited messages (text, voice, photo and video) with their personal therapist within days of registration. Therapists are recommended to engage daily during their business hours. Every Talkspace member is granted a complimentary, 10-minute video session to get to know their new therapist. Additional live sessions can also be scheduled.
Talkspace Therapy is available to members ages 13+.
This membership shares in services provided before and after your child is born. Conception that occurs prior to membership or within the first 60 days of membership is eligible for sharing, but with a $50,000 limit.
In Network
Out of Network
There are dozens of preventive care services available for free with every plan, including check-ups, counseling, screenings, and immunizations. These services are government mandated. To learn more, scroll down to the Free Preventive Care section below.
This includes labor, delivery (including c-section), and any recovery needed at a hospital. Newborns whose birth is part of a shareable maternity need must be enrolled by the parent within 30 days of birth.
The Accident supplemental benefit pays up to the scheduled maximum amount, after the deductible, for medical charges resulting from a covered accident. Benefits are paid directly to the primary member.
Includes general nursing care, up to the semi-private room rate.
Includes hospital miscellaneous expense during hospital confinement or for outpatient
surgery under general anesthetic, such as the cost of the operating room, laboratory tests, x-ray examinations, anesthesia, drugs (excluding take-home drugs) or medicines, therapeutic services and supplies.
Includes inpatient and outpatient; limited to 2x per covered individual per accident.
Limited to 10x per covered individual per accident
Based on actual expenses in addition to emergency room, physical therapy, imaging, ambulance, physician visits and follow-ups.
Critical Illness supplemental benefit provides additional coverage for medical emergencies like heart attack, stroke, invasive cancer or ESRD. Critical Illness will pay a lump sum benefit as shown in the schedule upon the first diagnosis of a covered condition for each incident (including reoccurrence). Benefits are paid directly to the primary member and can be used however they choose. Covered spouses receive 100% of the benefit amount and covered children receive 50% of the benefit amount.
Amount Paid
Lump Sum You Get
A 30-day waiting period applies.
All plans include membership with telemedicine, providing unlimited access to a physician 24/7 with no cost for general medical visits.
Our physicians are available 24/7 for your family. Speak with a physician for conditions like the flu, pink eye, rashes, and much more.
Every plan includes over 74 preventive care services that are completely free on day one. These services keep you healthy before you become sick, including routine check-ups, counseling, screenings, and immunizations. For information on services covered click here.
NOTICE: ClearShare is not insurance or an insurance policy nor is it offered through an insurance company. Neither is ClearShare a discount healthcare program nor a discount health card program. Whether anyone chooses to assist you with your medical bills will be totally voluntary, as neither ClearShare nor any other member is liable for or may be compelled to make the payment of your medical bill. As such, ClearShare should never be considered as insurance. Whether you receive any amounts for medical expenses and whether or not ClearShare continues to operate, you are always personally responsible for the payment of your own medical bills. ClearShare is not subject to the regulatory requirements or consumer protections of your particular State’s Insurance Code or Statutes.
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For support email us at planhelp@clearwatersavings.com
2022 Clearwater Benefits. All Rights Reserved.