FAQ &
Video Learning
Welcome to the FAQ and Video Learning Page!
You will find answers to common questions and informative videos to help you understand Align’s healthcare programs
Welcome to the FAQ and Video Learning Page!
You will find answers to common questions and informative videos to help you understand Align’s healthcare programs
Yes. Providers are usually board-certified physicians. In some instances, a practice may offer a nurse practitioner (NP) or physician’s assistant (PA)
In an emergency or life threatening situation, seek a hospital or call for an ambulance. In most cases, your Direct Primary Care or Virtual Primary Care should be accessible virtually or via text or email to help advocate, navigate and coordinate care. If needed, the Medical Cost Share program would kick in once the member pays their Initial Unshareable Amount (IUA) coordinating with Zion Health using their customer service.
No. Typically membership rates do not change with DPC unless a provider re-negotiates their contract for some unexpected reason. Members would be notified in the event this occurs.
No. At this time, DPCs are not recognized by IRS to be paid with pre-tax or HSA payments.
No. Plans are NOT insurance and do not qualify for the employer tax credits. For information regarding tax credits, please consult with a tax professional.
Our programs do not accept members 65+ however, some DPCs standalone may allow for 65+. Members would need to check with individual providers to identify.
Not unless combined with a qualified Minimum Essential Coverage (MEC) plan. Associations and groups may qualify for our MEC options. Individuals are not allowed on our MEC plans.
The Network Plus+ Plan is compliant with Part A of the Affordable Care Act and The Minimum Value Plan (MVP) is compliant with Part B of the Affordable Care Act.
Yes. Please refer to the business or group solutions at www.alignhealthpartners.com.
Yes. We have 1-888 numbers and help desks for member convenience.
You will find Information Cards with all the important information you need to use your plan in your Member Portal.
There is no “open enrollment” since these are month to month programs.
Termination can be done at anytime up till the 20th of the month at midnight just like enrollment.
This is a high-functioning healthcare plan as an alternative to traditional insurance.
The Basic, Virtual/Virtual Plus+, and Direct/Direct Plus+ plans are available to individuals and families. Visit the individuals and family plans page for plan information.
We currently have Dental and Vision plans available for Businesses and Trade Organizations and Associations. They must be coupled with an Align Health Plan. We do not have Dental or Vision plans available to individuals or families at this time.
Visit the Dental and Vision page for more information.
VPC is a new genre of primary care. Members enjoy a healthcare with the same board-certified physician with cost-effective care conveniently delivered online via a secure, HIPAA-compliant mobile and web app.
Understanding VPC: Video – Understanding VPC
Member Intro: Akos_VPC_Member_Introduction on Vimeo
Direct Plans are considered in person primary care where Virtual plans are web or mobile primary care visits. Most Direct plan physicians offer both “hands on” and virtual services.
Virtual primary care providers often refer to “fee for service” doctors near members’ needs when required at discounted direct pay (cash pay) rates. Members also submit medical needs to be paid through their Medical Cost Sharing plan once they have paid their Initial unshareable Amount (IUA).
Our partner, Akos MD is a revolutionary telemedicine company providing patients virtual access to board-certified physicians 24/7/365. Simply access thru your smartphone or tablet and you can have a virtual consultation with your care navigator or physician in minutes.
Confidentiality is a top priority for Akos MD national providers. Our app has been designed on a HIPAA-compliant platform so you can rest assured your information is securely and privately stored.
Each of our physicians undergo a rigorous credentialing process based upon guidelines set by the National Committee for Quality Assurance (NCQA). All physicians in the Akos Preferred Provider Network are board-certified, licensed and credentialed. All Akos physicians have completed our Akos comprehensive training program.
Yes, upon enrollment you will be assigned a board-certified physician licensed in your state along with a care navigator for proper coordination of care.
When medically necessary, Akos physicians are able to prescribe a wide range of medications to treat your condition. Akos physicians do not prescribe or renew a prescription for controlled substances regulated by the U.S. Drug Enforcement Agency that have been designated as U.S. controlled substances.
If our physician determines a medication is medically necessary, they can write a prescription for non-controlled medications which will be sent electronically to the pharmacy of your choice.
Our Basic, Virtual, and Virtual Plus+ Programs are Virtual plans.
The Basic plan does not include Worldwide emergency, surgery/specialist, and hospitalization cost protection, but both the Virtual / Virtual Plus+ plans do. The Virtual Plus+ includes the added on features of mammogram, colonoscopy, immunizations up to age 16, and one external visit per year.
In the United States, direct primary care (DPC) is a subscription membership type of primary care service, billing and payment arrangement made between patients and medical providers, without sending claims to insurance providers.
Understanding DPC: What is Direct Primary Care?– YouTube
Understanding Align’s DPC Program: Understanding Aligns’ Direct Primary Care Program – YouTube
No. Membership is not insurance. Align provides a healthcare membership based on the direct primary care (DPC) payment model – an innovative alternative payment model that consists of a flat and affordable membership fee. This membership provides unlimited access to primary care services.
The Align Health Advantage: HEP’s Self-Insured Advantage – YouTube
No. However, a few select providers may limit or cap the number of annual visits per member. New members should check the provider notes upon enrollment to confirm.
No. Members can select from our national directory where contracted providers are located. Also, if members have an existing primary care provider interested in working with our program, we can arrange to contract with them.
Direct primary care providers accept members regardless of any pre-existing conditions.
DPCs often coordinate care and refer to specialists when needed. No network required allowing members freedom to choose any specialist desired worldwide. This allows members to utilize their Medical Cost Sharing program once they have paid their initial unshareable amount (IUA) – (See Medical Cost Sharing)
Yes. With our Silver and Gold Plans combining the Medical Cost Sharing benefit which pays for medical needs once a member has paid their Initial Unshareable Amount (IUA).
Some DPCs offer x-ray in-house where others refer or recommend local arrangements at significant discounts. Members with Medical Cost Share program may choose to submit for payment if more than their Initial Unshareable Amount (IUA).
Our programs have partnered with Quest Diagnostics thru Akos MD to offer a significant direct pay national discount. Members would just need reference their lab benefit ID or contact Akos MD to coordinate discount at point of service.
Yes. The Network Plus+ Plan meets the Part A Tax requirements and the Minimum Value Plan – MVP meets the Part B Tax requirements of the Affordable Care Act (ACA). Companies offering both the Network Plus+ and Minimum Value Plans are 100% compliant with the ACA.
The Network Plus+ plan requires at least 2 employees be enrolled. The Minimum Value Plan – MVP requires a business employs a minimum of 50 employees.
Plans provide 100% coverage for preventative services as outlined by the Affordable Care Act and shown on healthcare.gov. No copays, deductibles, or other out-of-pocket costs.
Yes. Plans include telemedicine membership with access to a physician 24/7.
The is a provider network for the Network Plus+ Plan through PHCS/Multiplan national PPO network of doctors. You can search for a provider at www.muliplan.com or call 800-922-4362. The Minimum Value Plan is network free but subject to reference based pricing.
Reference based pricing in healthcare is a model that pays claims based on an established benchmark rather than based on a carrier-determined fee. This means employers’ health care costs are set based on reference prices, not arbitrary markups from carriers.
A membership-based non-insurance arrangement established for the purpose of sharing legitimate healthcare expenses between members.
Understanding Medical Cost Sharing: Zion Health Introduction on Vimeo
Intro Slide: Resources | Zion Health | Medical Cost Sharing
The Virtual, Virtual Plus+, Direct, and Direct Plus+, and Network Plus+ plans have medical cost-sharing protection.
IUA is the amount paid by the Member before the Zion Health community shares in Medical Expenses. This amount is also known as your personal responsibility. Zion Health has three primary levels of personal responsibility. $1,000, $2,500 and $5,000. The lower the Initial Unshareable Amount, the higher the monthly sharing contributions.
Understanding the IUA: IUA 01 – How the IUA Works on Vimeo
Benefits of the IUA: IUA 02 – Why You Benefit From IUAs.mp4 on Vimeo
Member households that experience multiple needs within a 12-month rolling membership year are asked to pay up to three Initial Unshareable Amounts per year. Additional needs that meet a $500 threshold would be considered fully shareable with the Zion Health community.
Members may choose to change their IUA once per membership year. If an IUA is lowered, a 60-day waiting period will apply to all needs other than those resulting from an accident.
Pre-existing conditions have a waiting or phase in period. Zion Health attempts to negotiate all medical bills received and many membership types include the PHCS network for pre-negotiated medical expenses.
Zion Health recognizes that every situation is different. Zion Health reserves the right to make exceptions for certain medical conditions on a case-by-case basis provided it serves to benefit the membership as a whole. Exceptions for high blood pressure, high cholesterol and diabetes (type 1&2) will not be considered a pre-existing condition as long as they have not been hospitalized for the condition in the past 12 months and able to control through edication or diet.
No. This is not an insurance plan and is not compliant with the ACA.
Medical need requests should be submitted through the Member Portal or Zion HealthShare website. Need requests should be submitted as soon as possible. Most non-emergency need requests, such as surgical procedures, should be submitted prior to the date of service. For any help with this process, members may contact Zion HealthShare directly
during business hours.
• Phone 888-920-9466
• Email needs@zionhealth.org
Contact the Medical Advocacy team for early sharing requests. The Medical Advocacy Service is complimentary to all Zion HealthShare members. Our team of experts is here to help you find quality providers and facilities. We can even schedule appointments, help members obtain self-pay discounts, and pay ahead of time for eligible expenses.
Contact the Medical Advocacy team:
• Phone 888-399-0017
• Email advocacy@zionhealth.org
Processing a Need: Zion Health and Member Needs on Vimeo
Typically, eligible reimbursement is made to Members or payment to the providers from the Benevolent Fund is completed within 5-7 days once all documentation has been received.
There are no lifetime or annual maximum amounts eligible for sharing for most medical needs. There is no limit on the number of needs that an individual Member or household may have.
Ambulance transports are shareable as part of a need when they are required in relation to a specific shareable illness or injury.
Emergency room visits are generally shareable separately or in conjunction with an eligible medical need related to an illness, injury, or accident. The first ER visit for a medical condition is treated as a normal need. Each additional visit related to the same condition requires the member to take on a personal responsibility of $500 in addition to the member’s IUA.
Members with nonemergency needs should seek out other treatment options such as doctor visits, telemedicine, urgent care clinics, or other appropriate care. Seeking proper nonemergency care reduces emergency room visits and the financial strain on the entire community.
As with any other medical need, expectant mothers pay a single IUA for all expenses related to their maternity need. Shareable expenses may be related to miscarriage, prenatal care, postnatal care, and delivery. STD screenings prescribed by a licensed practitioner as part of routine prenatal care are shareable as part of the maternity need.
Pregnancy is considered a pre-membership medical condition if conception occurs within the first 60 days of the membership. Zion Health requires notes from the first provider visit in order to verify the conception date.
Long-term care and skilled nursing are shareable when prescribed by a licensed medical provider for recovery from a shareable injury or illness. Sharing for these services is limited to 90 days per medical need.
Member households that experience multiple needs will be responsible for up to three IUAs within a rolling 12-month period. After a member has paid three IUAs in a twelve-month period, any additional shareable needs of $500 or more will be shared with the Zion Health community at one hundred percent.
Not at this time. Only Associations or Businesses are eligible to add on Dental or Vision plans.
Plans must be coupled with an Align Health Plan. Businesses with up to 10 eligible members and at least 2 enrollees are eligible.
No network requirements. You are free to choose any licensed provider
Yes. The dental network of providers can be found www.ppousa.com
No. There is not waiting period, so you can access your benefits on day 1.
Align Health has a single sign-on portal which handles onboarding and enrollment, resulting in a seamless, user-friendly member and provider experience.
Interested in Align 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.