SmartHealth Advantage
Comprehensive Care, Hospital, Surgery, Doctor Visits, & more
SmartHealth Advantage Plan
The SmartHealth Advantage Plan provides you and your family with an affordable and reliable comprehensive medical care benefit for major health needs such as hospitalization, surgery, cancer treatment, diagnostic labs, and imaging, and maternity.These comprehensive medical benefits are facilitated through a medical share plan which provides both lower out-of-pocket expense as well as lower monthly costs.
Additionally, the SmartHealth Advantage Plan includes all of the benefits contained in both the SmartHealth Basic and SmartHealth Plus plans.
Plans start at just $329.00/month for groups and $379.00/month for individuals.
SHC Plus Plan Highlights
No network requirement for comprehensive care benefits
Initial Unshareable Amount: $1000 or $2500 IUA – max. per plan. 3 IUAs per 12 month period from date of 1st IUA
COMPREHENSIVE CARE BENEFIT-
Inpatient benefit paid at 100% for shareable medical needs amount, after IUA is met.
- Hospital Confinement - initial admission and continued stay
- ICU & sub-acute ICU
- Surgery & Anesthesia
- Rehabilitation Unit (not drug or alcohol related)
- Labs & Diagnostic Imaging (diagnostic lab tests, x-ray, mri, ct, pet, eeg, gastroenterology)
- Physician & Specialist visits
- Emergency Room
COMPREHENSIVE CARE BENEFIT-
Outpatient benefit paid at 100% for shareable medical needs amount, after IUA is met.
- Surgery & Anesthesia (includes. Physician & facility fees)
- Rehabilitation Physical Therapy (not drug or alcohol related)
- Labs & Diagnostic Imaging (diagnostic lab tests, x-ray, mri, ct, pet, eeg, gastroenterology)
- Physician & Specialist visits
- Emergency Room
COMPREHENSIVE CARE BENEFIT-
Maternity benefit paid at 100% for shareable medical needs amount, after IUA is met.
- Maternity (includes physician visits, delivery, surgery, hospital stay)
- Emergency Room
- NICU & sub-acute NICU
COMPREHENSIVE CARE BENEFIT-
End of life services benefit is shareable for all services required at time of death for a participating member. Paid once per decedent.
- Primary or spouse: $10,000
- Child: $2500
IN-NETWORK - Multiplan PHCS
$25 co-pay for all outpatient physician office visits at primary care physician office, specialist, urgent care, or retail medical clinic. Plan pays up to $200 for services rendered per visit after co-pay. Max. benefit 4 or 6 visits per insured/year
OUT-OF-NETWORK
$25 co-pay for all outpatient physician office visits at primary care physician office, specialist, urgent care, or retail medical clinic. Plan pays up to 125% of Medicare for services rendered per visit after co-pay. Max. benefit 4 or 6 visits per insured/year
IN-NETWORK - Multiplan PHCS
No cost for all covered wellness and preventive care services. Max. benefit: 1 exam per year per insured History, Physical Exam, Measurements (height, weight, body mass index).
OUT-OF-NETWORK: Not covered.
IN-NETWORK - Multiplan PHCS
No cost for all covered wellness and preventive care services.
OUT-OF-NETWORK: Not covered.
Covered Preventive Services for Adults
(ages 18 and older)
- Abdominal Aortic Aneurysm Screening - One-time screening for age 65-75
- Blood Pressure screening - One-time per plan year
- Cholesterol screening - One-time per plan year
- Type 2 Diabetes screening - One-time per plan year
- Hepatitis B screening for adults at high risk - One-time per plan year
- Hepatitis C screening for adults at high risk - One-time per plan year
- HIV screening & counseling - One-time per plan year
- Immunization vaccines One-time per plan year per immunization (EACH) - hepatitis A & B, herpes zoster, human papillomavirus, influenza (flu shot), measles, mumps, rubella, meningococcal, pneumococcal, tetanus, diphtheria, pertussis, and varicella
- Obesity screening & counseling - One-time per plan year
- Sexually Transmitted Infection (STI) prevention counseling - One-time per plan year
- Syphilis screening - One-time per plan year
IN-NETWORK - Multiplan PHCS
No cost for all covered wellness and preventive care services.
OUT-OF-NETWORK: Not covered.
Covered Preventive Services for Women
(ages 18 and older)
- BRCA counseling and genetic testing - One-time per plan year for Women at higher risk
- Breast Cancer Mammography Screenings - One-time per plan year for women age 40+
- Breast Cancer Chemo prevention counseling - One-time per plan year
- Cervical Cancer screening - One-time per plan year
- Gestational Diabetes screening - One-time per plan year
- Hepatitis B screening - One-time per plan year
- HIV screening & counseling - One-time per plan year
- Human Papillomavirus (HPV) DNA test - One-time every 3 years for women with normal cytology age 30+
- Osteoporosis screening - One-time per plan year for women age 60+
- Well-woman visits - To obtain recommended preventive services
IN-NETWORK - Multiplan PHCS
No cost for all covered wellness and preventive care services.
OUT-OF-NETWORK: Not covered.
Covered Preventive Services for Children
(ages 18 and older)
- Immunization vaccines One-time per plan year per immunization (EACH) - hepatitis A & B, herpes zoster, human papillomavirus, influenza (flu shot), measles, mumps, rubella, meningococcal, pneumococcal, tetanus, diphtheria, pertussis, and varicella
- Autism screening - Limited to 2 screenings up to age 26 months
- Blood Pressure screening - One-time per plan year
- Congenital Hypothyroidism screening - One-time per plan year for Newborns up to age 3 months
- Phenylketonuria (PKU) screening - One-time per plan year for Newborns up to age 3 months
- Sexually Transmitted Infection (STI) prevention counseling & screening - One-time per plan year for adolescents aged 12 to 17 years
- Tuberculin testing - One-time per plan year
- Vision screening - One-time per plan year for children up to age 5
Every subscriber is assigned a primary care provider to support overall health and wellness as well as management of chronic medical conditions and the coordination of care with local medical providers (i.e., specialists).
For immediate diagnosis, treatment, or direction of acute medical conditions.
Preliminary diagnosis, counseling, and treatment and/or referrals to local mental health specialists as appropriate.
We first diagnose and treat all that is responsible to handle virtually and then guide our members to the highest value, lowest cost providers and resources in their geographic area, including prescriptions, local labs, imaging, and other diagnostic services.
Weight loss, smoking cessation, and overall lifestyle coaching and support.
Consultation with our maternal and fetal medicine specialists, advice, guidance, lactation consults and more.
We support the patient empowerment journey through online education, research tools, a medical grade symptom checker, and much more.
Comprehensive formulary with over 2000 medications. 200+ of the most commonly prescribe medications for $1. Accepted at over 70,000 participating pharmacies. Includes direct mail order delivery, international pharmacy access, prescription assistance program, pet medications, and discounted diabetic supplies. See Basic Rx Benefit Overview for details.
Thousands of at-home diagnostic lab tests and screening tests direct to you. Results delivered through our secure patient portal. Share and discuss your results with your Virtual Primary Care Physician.
Ready To Get Started?
Give Us A Call (689) 999 - 0001
When you're ready to start saving on your healthcare benefits, our benefit counselors are here to help.
Simply give us a call or click the link to schedule an appointment at your convenience.
The SmartHealth Company works exclusively with small business groups, sole proprietors, and independent contractors to provide them with affordable and accessible health benefits to give them a competitive advantage in the work marketplace to retain and attract the quality talent needed to help make their businesses succeed.