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
The Virtual Primary Care Plan is not ACA Compliant.
The Unlimited Open Network Plan is compliant with Part A of the Affordable Care Act and the Bronze PPO MVP is compliant with Part A and B of the Affordable Care Act.
There is no “open enrollment” since these are month to month programs. If you enroll by the 20th, you will be eligible for benefits the 1st of the following month.
Yes. We have 1-888 numbers and a help desk to assist members in navigating their care.
You will find Information Cards with all the important information you need to use your plan in your Member Portal.
Termination can be done at anytime up till the 20th of the month at midnight just like enrollment.
Our member-focused affordable healthcare plans are an excellent alternative to traditional insurance.
The Virtual Plan is available for Individuals/Families.
We currently have Dental and Vision plans available for Businesses and Trade Organizations and Associations with at least 10 eligible members. 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.
In an emergency or life threatening situation, seek a hospital or call for an ambulance. In most cases, your 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 will share into acute medical costs incurred outside the Unite States once the member pays their Initial Unshareable Amount (IUA) coordinating with Zion HealthShare using their customer service.
Our programs do not accept members 65+.
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
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.
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 HealthShare Introduction on Vimeo
The Virtual and Unlimited Open Network plans have medical cost-sharing.
IUA is the amount a member will pay per sharing request before the Zion HealthShare community shares in eligible medical expenses. This amount is also known as your personal responsibility. Zion HealthShare 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
We provide a safeguard for households that experience more than three (3) sharing requests in a rolling 12-month period. Each household membership will only be responsible for three (3) IUAs in a rolling 12-month period beginning on the date the member submits the verified IUA. If a household has paid three (3) IUAs in a rolling 12-month period, any additional eligible sharing requests exceeding $500 will be shared with no IUA responsibility.
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-membership conditions have a waiting or phase in period.
No. This is not an insurance plan and is not compliant with the ACA.
Sharing requests should be submitted through the Member Portal or Zion HealthShare website. Sharing requests should be submitted as soon as possible but no later than six months of the date of service. Most non-emergency sharing 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@zionhealtshare.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 the highest care for all your sharing requests. Use the Medical Advocacy service to find fair priced providers and pay for your service or procedure ahead of time. 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@zionhealthshare.org
Processing a Sharing Request: Zion Health and Member Sharing Requests on Vimeo
Typically, eligible reimbursement is made to Members or payment to the providers from the Zion HealthShare Community 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 eligible sharing requests. There is no limit on the number of sharing requests that an individual Member or household may have.
Medical transportation, including air and ground, is eligible for sharing when it is required in relation to a specific shareable illness or injury. Every effort should be made to be transported to the closest appropriate facility.
Emergency room visits are generally shareable separately or in conjunction with an eligible sharing request related to an illness, injury, or accident. The first ER visit for a medical condition is treated as a normal request. 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 sharing request, expectant mothers pay a single IUA for all expenses related to their maternity sharing request. 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 not shareable if conception occurs before the membership start date. Maternity sharing requests must be submitted no later than 6 months after pregnancy confirmation at your initial provider visit.
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 sharing request.
Member households that experience multiple sharing requests 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 eligible sharing requests of $500 or more will be shared with the Zion HealthShare community.
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.