GMT20231024-165659_Recording.transcript (1).PDF

WEBVTT 1 00:00:07.700 --> 00:00:14.919 Amanda Sohaney: So welcome everyone. Thank you so much for taking time out of your busy day to join me here today for this training. 2 00:00:15.210 --> 00:00:24.799 Amanda Sohaney: And I'm gonna start kind of slow, as I attempt to admit people to the room and a...

WEBVTT 1 00:00:07.700 --> 00:00:14.919 Amanda Sohaney: So welcome everyone. Thank you so much for taking time out of your busy day to join me here today for this training. 2 00:00:15.210 --> 00:00:24.799 Amanda Sohaney: And I'm gonna start kind of slow, as I attempt to admit people to the room and also go through this presentation at the same time. So this is part one of 3. 3 00:00:26.940 --> 00:00:52.709 Amanda Sohaney: Please hold all questions until the end. Some of the questions that come up I might be answering later in the presentation. Do write them down as we go, so that you don't forget. Anna. There will be a test. We're gonna release it around October thirtieth. It is open note. It's just a knowledge check. You don't need to panic about it. It's not gonna be super hard. It's just meant to kind of solidify the knowledge that we're going over here with 3 days worth of training. 4 00:00:54.670 --> 00:00:57.100 Amanda Sohaney: So say, we're going over the company overview 5 00:00:57.160 --> 00:01:04.020 Amanda Sohaney: health share 101 clear share plans, care, coordination for clear share and virtual services. 6 00:01:06.610 --> 00:01:11.149 Amanda Sohaney: So, starting with our company overview, who is who in the ecosystem. 7 00:01:12.660 --> 00:01:14.579 Amanda Sohaney: So here's our corporate org chart. 8 00:01:14.670 --> 00:01:25.510 Amanda Sohaney: Clearwater benefits holdings is the Holdings company that holds together our brokerage arm and our administrative arm. This entity houses shared services like finance technology and marketing 9 00:01:26.300 --> 00:01:42.069 Amanda Sohaney: Clearwater. The agency does the selling. It's the broker for clear share memberships and insurance plans. Through trident. Clearwater also sells a variety of other insurance products, such as plans on healthcare. Gov. Rec. Point supplementals and Manhattan life supplementals 10 00:01:42.970 --> 00:01:48.869 Amanda Sohaney: Clearwater benefits administrators is the administrator for clear share as well as trident, self-funded mech 11 00:01:49.090 --> 00:01:58.969 Amanda Sohaney: major medical dental and vision plans. Administrative work includes customer service plan, design, billing and paying claims and needs 12 00:02:00.100 --> 00:02:10.349 Amanda Sohaney: in the ecosystem are also trident and clearshare. Trident has a company that provides virtual assistance services and clearshare is a nonprofit healthcare sharing ministry. 13 00:02:12.670 --> 00:02:15.960 Amanda Sohaney: So try it in clear share. But the money behind the plans 14 00:02:16.080 --> 00:02:31.099 Amanda Sohaney: members must first become limited partners with Trident, and then they have access to Trident's employer sponsored benefits. This is similar to how you might get a job at a company. You would be considered A. W. 2 or full time employee, and then you become eligible for employer. Sponsored benefits 15 00:02:31.830 --> 00:02:36.399 Amanda Sohaney: and or members can sign up for clear share, which is a healthcare sharing ministry. 16 00:02:38.770 --> 00:02:53.729 Amanda Sohaney: Clichare plans cover 2 forms, merge plans which offer some day to day coverage, like doctor visits and clear share only, which is like a catastrophic plan, which only covers, only offers coverage for the big stuff, like hospital visits and surgeries 17 00:02:55.000 --> 00:03:09.200 Amanda Sohaney: clear share. Only plans are often paired with a trident met plan. These plans look and feel like the clear share merge plans. Their names are even the same, and the coverages are similar. There's a couple of key differences, mostly on the back end. And we're gonna review those later on. 18 00:03:11.840 --> 00:03:18.219 Amanda Sohaney: But here's a fun chart to break it down. So our role is Clearwater. We're selling the plans, and we do the administration. 19 00:03:18.330 --> 00:03:25.430 Amanda Sohaney: And just a reminder I will be sending out these slides, so don't feel like you need to review this and memorize it right now, you will have access to it later. 20 00:03:25.730 --> 00:03:38.719 Amanda Sohaney: So, Clearwater. The agency is the broker that sells the plants. Clearwater benefits administrators. The Tpa is doing administration. I have a couple notes here that Hma, another Tpa also assists us a lot with this 21 00:03:39.680 --> 00:03:50.420 Amanda Sohaney: Triton's role is the employer of all the insurance products, and you'll see that next to clear share memberships, Trident has a big red and done trident does not have any role in clear share 22 00:03:50.870 --> 00:03:56.829 Amanda Sohaney: and then clear share's role, no role in the insurance products but offers those clear share memberships. 23 00:03:59.320 --> 00:04:06.840 Amanda Sohaney: And here are some additional resources. Again. You'll be able to click on these when you see the slides. If you want to explore these this information a little bit more. 24 00:04:08.660 --> 00:04:14.169 Amanda Sohaney: So now let's dive into health, share 1 one. What's a health share? And how is it different from insurance? 25 00:04:16.140 --> 00:04:26.430 Amanda Sohaney: So health share also called medical cost sharing, or a healthcare sharing ministry provides an organized structure for a community of like-minded members to contribute towards each other's medical costs. 26 00:04:26.580 --> 00:04:43.930 Amanda Sohaney: They're not for profit organizations in which members agree to abide by a commonly shared code of conduct to help keep the overall care costs for the community down. Health shares are not insurance, health shares are not bound by State or Federal government, laws and regulations around insurance. 27 00:04:47.550 --> 00:04:51.789 Amanda Sohaney: So how share compared to health insurance is like comparing apples and oranges. 28 00:04:52.080 --> 00:05:01.290 Amanda Sohaney: apples and oranges have similar health benefits. They can prevent many of the same diseases. They're both high in fiber vitamins and minerals, but the exact nutritional content varies. 29 00:05:01.790 --> 00:05:10.350 Amanda Sohaney: So imagine you're going to a farmer's market to buy oranges, because you're looking for a sweet and healthy snack. You go up to a stand and you ask them where the oranges are 30 00:05:10.600 --> 00:05:19.430 Amanda Sohaney: so in scenario one. They've actually painted their apples to look like oranges because they heard that oranges sell better. But this farmer only grows apples. 31 00:05:19.630 --> 00:05:32.889 Amanda Sohaney: They hired an artist for this. So they look really realistic, because that is this cake trend. So you buy the painted apples, thinking that they're oranges. You go home and then try to eat one, and expecting an orange. You are shocked that it's not an orange. 32 00:05:33.260 --> 00:05:44.299 Amanda Sohaney: You actually do like apples, and would enjoy this fruit under other circumstances. But this produce stand is lying to you, so you blast them on social media. You leave bad reviews, and you boycott boycott them for life 33 00:05:45.030 --> 00:05:57.400 Amanda Sohaney: in scenario 2. You've asked for the oranges. The produce stand tells you that they don't have any oranges, but they actually have apples, which are also a sweet and healthy snack, and they're a dollar less than the oranges at the produce stand next door. 34 00:05:57.660 --> 00:06:13.589 Amanda Sohaney: Groceries are expensive these days, so you say, wow! That is great. I do love apples. You buy the apples, and then you joy. You enjoy the sweet and healthy snack that you were looking for, and you spend your savings on a fancy coffee for yourself. This is now your favorite produce. Stand, and you tell all your friends about it 35 00:06:15.770 --> 00:06:30.870 Amanda Sohaney: so like apples and oranges, health shares, insurance and insurance are similar, but not the same. Health share and insurance are both solutions to the same problem, paying for medical expenses. They can cover many of the same things, but the exact coverage will vary. 36 00:06:31.000 --> 00:06:38.429 Amanda Sohaney: Health insurance is is required by law to cover certain things be licensed in certain ways and operate in certain ways. 37 00:06:38.460 --> 00:06:42.110 Amanda Sohaney: Health shares basically come up with their own rules and govern themselves. 38 00:06:42.640 --> 00:06:54.990 Amanda Sohaney: And just like, if you tried to trick someone into thinking they're buying an orange, and then it turns out to be an apple. If you sell someone else share and pretend it's insurance. They will be shocked and upset when it doesn't work, how they expect it will work. 39 00:06:55.540 --> 00:07:06.529 Amanda Sohaney: But, on the other hand, you educate someone and make them aware of these differences, and not try to fool them into buying or thinking they have something they don't. Then they'll better understand and know how to navigate the situation better. 40 00:07:07.230 --> 00:07:09.490 Amanda Sohaney: So very simplified example. Here 41 00:07:09.800 --> 00:07:35.139 Amanda Sohaney: a member goes to the hospital, and in scenario one they think they have insurance. They hand over their id card. The provider thinks that they don't take this quote insurance and tells that to the member the member thinks they aren't covered thinks they're stuck with a huge bill. The member calls us yells at us. They want to cancel. They leave reviews that were a scam. We end up on the phone with a provider's office for 10 h, attempting to get all the right paperwork, and everyone is upset 42 00:07:36.160 --> 00:07:46.089 Amanda Sohaney: in scenario 2. The member knows that they have a health share and knows that they need to read their Id card for instructions, because this isn't going to work quite like they're used to. 43 00:07:46.130 --> 00:07:50.240 Amanda Sohaney: They know they have to tell their provider they're a cash, pay patient and get a super bill. 44 00:07:50.280 --> 00:07:54.450 Amanda Sohaney: Then they open their knee requests online and their expenses process 45 00:07:54.540 --> 00:08:02.450 Amanda Sohaney: in a timely manner. The member loves us, leaves us a great review, tells all their friends, and goes on a vacation with their monthly cost savings. 46 00:08:02.700 --> 00:08:12.619 Amanda Sohaney: So, in conclusion, it's extremely important to understand that health shares and health insurance are not the same, and under no circumstances should they be presented as the same. 47 00:08:16.350 --> 00:08:20.980 Amanda Sohaney: so to help differentiate between health share and insurance. We use different terminology. 48 00:08:22.340 --> 00:08:35.580 Amanda Sohaney: Insurance term should never be used around health share. So for healthcare, we say we have means and insurance. You have claims for health share, we share a needs, we arrange cost, sharing and insurance. We pay claims. 49 00:08:35.970 --> 00:08:41.550 Amanda Sohaney: health shares, have monthly costs or monthly contributions, insurance plans have premiums. 50 00:08:42.260 --> 00:08:55.259 Amanda Sohaney: our health share clear share has an annual Max which is similar to a deductible, which is an insurance term. and instead of Copay we use terms like visit, fee or member cost or patient responsibility. 51 00:08:58.450 --> 00:09:05.470 Amanda Sohaney: So just a reminder to please hold all your questions until the end. And now we are going to dive into clearshare memberships. 52 00:09:08.910 --> 00:09:15.260 Amanda Sohaney: The Clear share membership. So reminder. Clearwater is a broker and an administrator for clear share memberships. 53 00:09:16.540 --> 00:09:29.119 Amanda Sohaney: We typically sell clear share memberships is 4 types. People can pick their day to day coverage in the form of advanced basic or Hsa, or they can choose no day to day coverage as a clear share, only membership. 54 00:09:29.910 --> 00:09:36.189 Amanda Sohaney: So first, we're going to talk about the clear share membership with no day-to-day coverage. This is known as clear share only. 55 00:09:37.290 --> 00:09:43.900 Amanda Sohaney: So recall the plan overview from the beginning of this presentation. We're about to review those clear share. Only memberships 56 00:09:46.210 --> 00:09:55.339 Amanda Sohaney: so clear share only memberships are governed by the member guidelines. You can find them on the clearshare website, clearsharehouse.org slash member guidelines. 57 00:09:55.630 --> 00:10:00.980 Amanda Sohaney: And I have a bunch of additional resources here. So when you get these slides feel free to click around. 58 00:10:03.860 --> 00:10:17.160 Amanda Sohaney: So to join clear share you have to adhere to the clear share statement of beliefs, and you participate in the community by paying. So these are the statements of beliefs that everyone agrees to when they join clear share. 59 00:10:19.640 --> 00:10:32.590 Amanda Sohaney: We have a couple of enrollment and requirements. So age caps, primary members have to be at least 18 years old. All members have to be under 65 years old. Independence can be on a parent's plan until they turn 26. 60 00:10:33.210 --> 00:10:37.710 Amanda Sohaney: We have 4 membership tiers member only member plus spouse 61 00:10:37.780 --> 00:10:45.260 Amanda Sohaney: member plus a child or any number of children, and then member plus family, which is the member spouse and any dependent children. 62 00:10:46.360 --> 00:10:53.350 Amanda Sohaney: Clear share also has a tobacco surcharge of $50 per household. If you have a tobacco user on the plan. 63 00:10:56.820 --> 00:10:58.410 Amanda Sohaney: how needs are shared. 64 00:10:59.210 --> 00:11:28.639 Amanda Sohaney: So the determination of a need medical needs are submitted on a per member per need basis. Medical needs may be injuries or illnesses that result in medical expenses. These medical expenses may be incurred by receiving medically necessary treatment from licensed medical professionals and facilities like physicians, emergency rooms and hospital facilities, expenses related to the same medical condition, whether expenses for a single incident or separate incidents. Incidents are shared as one need. 65 00:11:29.690 --> 00:11:39.850 Amanda Sohaney: in order to have a need shared, the member must first meet their annual Max. The annual Max, is the amount that the member pays before the clear share community will share in medical expenses. 66 00:11:39.920 --> 00:11:45.850 Amanda Sohaney: Clear share has 3 annual Max tiers, 1,000 2,500 $5,000, 67 00:11:46.220 --> 00:11:51.090 Amanda Sohaney: all qualifying medical expenses submitted after a member pays their annual Max 68 00:11:51.100 --> 00:12:05.339 Amanda Sohaney: are shareable with the clear share community at 100. There's no annual or lifetime limit, and members don't need to pay the annual Max again until a new calendar year begins, and members only need to pay that annual Max once per calendar year 69 00:12:06.170 --> 00:12:16.350 Amanda Sohaney: for members who are paired, their clear share only membership with a mech plan. Copays and costs that might apply to their insurance plan. Deductible don't accumulate towards the annual, Max. 70 00:12:16.440 --> 00:12:22.480 Amanda Sohaney: So if you're pairing clearshor with the Mech plan costs that are paid by the mech don't accumulate towards clearshor costs. 71 00:12:22.510 --> 00:12:24.730 Amanda Sohaney: and we're going to touch on that more later. 72 00:12:27.580 --> 00:12:43.250 Amanda Sohaney: If you have family members on your 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 clear, clear share community will share in eligible, eligible medical expenses at 100%. 73 00:12:43.850 --> 00:12:50.950 Amanda Sohaney: The family annual. Max is generally the number of people on the plan times 2, and then Kappa times 3 for those larger households 74 00:12:51.200 --> 00:12:56.570 Amanda Sohaney: and the 5,000 annual Max tier is about 2 and a half times the annual Max. 75 00:12:56.880 --> 00:13:05.209 Amanda Sohaney: So, looking at this helpful chart, here, a family of 4 on the clear share, 1,000 plan is going to have a family annual Max of $3,000. 76 00:13:06.460 --> 00:13:18.060 Amanda Sohaney: So let's walk through an example. We have a family of 4 on a clear 1,000 plan. Their annual Max is 1,000, and the family annual. Max is 3,000, which we know from the chart on the slide. We just looked at. 77 00:13:19.010 --> 00:13:25.289 So let's say, in January the primary member is removing holiday lights from their house and falls off the ladder and breaks their leg. 78 00:13:25.440 --> 00:13:34.579 Amanda Sohaney: They pay a thousand dollars. They've met their annual Max, and now clear share will share 100% in all eligible expenses for the primary member. For the rest of the year. 79 00:13:36.690 --> 00:13:40.100 Amanda Sohaney: In March, child number one's appendix has to be removed. 80 00:13:40.140 --> 00:13:54.189 Amanda Sohaney: The family pays $1,000 to meet the child's annual Max, and now clear share will share in child one's eligible expenses, one 100% through the end of the year, and the whole family has now paid $2,000 towards their family annual. Max. 81 00:13:56.510 --> 00:14:05.409 Amanda Sohaney: It's an unlucky time for the primary member in June. They have to get their gall bladder removed. Lucky for them! They've already paid their 1,000 annual Max for the year. 82 00:14:05.660 --> 00:14:16.510 Amanda Sohaney: Clearshare, determines the gall bladder removal is shareable and shares in the need. A 100%. The primary member pays nothing, and the household has still paid a total of $2,000. 83 00:14:18.900 --> 00:14:30.309 Amanda Sohaney: In July. Child number 2 gets stung by a bee for the first time, and the family discovers the child is allergic. It's a fairly minor reaction. So they just go to urgent care, and the physics costs $700. 84 00:14:30.480 --> 00:14:39.009 Amanda Sohaney: So trial number 2 is still on the hook for $300 to meet that $1,000 annual, Max, before clear share is gonna start sharing and expenses. 85 00:14:39.020 --> 00:14:44.029 Amanda Sohaney: but the whole household is now up to $2,700 paid out of pocket. 86 00:14:46.170 --> 00:14:54.459 Amanda Sohaney: Then, in September the spouse trips over a toy, falls down the stairs and breaks an arm. The er visit and hospital bill is $7,000, 87 00:14:54.800 --> 00:15:11.169 Amanda Sohaney: but the spouse only needs to pay $300, and now the household has hit their family annual. Max Clar share is now going to share in eligible expenses at 100, even before the spouse meets their full annual, Max, because the entire household has now hit that family annual Max cap. 88 00:15:13.940 --> 00:15:19.409 Amanda Sohaney: So then, later in November, child Number 2 springs their ankle and has to go to urgent care again. 89 00:15:19.470 --> 00:15:25.579 Amanda Sohaney: So previously, child number 2 had paid $700 out of that $1,000 back in July. 90 00:15:25.590 --> 00:15:36.460 Amanda Sohaney: but because the entire household has since hit that family annual Max, of $3,000. Child numbers to need is now shareable at 100, and the family doesn't pay anything. 91 00:15:39.020 --> 00:15:45.790 Amanda Sohaney: Another reminder that we're saving questions to the end. So if you have any, please write them down so that we can come back to it later. 92 00:15:48.210 --> 00:15:49.860 Amanda Sohaney: So how needs are shared. 93 00:15:50.080 --> 00:16:03.100 Amanda Sohaney: Members submit their need requests on the clear share website on the website. There's a form that they must fill out. And here's a screenshot of it here, and they should also attach the super bill, and that is the itemize bill with medical codes on it 94 00:16:03.150 --> 00:16:08.560 Amanda Sohaney: and their medical records. We need the medical records to help determine if the needs are shareable. 95 00:16:09.690 --> 00:16:14.590 Amanda Sohaney: So, in order for a need to be shared, the member must be up to date on their monthly contributions. 96 00:16:14.940 --> 00:16:29.419 Amanda Sohaney: The membership must be active during the dates of service when the medical bills are received. At the time the annual Max is paid. and if a membership deactivates before the determination of sharing is made, then the bills will not be shared with the community. 97 00:16:29.840 --> 00:16:47.920 Amanda Sohaney: So this is different from insurance under a true insurance plan. As long as your dates of service, or when your plan was active, your claims will be paid. but with health share. If you have not received that determination of sharing, and you cancel your membership. The need is gonna be denied, even if the dates of service were, while your membership was active 98 00:16:53.210 --> 00:17:03.830 Amanda Sohaney: to keep membership contributions low for all members, clear share implements, a waiting period of sharing for sharing of medical conditions that exist prior to enrollment in a clear share membership. 99 00:17:04.310 --> 00:17:12.069 Amanda Sohaney: This is another big area where health share is different from insurance insurance plans cannot refuse to cover pre existing conditions. 100 00:17:12.400 --> 00:17:15.709 Amanda Sohaney: but because health shares are not regulated by the same laws. 101 00:17:15.730 --> 00:17:20.240 Amanda Sohaney: They can deny sharing, because the condition existed prior to membership. 102 00:17:21.089 --> 00:17:35.310 Amanda Sohaney: So clear share has a 12 month. Look back period means that arise from conditions that existed prior to membership are only shareable. If the condition was regarded as cured and did not require treatments for 12 months prior to the effective date of membership. 103 00:17:35.520 --> 00:17:45.430 Amanda Sohaney: This is 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. 104 00:17:46.240 --> 00:17:58.400 Amanda Sohaney: So note that experienced symptoms is not on this list. So this is an area that sets clear share. Apart from other health shares. We also have the shortest look back period, just 12 months, and the most defined definition. 105 00:17:58.470 --> 00:18:03.970 Amanda Sohaney: So essentially, if the condition does not appear on a person's medical record, it would be considered charitable. 106 00:18:05.200 --> 00:18:17.839 Amanda Sohaney: Some exceptions, high blood pressure, high cholesterol and diabetes are not considered pre-membership conditions as long as the member has not been hospitalized in 12 months and can control the conditions through medication or diet 107 00:18:18.840 --> 00:18:29.909 Amanda Sohaney: and cancer. Heart disease, stroke and Copd are the big ones. They have a look back period of 5 years. So health share is really not a good fit for people who have these conditions. 108 00:18:35.140 --> 00:18:48.010 Amanda Sohaney: Premiership medical conditions have a phase in period where sharing is limited. So, starting from the initial effective date, members have a one year waiting period before pre-membership medical conditions become shareable 109 00:18:48.370 --> 00:18:57.890 Amanda Sohaney: after the first year. Pre-membership medical conditions. Our needs are eligible for sharing on a limited basis with the amount increasing each membership year. 110 00:18:58.090 --> 00:19:07.110 Amanda Sohaney: So year one is that waiting period, and in year 2 they're shareable up to $25,000, and then going all the way up to year 4 and $125,000 111 00:19:11.900 --> 00:19:25.690 Amanda Sohaney: member needs not associated with a pre membership. Medical condition are generally shareable. So we have 30 conditions listed in the guidelines with specific sharing qualifications, and there are 16 conditions listed that are not shareable at all. 112 00:19:26.170 --> 00:19:44.180 Amanda Sohaney: So it's hard to memorize all of these. But you can use control. F or command, app to quickly search the guidelines for specific conditions that you might have questions about. You should definitely use variations of the word that you're looking for to help make sure that you find it so. For example, a common question is, is bariatric surgery shareable? 113 00:19:44.180 --> 00:20:01.569 Amanda Sohaney: So bariatric is not listed in the guidelines. But weight loss, surgery is so you might want to try searching for bariatric, and you know, weight or weight, loss, weight, reduction to help end up on that line. Item where you can find out the conditions under which that need would be shareable 114 00:20:06.210 --> 00:20:13.549 Amanda Sohaney: maternity. As a general rule, general rule, maternity needs are shareable, and are treated like any other medical need. 115 00:20:13.720 --> 00:20:25.939 Amanda Sohaney: as with any other medical need, expectant mothers pay their annual maximum for all expenses related to their maternity need. There's not a separate annual Max for maternity that applies to the calendar year, just like any need 116 00:20:26.450 --> 00:20:38.800 Amanda Sohaney: any need of the baby, whether occurring before after birth, is separate from the mother's maternity. Mean expenses for any pregnancy or birth. Related complications of the mother are shared as part of that maternity mean 117 00:20:40.180 --> 00:20:50.180 Amanda Sohaney: pregnancy prior to membership conception that occurs prior to membership or within the first 60 days of membership, is eligible for sharing. But with a $50,000 limit. 118 00:20:50.220 --> 00:20:57.280 Amanda Sohaney: and in that event medical expenses for the newborn are also eligible for sharing. But with another $1,000 limit 119 00:21:00.710 --> 00:21:11.809 Amanda Sohaney: clear share only network. There isn't one. So any services included on this clear share. Only part of the plan are not part of any network. There's no doctor lookup, and members can go anywhere for care 120 00:21:12.210 --> 00:21:18.159 Amanda Sohaney: in our marketing and sales materials. We word this as clear share has no restrictions on providers you can access. 121 00:21:18.190 --> 00:21:29.539 Amanda Sohaney: and this is because legal told us that network is commonly used for insurance, and we should avoid using the word network to describe clear share. And so that's why we say there are no restrictions on providers. 122 00:21:32.360 --> 00:21:40.789 Amanda Sohaney: So for more information, I highly recommend a read through, or at least a skim of the full member guidelines, which again, you can find on the clear share website. 123 00:21:46.590 --> 00:21:50.070 Amanda Sohaney: Now, we're going to talk a little bit about clear share merge plans. 124 00:21:53.710 --> 00:22:03.860 Amanda Sohaney: So going back to our plan overview. We're about to review these merge plans here. So that's advanced clear share and basic clear share with all the annual Max tiers. 125 00:22:07.000 --> 00:22:10.149 Amanda Sohaney: So we're gonna start with the advanced merge plan 126 00:22:11.500 --> 00:22:12.579 Amanda Sohaney: here it is. 127 00:22:12.820 --> 00:22:21.250 Amanda Sohaney: So when members select the advanced Clear share plan, they're adding on several shareable services to that clear share, only membership that we just went over 128 00:22:21.370 --> 00:22:30.750 Amanda Sohaney: with clearshare. Only these services are usually only shareable if they're related to a bigger need, such as a follow-up visit as follow-up specialist visit after a surgery 129 00:22:31.440 --> 00:22:37.590 Amanda Sohaney: with the advanced clear share plan. These services are shareable after a set member cost or visit fee. 130 00:22:39.800 --> 00:22:53.879 Amanda Sohaney: So remember, these fees resemble Copays. They look like copays, but they're not a copay, because this merge plan is a hundred percent health share, and we do not use insurance terms in order to help differentiate between insurance and health share. 131 00:22:56.720 --> 00:23:06.629 Amanda Sohaney: So for the services listed here that are included under the advanced portion of the plan. these services are available for sharing even before you've paid your annual maximum. 132 00:23:06.810 --> 00:23:24.700 Amanda Sohaney: The expenses for these services don't accumulate towards your annual maximum, and the shareable amounts don't change even after you've paid your annual maximum for other services. In the event that any of these services are result of another shareable need, they may be considered for inclusion in your annual Max, or without a member, cost 133 00:23:25.500 --> 00:23:35.530 Amanda Sohaney: so essentially annual. Max does not apply, and then also, the services listed here are available for sharing, regardless of any pre-membership conditions and waiting periods 134 00:23:36.310 --> 00:23:43.100 Amanda Sohaney: so essentially shareable, no matter what, but don't accumulate towards or count towards the annual Max. 135 00:23:45.670 --> 00:23:49.410 Amanda Sohaney: The services listed here are on 2 Ppo networks. 136 00:23:49.510 --> 00:24:04.120 Amanda Sohaney: Phcs specific services is the primary network, and PN. OA. Exclusive is the secondary network. Other services, those ones that are included as part of the clear share. Only membership that we previously went over 137 00:24:04.260 --> 00:24:15.030 Amanda Sohaney: don't have any network restrictions, and members can go anywhere for these services. Members can go in network and pay less, or they can still go out of network. They'll just pay a little bit more. 138 00:24:17.960 --> 00:24:27.610 Amanda Sohaney: So to recap services services that are part of the advanced portion of the plan, or that have a member cost. Associated with them are part of 2 networks 139 00:24:27.650 --> 00:24:35.529 Amanda Sohaney: and services that are part of clear share only, or where the annual Mac supplies are not part part of a network, and members can go anywhere. 140 00:24:37.590 --> 00:24:41.709 Amanda Sohaney: So here's some additional resources about the advanced plan that you can check out. 141 00:24:46.210 --> 00:24:48.800 Amanda Sohaney: And now we're going to talk about the basic merge plan. 142 00:24:51.740 --> 00:25:07.329 Amanda Sohaney: So like the advanced plan, when members select the basic, clear share plan. They're adding on several shareable services to that clear share only membership with the basic clear share plan. The services listed here are shareable after that set member cost or visit fee 143 00:25:09.560 --> 00:25:18.870 Amanda Sohaney: like before. These fees resemble copays. But they're not Copays, because this plan is a hundred percent health share, and we do not use insurance terms to describe health share 144 00:25:21.590 --> 00:25:39.479 Amanda Sohaney: like the advanced clear share. The services included under the basic portion of the plan, are available for sharing even before you paid your annual maximum expenses. For these services do not accumulate towards your annual maximum, and the shareable shareable amounts don't change even after you've paid your annual maximum for other services. 145 00:25:39.890 --> 00:25:48.300 Amanda Sohaney: in the event that any of these services are a result of another shareable deed, they may be considered for inclusion in your annual Max or without a member cost. 146 00:25:48.990 --> 00:25:55.760 Amanda Sohaney: and these services listed are available for sharing, regardless of pre-membership conditions and waiting periods 147 00:25:59.720 --> 00:26:11.650 Amanda Sohaney: like the advanced plan. The services listed here are on 2 Ppo networks. Phcs specific services is the primary network and P. Noa exclusive is the secondary network. 148 00:26:11.890 --> 00:26:18.460 Amanda Sohaney: All other services, those ones included in the clear share only membership do not have any network restrictions. 149 00:26:20.550 --> 00:26:22.679 Amanda Sohaney: So to recap the basic plan again. 150 00:26:22.740 --> 00:26:36.569 Amanda Sohaney: services, part of the basic portion of the that have a member cost associated with them are part of 2 and services that are a part of clear share only, or where Mac supplies are not part of a network, and members can go plan, or networks the annual anywhere 151 00:26:38.650 --> 00:26:43.839 Amanda Sohaney: also have some additional resources resources on the basic clear share plan available here 152 00:26:45.030 --> 00:26:57.040 Amanda Sohaney: and now we will take a look at a side-by-side comparison of the advanced clear share and basic clear share plans. So the clear share only portion of the membership that covers the big stuff is identical on both 153 00:26:57.150 --> 00:27:01.849 Amanda Sohaney: the advance and basic portions of the plan will add on certain services. 154 00:27:02.680 --> 00:27:13.379 Amanda Sohaney: The advanced plan includes in network and out of network services for a broad range of day to day services like doctor visits, urgent care lab work, X-rays imaging and prescriptions. 155 00:27:13.500 --> 00:27:26.770 Amanda Sohaney: The basic plan includes only in network services for doctor visits and prescriptions. Everything else would fall under the clear share portion of plan where the annual Max applies and premembership conditions will apply. 156 00:27:29.980 --> 00:27:34.989 Amanda Sohaney: So the last plan type in the clear share category is the Hsa plus clear share plan. 157 00:27:36.500 --> 00:27:48.290 Amanda Sohaney: and the Agsa portion of this plan is actually a trident mech plan. It's insurance and not health share. So we're gonna cover it more tomorrow as well as talk about the differences between those mech and merge plans. 158 00:27:52.740 --> 00:27:56.420 Amanda Sohaney: Alright. So now we're going to talk about care, coordination for clear share. 159 00:27:59.830 --> 00:28:03.479 Amanda Sohaney: Air, coordination is here to help you lower your healthcare costs. 160 00:28:03.540 --> 00:28:10.150 Amanda Sohaney: We connect you with lower costs, high quality providers for your labs, imaging and major procedures. 161 00:28:10.940 --> 00:28:23.070 Amanda Sohaney: So when a member needs labs imaging or another major procedure. They'll call or email Us. Our care coordination team works to find a provider in the members area that has positive outcomes and that charges a lower price. 162 00:28:23.260 --> 00:28:34.350 Amanda Sohaney: Care, coordination will recommend a provider, and if the member uses it, their out of pocket costs, including those member fees or their annual Max can be waived so their cost, their care, would be totally free. 163 00:28:37.270 --> 00:28:40.640 Amanda Sohaney: So why do we do this? Here is an example 164 00:28:40.950 --> 00:28:48.049 Amanda Sohaney: we had a member that needed knee replacement, surgery, and there were 2 options for care nearby. So Md. Anderson Hospital 165 00:28:48.140 --> 00:28:50.720 Amanda Sohaney: and an orthopedic surgery center. 166 00:28:50.890 --> 00:28:57.129 Amanda Sohaney: So Md. Anderson, their specialty is not Ortho, and they were charging 80,000 for the proced procedure 167 00:28:57.280 --> 00:29:03.180 Amanda Sohaney: at the orthopedic Surgery Center. They do specialize in Ortho, and they were only charging $40,000. 168 00:29:03.820 --> 00:29:17.769 Amanda Sohaney: So we recommended the orthopedic surgery center because their surgeons are more specialized and experienced. Their price is way lower, and we cut the cost in half, which allows us to keep our monthly costs low. So the plan saved $40,000 here. 169 00:29:18.060 --> 00:29:28.050 Amanda Sohaney: and we pass those savings on to the member by covering all their out of pocket fees. So they got a knee replacement surgery for free, just for choosing an experienced and fair provider 170 00:29:32.270 --> 00:29:36.039 on clear share plans. Not every service qualifies for care, coordination. 171 00:29:36.120 --> 00:29:39.670 Amanda Sohaney: lab work, and anything more expensive than that will qualify. 172 00:29:39.850 --> 00:29:46.569 Amanda Sohaney: So doctor visits don't qualify because of cost savings just aren't enough to justify the work involved in finding that provider 173 00:29:46.770 --> 00:29:55.780 Amanda Sohaney: and emergency services don't qualify because care coordination requires a lot of time. Our team has to research providers and recommend them, and emergency services can't wait. 174 00:29:58.210 --> 00:30:07.349 Amanda Sohaney: Care. Coordination can also help find local providers. If the primary and secondary network such Phcs specific services and pnoa exclusive? 175 00:30:07.420 --> 00:30:12.769 Amanda Sohaney: So if they don't provide the coverage that a member needs in their area, then care coordination can help 176 00:30:15.060 --> 00:30:32.939 Amanda Sohaney: one of them. The biggest questions I think we get is, can members choose a doctor? They want to see? And the answer is, no, so care coordination works to find and recommend you a fair priced high quality provider. If members want to choose their own provider, then they should use their plans applicable in network or out of network services. 177 00:30:35.860 --> 00:30:46.489 Amanda Sohaney: So a couple additional resources here about care, coordination, introduction to care, coordination and a new care coordination. FAQ, which everyone should check out and will be on our new website very soon. 178 00:30:47.310 --> 00:30:56.640 Amanda Sohaney: And an important note here that care coordination works a little bit differently on clear share, that on major medical. And we're going to review this more in our part, 2 training. 179 00:31:00.230 --> 00:31:05.240 Amanda Sohaney: And now we will talk about virtual services, and then we will get to questions. 180 00:31:07.760 --> 00:31:12.069 Amanda Sohaney: So virtual services. We have lyric telemedicine, and Talkspace. 181 00:31:15.180 --> 00:31:24.060 Amanda Sohaney: Their telemedicine is included with every plan so clear, share only clear, share, merge, and try and mech and major medical plans which we'll be going over tomorrow. 182 00:31:24.850 --> 00:31:35.689 Amanda Sohaney: Lyric services include urgent care for $0 and behavioral health counseling. We don't often advertise lyrics, behavioral health, because we also have talks base for mental health, which we'll discuss next 183 00:31:36.610 --> 00:31:41.750 Amanda Sohaney: members can access lyric through health wallet, or by calling lyric toll through toll free. 184 00:31:41.900 --> 00:31:50.200 Amanda Sohaney: You have to be at least 18 to have your own lyric account. So adult dependents and spouses can access lyric through their own health, while accounts 185 00:31:50.250 --> 00:31:59.659 Amanda Sohaney: and primary members can add dependent child dependent, a dependent child, or children to their account through their alyric account settings. 186 00:32:02.620 --> 00:32:11.900 Amanda Sohaney: talks based mental health has also included with every plan clear share only clear share merge, and the trident mech and major medical plans which we're discussing tomorrow. 187 00:32:12.470 --> 00:32:23.320 Amanda Sohaney: Talkspace includes unlimited messaging therapy for $0, 1 30 min live therapy session per month for individuals aged 13, and up additional visits are $65, 188 00:32:23.350 --> 00:32:30.510 Amanda Sohaney: and psychiatry is for individuals aged 18, and up, and the plan includes 13 sessions a year for free 189 00:32:33.040 --> 00:32:40.770 Amanda Sohaney: to access talks. Base members. Just go to the URL here and enter the organization name for therapy or the keyword for psychiatry. 190 00:32:41.040 --> 00:32:53.229 Amanda Sohaney: So these org names and keywords are not public. This is all that people need to access the benefit. There's no other eligibility checks that we have with Talkspace, so don't give this information away to people who are not members 191 00:32:54.140 --> 00:32:58.979 Amanda Sohaney: on the landing page. talkspace.com slash. Clearwater looks like this image here on the slide. 192 00:32:59.110 --> 00:33:10.179 Amanda Sohaney: The big green button that says, get started is to sign up for therapy. And then if someone is looking for psychiatry, it's the small text link kind of hidden underneath. And that is how you sign up for psychiatry. 193 00:33:13.120 --> 00:33:16.510 Amanda Sohaney: and that is all I have. So we'll open up the floor to questions. 194 00:33:16.700 --> 00:33:24.209 Amanda Sohaney: Oh, but before tomorrow we're gonna review mech plans, major medical plans, Hsas and supplementals 195 00:33:25.810 --> 00:33:37.019 Amanda Sohaney: for questions. Since we have so many people, please use the raise hand function on zoom. So it's next to share screen. There should be a button called reactions. You can click that, and there's an option to raise your hand. 196 00:33:37.910 --> 00:33:49.959 Amanda Sohaney: and if we run out of time you're watching the recording, or you think of a question after this meeting is over, feel free to use this link which I will share out with the slides, so you can ask your question there and still get it answered. 197 00:33:53.210 --> 00:33:57.340 Amanda Sohaney: So feel free to raise your hand, if and when you have questions. 198 00:34:01.820 --> 00:34:02.770 Amanda Sohaney: Stacy. 199 00:34:05.070 --> 00:34:26.709 Stacey Koehn: sorry I needed to unmute Mandy. First of all, this is so great, I think my biggest question is on. If somebody's calling. If somebody's booking a call, are we typically selling merged plans? II think my confusion is, when are we selling merge plans versus selling the mech plus clear share plans. And maybe that's a question for Caleb. 200 00:34:27.310 --> 00:34:38.070 Amanda Sohaney: Yeah. So that's a great question. I can take it. We are talking more about Mac plans and merge plans tomorrow, so a lot of your questions will be answered then. But the short answer is, the default is merge plans. 201 00:34:38.100 --> 00:34:57.579 Amanda Sohaney: You get a mech plan. If you live in one of our Mac States where there's an individual mandate requirement, I don't have them memorized off the top of my head. There's like 5 of them. We'll talk about them tomorrow. Or if you're a member of like a small group like a true group, they typically will elect Mec to meet various insurance requirements. 202 00:34:59.370 --> 00:35:01.239 Stacey Koehn: Perfect. Thank you so much. 203 00:35:03.670 --> 00:35:04.650 Amanda Sohaney: Connie. 204 00:35:07.020 --> 00:35:10.989 conniepiasta: I have a question about the annual Max reset. 205 00:35:11.260 --> 00:35:21.700 conniepiasta: So I get from January to December. If you have a surgery here, and then a hospital er in 2 separate years 2 separate annual Maxes. What about the ones that carry over. 206 00:35:22.470 --> 00:35:30.489 conniepiasta: So if I broke my leg in December, and then I needed to start physical therapy in February. It's all related to the same incident. 207 00:35:31.250 --> 00:35:53.969 Amanda Sohaney: Yep, so our annual Max is per calendar year, and that covers any need in that calendar year. So when the annual Max does reset even if it's still related you will have to pay your annual Max again. The only exception is for maternity needs which we do consider. You know, whenever you pay your whenever you pay an annual Max that relates to your maternity need that's supposed to 208 00:35:54.130 --> 00:36:03.489 Amanda Sohaney: still count, even if if your maternity overlaps year. That's not quite written into the member guidelines yet. And I know there's a lot of grey area. But that's how we plan to operate. 209 00:36:03.640 --> 00:36:09.090 conniepiasta: Okay, that's what I was gonna ask, too, was maternity if they had to pay it a second time. 210 00:36:09.410 --> 00:36:13.859 conniepiasta: not for any but any other need. Yes, thank you. 211 00:36:15.940 --> 00:36:17.070 Amanda Sohaney: Marjorie. 212 00:36:20.260 --> 00:36:35.110 Margery McAlister: Okay. First of all, you did a great job. So thank you for being so thorough. My question was about the clear share. So say. somebody, it's about there. Say, they're gonna get on their spouse's 213 00:36:35.300 --> 00:36:47.410 Margery McAlister: insurance plan, but they've been doing clear share. And right before they end up switching. they get in a car accident, or whatever. And does that mean 214 00:36:47.520 --> 00:36:53.290 Margery McAlister: that once they switch over even, we won't cover any of that cost. 215 00:36:53.910 --> 00:37:07.730 Amanda Sohaney: Yeah. So if a determination of sharing has not been made. The Member guidelines state that the need would not be shared. So if they're planning to cancel their plan. you know, on October 30 first, and they get into an accident on October thirtieth. 216 00:37:09.250 --> 00:37:28.779 Amanda Sohaney: Technically, according to the guidelines that would not be shareable. You know, we're nice people. So we definitely look at exceptions, a lot especially when there's gray area like that. And it's a true accident. So that's something that we'd have to take on a case by case basis, but following the member guidelines, that need would not be shareable, and they would need to stay on clear share in order to have that need shared. 217 00:37:28.900 --> 00:37:30.900 Margery McAlister: Okay. thanks. 218 00:37:36.920 --> 00:37:37.840 Amanda Sohaney: Stacy. 219 00:37:38.080 --> 00:37:41.550 Stacey Koehn: Yeah, Mandy. So, Marjorie, I love that question. 220 00:37:41.860 --> 00:37:52.189 Stacey Koehn: I don't know what the cancellation process looks like. But when someone tries to cancel, do we communicate that to them in writing or verbally? 221 00:37:53.730 --> 00:37:55.310 Amanda Sohaney: I see Connie nodding. 222 00:37:55.380 --> 00:38:07.060 conniepiasta: Customer service does before we cancel their plan. We'll let them know you have an open need that hasn't been determined yet. Here's a blur from the member guidelines, so they can kind of pick and choose what they want to do with that information. 223 00:38:07.550 --> 00:38:12.360 Stacey Koehn: Thank you, Connie. That's I was hoping for that answer, and I'm thank you all for handling that 224 00:38:21.330 --> 00:38:23.839 Amanda Sohaney: any other questions. Awesome. Cheryl. 225 00:38:26.710 --> 00:38:42.619 Cherelle Tye: thank you so much for all that. That was amazing. I have a question regarding the basic plan. In regards to imaging and urgent care do the Pre X limitations apply? 226 00:38:42.930 --> 00:39:08.989 Amanda Sohaney: Yes. So on the basic plan. I not gonna attempt to go back that many slides. But the basic plan only covers your preventive care. Primary care and specialist doctor visits. So anything else that's not part of that like added on services are gonna fall to clear share. So the annual Mac supplies Premiership limit pre membership limitations also apply for anything not included in those basic services. 227 00:39:09.940 --> 00:39:23.020 Cherelle Tye: Awesome. Follow up question when they if someone's if a members on a basic plan and they do get one of those services, urgent care. 228 00:39:23.230 --> 00:39:36.270 Cherelle Tye: X-rays imaging or blood work outside of preventative. Do they need to submit a needs request, because so that it will go toward their annual? Max. 229 00:39:36.540 --> 00:39:38.070 Amanda Sohaney: Yes, that is correct. 230 00:39:39.010 --> 00:39:40.069 Cherelle Tye: Thank you. 231 00:39:43.470 --> 00:39:44.580 Amanda Sohaney: Aaron. 232 00:39:45.630 --> 00:39:54.760 Erin Gant: Hey? Great job, Mandy? I was just a second question to the one that was asked prior to Cheryl's. 233 00:39:55.220 --> 00:40:01.610 Erin Gant: how long does it take? Typically on average for us to give them a determination on their needs requests 234 00:40:01.740 --> 00:40:11.020 Erin Gant: like. If they are gonna cancel, is it? Is it pushed up in the queue at all. Or Yeah, I just wondering. 235 00:40:11.280 --> 00:40:17.749 Amanda Sohaney: That is a great question. I don't know if Brenda is here. It wants to take that. 236 00:40:18.010 --> 00:40:19.800 Brenda Carbajal: Yes, I am 237 00:40:19.920 --> 00:40:36.209 Brenda Carbajal: so typically if we have everything that is required in the need it determination can take anywhere between 30 to 60 days. And that's currently because we have a backlog, and so needs are a little bit delayed, and being addressed 238 00:40:36.280 --> 00:40:44.520 Brenda Carbajal: once we are out of the backlog, it should take the 21 days that we have stated on our member guidelines as long as it's a complete need. 239 00:40:44.550 --> 00:40:47.560 Brenda Carbajal: So a lot does need to come from the member. 240 00:40:47.590 --> 00:40:59.700 Brenda Carbajal: If we have an incomplete need. And we're waiting on medical records that obviously prolongs the decision process. But there is a 6 month limit from the date of service, and that is being enforced to current needs. 241 00:41:03.560 --> 00:41:21.450 Amanda Sohaney: Thank you, Brenda. And to add on to that needs are reviewed by a team of humans. So there's, you know, a legitimate human reviewing every need. So you know, in the event, when there is, you know, gray area or someone's deed has been in the backlog for several months, and they're wanting to cancel. There's a human review to kind of take that into account. 242 00:41:22.850 --> 00:41:38.589 Stacey Koehn: and I'll just add one more thing. I have seen it before in the past, where sometimes, trying to get a medical record from a provider can take months. So sometimes it's not in our control when we're waiting from information from somebody else. 243 00:41:42.070 --> 00:41:46.020 Amanda Sohaney: Thank you, Stacey. Question from Thad. 244 00:41:46.970 --> 00:41:50.869 Thad Puckett in Austin, TX: So you had, you had stated on the 245 00:41:51.050 --> 00:41:56.740 Thad Puckett in Austin, TX: That's a requirement for a member to submit a medical need? 246 00:41:56.890 --> 00:42:10.060 Thad Puckett in Austin, TX: Is that inclusive inclusive of situations where it's just a day to day, doctor visit? Do they need to identify themselves as cash? Pay patients at that point? Or do they simply can they just show the card and rely on 247 00:42:10.090 --> 00:42:13.250 Thad Puckett in Austin, TX: a network to get the the information? 248 00:42:13.960 --> 00:42:30.279 Amanda Sohaney: Yeah. So if they have the advanced or basic plan where they do have, you know, member fees associated with those visits, they should be able to show their card. The provider should be able to process it like it's a claim. It goes to the network for repricing. 249 00:42:30.280 --> 00:42:48.539 Amanda Sohaney: There are instances where the provider won't accept it. You know the Id cards do say this is health share sometimes they don't know, you know, whatever. So in theory, that doesn't always work out in that case they'd have to contact us, they can submit a need and then it would just be a request for reimbursement at that point. But yes, if 250 00:42:48.540 --> 00:42:57.560 Amanda Sohaney: you know a service with the member, fee is included in their plan, they should be passing over their member Id to get that covered as if it were a claim. 251 00:43:00.910 --> 00:43:01.750 Thad Puckett in Austin, TX: Thank you. 252 00:43:02.870 --> 00:43:03.820 Amanda Sohaney: Caleb. 253 00:43:07.970 --> 00:43:15.840 Caleb Childress: First of all, that was amazing. I don't know how many of these conversations I've had, but you could definitely sell this as least as well as we do. Thank you so much, that's all. 254 00:43:16.480 --> 00:43:31.049 Caleb Childress: I'm still a little bit fuzzy on some of the things that we? I wanna make sure that we're saying things the way that we should be for care coordination, meaning those folks in my team who are talking to the people live about this stuff. 255 00:43:31.400 --> 00:43:47.360 Caleb Childress: When it comes to the doctors that they prefer. Obviously we cannot guarantee those doctors. But part of what we have said occasionally, up to this point, and if it's wrong, we will stop is We 256 00:43:47.530 --> 00:43:57.599 Caleb Childress: remember these are negotiations with these doctors. We will start with the doctors that you wish to use. But again, these are negotiations. They can say no. 257 00:43:57.830 --> 00:44:07.559 Caleb Childress: so they say we we pay them pretty well, so they don't often say no, but it does happen. Be aware. That is that a fair statement? Can we 258 00:44:07.730 --> 00:44:19.720 Caleb Childress: compliantly say something similar to that? I wanna say, yes, and I'm gonna toss this again over to Brenda to see if she has any input since she is very much in this process. 259 00:44:20.130 --> 00:44:35.590 Brenda Carbajal: Yes, so we will try to work with the members provider. That will be the first source, because they already have an established relationship with them. But it really will come down to savings. So if we're able to redirect the member to a different provider that's in the area that still has great 260 00:44:35.830 --> 00:44:42.799 Brenda Carbajal: reviews, then we will redirect them. So we'd make that pretty clear from the beginning. When we initiate the conversation. 261 00:44:42.850 --> 00:44:54.049 Brenda Carbajal: We do, we will try just because we don't wanna want to obviously delay the care. But it really comes back down to what's gonna be the best saving for the plan for the member and not delaying their care. 262 00:44:54.250 --> 00:45:01.880 Caleb Childress: So if somebody is a better quality and costs less ultimately, we're going to refer to that better experience at the better at the better price 263 00:45:01.990 --> 00:45:03.490 Brenda Carbajal: that is correct, and it 264 00:45:03.920 --> 00:45:25.190 Brenda Carbajal: yes, and the member they can request the second opinion if they don't like the first option that we provide. And if, yeah, if they don't like the second opinion, then they're able to move forward with their provider. They would just have to go through the needs process in some cases, and then be responsible for their responsibility, either whatever the copay is or the out of pocket. Max. 265 00:45:25.290 --> 00:45:30.419 Caleb Childress: Nice. Okay, and I think my second do? Do I have space for a second question. 266 00:45:31.010 --> 00:45:46.839 Caleb Childress: Cool. Just wanna honor that? Let's see. So thinking of clear share. Only obviously there are. No, there's no set cost experience here. There's no co-pay here. We're just paying cash. Pay. Rates and things are Subm are are contributing to the annual Max. 267 00:45:46.840 --> 00:46:10.640 Caleb Childress: Do we still use care coordination for diagnostic tests? Obviously, I believe we'd still do treatments and and all that that yarn? But would we still do not not specialists. We don't do specialists for care coordination on the clear share side. But do we still do even specialists, medication or specialty medications? We still do diagnostic tests 268 00:46:11.680 --> 00:46:35.410 Amanda Sohaney: so diagnostic tests. Yes, to be shared under clear share. It would have to be, you know, related to a need. You can't just go, you know. Get your preventive care blood work on a clear share. Only membership. It's not included. So yeah. As long as it's an eligible service. On clear share, only you can still use care coordination for it. It would waive the annual Max, if you use that, recommended provider, since there's no like visit Fee associated with that 269 00:46:36.240 --> 00:46:38.350 Amanda Sohaney: for specialty medication. 270 00:46:38.500 --> 00:46:47.790 Caleb Childress: I think that depends cause there are, you know, prescriptions generally aren't covered. There's a lot of sharing qualifications for prescriptions on a clear share. Only membership. 271 00:46:48.390 --> 00:47:05.440 Amanda Sohaney: but and you know what I don't even think we have, I am on clear share, only memberships. 272 00:47:05.990 --> 00:47:09.720 Stacey Koehn: So Mandy, though on a clear share, only plan. 273 00:47:09.970 --> 00:47:11.010 Jake Norman: If 274 00:47:11.080 --> 00:47:17.910 Stacey Koehn: let's say I'm gonna throw a scenario, let's say somebody ended up getting cancer on a clearshor only plan. 275 00:47:18.000 --> 00:47:23.120 Stacey Koehn: And obviously, some of those cancer medications are extremely costly. 276 00:47:23.140 --> 00:47:27.769 Stacey Koehn: Would those medications be 277 00:47:28.260 --> 00:47:30.760 Stacey Koehn: shareable through the need? 278 00:47:31.100 --> 00:47:41.780 Amanda Sohaney: Yeah. So there is, a specific sharing qualification listed out for prescriptions on clear share, only members memberships. So if the prescriptions 279 00:47:41.840 --> 00:47:55.750 Amanda Sohaney: prescribed apply to all of the things listed for prescription sharing, then. Yes, they would be shared. I think it's like the prescriptions have to accumulate to $500. They have to be related to a shareable need. They have to be prescribed 280 00:47:55.930 --> 00:48:05.500 Amanda Sohaney: biomedical, professional, and I think there's a couple of other ones. I don't have it memorized right now, but as long as it meets the qualifications yes, they would be shared. 281 00:48:06.220 --> 00:48:07.180 Stacey Koehn: Thank you. 282 00:48:15.050 --> 00:48:16.840 Amanda Sohaney: Any other questions. 283 00:48:21.870 --> 00:48:22.690 Amanda Sohaney: Jake. 284 00:48:23.930 --> 00:48:35.649 Jake Norman: Yes, and I'm so sorry II came in a little bit late, so if I'm if I'm asking something that was already covered, forgive me. But you had mentioned something about the annual, Max being on a calendar year. 285 00:48:35.690 --> 00:48:49.780 Jake Norman: and so I just wanted to make sure I get clarification on this. Somebody enrolls in September, September first of 2,023 is there annual Max Reset, January one of 2024. 286 00:48:49.870 --> 00:48:56.740 Amanda Sohaney: Yes, that is correct. So they'd have a short plan year their first year and then all other years, it does follow the calendar year. 287 00:48:57.360 --> 00:49:18.549 Jake Norman: Okay? And then, basically with their would there kind of open enrollment period still fall within the kind of calendar year. Open enrollment period of November first to December 30, first, in which they can make changes to their plan. What what if they're coming to their actual renewal 288 00:49:18.900 --> 00:49:28.689 Jake Norman: or anniversary date. Is there a time in which they can make changes to their plan? September 2024, or leading up to September 2024 as well. 289 00:49:28.830 --> 00:49:43.609 Amanda Sohaney: Yeah. So right now, the member guidelines and our business rules state that you can make changes at your like renewal period, like based on when you sign up. So you know, September, September, if that's when you signed up or during open enrollment, so there would be 2 290 00:49:44.790 --> 00:49:55.330 Jake Norman: great. That's perfect. III just wanted to make sure I was abundantly clear on that, especially with the annual Max in terms of when it resets. So that was helpful. Thank you again. And this was, this is a perfect presentation. 291 00:49:55.600 --> 00:49:56.700 Amanda Sohaney: Thank you. 292 00:49:58.750 --> 00:49:59.650 Amanda Sohaney: bad. 293 00:50:00.560 --> 00:50:09.159 Thad Puckett in Austin, TX: Some of our websites, especially the Xp site, still uses the term teletoc. Is that intentional, or an accident or a relic? 294 00:50:09.860 --> 00:50:27.030 Amanda Sohaney: Thank you. Yeah. I know our s