How It Works
How Does Impact Health Sharing Work?
Impact Health Sharing is a not-for-profit, non-insurance alternative to the high cost of health insurance. The concept has been around for decades and has been proven to work better and feel better than insurance.
Impact isn’t insurance, it’s a health care sharing program. It’s a community of individuals, families, and small businesses just like you and me…who share and pay each other’s medical bills.
Impact is a not-for-profit organization and it’s a community that consistently and voluntarily pay each other’s medical bills. Unlike insurance, there is no incentive to not pay a medical bill.
Most families don’t have the means to finance and reserve funds for their own healthcare risk. So, they sell their “risk” to an insurance company in exchange for a contract and promise of payment. You’ll have to pay the insurance company a “premium” to accept your risk.
That’s not the case with health care sharing. You’re not relying on a guarantee, a contract or a “promise to pay” from an insurance company. Like millions of others who participate in health care sharing every day, you’re relying on the voluntary commitment and consistency of the Impact Member community.
Health care sharing is different than insurance in that your money is always going to help another member in need and not some cold and disinterested insurance company. You’ll have full visibility on who you are helping even before funds are transferred from your account. You will even be able to send them a “note of encouragement” or a “prayer.” Finally, you can see how all of the contributions of the Impact community are being used. You’ll never get that kind of transparency and accountability from an insurance company.
A few of our features are:
Key Things to Understand
Primary Responsibility Amount (PRA)
Members choose a Primary Responsibility Amount (PRA), which is similar to an annual deductible. The amount you choose is how much you will have to pay for eligible medical expenses before member sharing kicks in. The size of the PRA you choose will determine your monthly Share. The higher the PRA the lower the Monthly Share Amount.
Let’s say you choose the $10,000 PRA, in case of an emergency, you would handle having to pay $10,000 out of pocket, but would enjoy the savings that the lower monthly Share affords. If your family would struggle with such a high PRA, you could choose a lower one but then will pay more in monthly Share amounts.
Provider Fee
As with health insurance, you will pay a provider fee as follows:
Preventitive Care
One annual well visit for members six years and older per membership year. Includes a $150 allowance for the following routine labs as ordered by the provider during the annual/well visit.
Impact is not contracted with a preferred provider organization. Members are free to seek care from the doctor or provider of choice.
Doctor Visits
When you need medical care, you will show your Impact Member ID card and pay your provider fee. The provider will bill Impact. The medical bill will be processed and discounted, and then your doctor will bill you for the amount you owe. Once the amount you pay meets your PRA for the year, your Eligible Medical Bills will be approved for Sharing.
Co-Share
After you have met your PRA, eligible bills will be Shared by the members at 90%. You will be responsible for 10%; up to a maximum of $5,000.
Pre-Existing Medical conditions
It’s important to understand the Preexisting Medical Condition limitations.
Pre-Existing Medical Conditions are conditions in which known signs, symptoms, testing, diagnosis, treatment, or use of medication occurred within 36 months prior to membership (based on medical records).
A known sign is any abnormality indicative of disease, discovered on examination/diagnostic testing before joining membership. A symptom is any subjective evidence of disease. In contrast, a sign is objective. A Pre-Existing Medical Condition is eligible for sharing after the condition has gone 36 consecutive months without known signs, symptoms, testing, diagnosis, treatment, or medication (based on medical records).
If you have been diagnosed with cancer that is in complete remission, and you are only undergoing testing for surveillance purposes, then bills related to those services will not be eligible for sharing for the first 36 months of membership.
If after 36 months you are without signs, symptoms, testing (other than surveillance testing), diagnosis, or treatment (medication), medical expenses related to that cancer diagnosis will be eligible for sharing. The Preexisting Medical Condition limitations do not apply to Members 65 years and older.
Prescriptions
Prescription medication expenses may be credited toward the PRA if they are not considered a treatment for chronic conditions that were preexisting when the member joined Impact. After the Member’s PRA has been met, the prescription amount may be shared as follows:
*Psychotropic medications and birth control expenses are not eligible for Sharing.
The shareable amount is limited to $1200 per member, per membership year after the PRA has been met.
Exceptions may be made in the case of medications for cancer and transplant recipients.
Advantages of Impact
You Can Join Anytime
That’s right! You can apply for Impact and join any time during the year. With Obamacare, you are forced to join within their Open Enrollment period, unless you have a change in status (move, have a baby, etc). You may be reading this during Open Enrollment—understand that you can join Impact anytime throughout the year. And you don’t need one of the special exemptions to make the switch.
It’s Significantly Cheaper
Use Any Doctor
Impact does not use a Provider Network; therefore, you can continue to use the doctors and hospitals of your choice, including specialists.
Options For 65 and Older
Impact does not use a Provider Network; therefore, you can continue to use the doctors and hospitals of your choice, including specialists.
Prescriptions
Prescriptions
It feels good to get honest prescription prices.
Impact Health Sharing is a not-for-profit, non-insurance alternative to the high cost of health insurance. The concept has been around for decades and has been proven to work better and feel better than insurance.
How do prescriptions work?
Impact members don’t gain access to a standalone solution like coupons or rebates to use at your local pharmacy to ‘save’ on prescriptions; instead, they enjoy access to a premier network of pharmacies that offer wholesale direct pricing to Impact members.
And this access gives members the real prices (aka skip the “markups and fees” part) on prescriptions.
Say goodbye to coupons and hello to more than 65,000 participating pharmacies. Plus, our members can easily check pricing in their member center, ensuring they always get the best price and total price transparency.
Prescription Costs
Are we saving money? YES!
Check out a few examples of savings on a 30-day supply of common medications.
Prescriptions and Impact
Prescription medication expenses for prescribed drugs that may be dispensed, injected, or administered may be credited toward the PRA if they are not considered a treatment for chronic conditions that were preexisting when the member joined Impact.
Prescription medications must be purchased using the member ID card (see RX information on the card). Members pay 100% of the prescription amount at the pharmacy.
The sharable amount is limited to $1200 per member per membership year after the PRA has been met.
Exceptions may be made in the case of medications for cancer and transplant recipients.
Note: Adult members 65 and older must have Medicare Part D for prescription costs to be Eligible for Sharing. (Including prescriptions for pre-existing conditions.) All sharing will be secondary to Medicare.
After the member’s PRA has been met, the prescription amount may be shared as follows:
Healthcare Sharing for Seniors
Impact Was Designed For You
Impact Health Sharing is available to anyone over the age of 65 with Medicare Parts A, B, and D. Once you have met your annual PRA of $1,000 (Primary Responsibility Amount), 100% of your eligible medical bills (not paid by Medicare) will be shared by the impact members with no pre-existing limitations for senior members.
And, Impact is open for enrollment year-round.
Seniors 65+
Adults over the age of 65 with Medicare Parts A and B can be members of Impact Health Sharing.
Adults over the age of 65 with Medicare Parts A and B. Eligible medical bills for members 65 or older are eligible for sharing with no co-share amount. Sharing is secondary to Medicare and is based on the difference between the Medicare allowable charges and the actual amounts paid by Medicare. The member must submit a copy of the Medicare Explanation of Benefits, in order for Impact to process bills.
The Pre-Existing Medical Condition limitations do not apply to members 65 years old and older.
Members 65 and older must have Medicare Part D for prescription costs to be eligible for sharing. All sharing will be secondary to Medicare.
Not eligible for sharing:
The tobacco assessment does not apply to Seniors, but BMI assessment does.
The PRA for senior adults is $1,000 with no Provider Fee, no Co-Share, and no Preexisting limitation.
How do prescriptions work for
Seniors 65+ with Medicare?
After your PRA has been met, the prescription amount may be shared as follows…
Do I have to upload bills from
Medicare if I am 65+?
Yes, learn how:
All medical bills (including prescriptions) should first be submitted to Medicare. Medicare will send you a Medicare Summary Notice (MSN) or Explanation of Benefits (EOB).
The EOB is a notice that you are sent in the mail every 3 months.
If you sign up for an electronic notice, you will get it monthly. You will want to do that and get them monthly to submit to Impact for more timely processing.
The MSN will show::
What should you do?
- Create an online Medicare Account at medicare.gov
- Once your account is created, you can download your MSN/EOB’s as often as you’d like.
- To prevent delays, you should print your MSN/EOB’s monthly and upload them to Impact using the medical expense tool. If you wait for Medicare to send them to Impact you could be waiting a very long time. Impact cannot process your bills until AFTER Medicare has processed them and you have submitted them to Impact.
Completing a medical expense form requires detailed information. Please provide as much as you can to ensure timely processing. Missing information may delay processing.
One of the most important things to include is the billing codes, or you can just ask your provider for the CMS1500/HCFA form or UB04 form to submit with your MSN or EOB.
Medicare should pay their portion of the bill and once you pay your $1000 PRA, Impact will share the remaining 20% of all eligible medical bills.
Remember that first, you must pay your Primary Responsibility Amount (PRA) of $1000 before Impact members will share the portion of your Eligible Medical Bills that Medicare allows but does not pay completely.
For instructions on how to upload the forms and to access the forms please visit our forms page here: https://www.impacthealthsharing.com/forms
For prescriptions to be eligible for sharing, members must have Medicare Part D.
Members must submit their Medicare Part D EOB to Impact through the Forms Section of your Member Center. Medicare will mail your Part D EOB monthly.
Going to the Doctor
Steps to Care
Impact Health Sharing is not a new concept, but it is a new blend of a lot of the things that work RIGHT in healthcare. And, getting the care you need is easy with a few simple steps.
1. Choose a Provider
Impact supports your choice to see any provider you choose.
If you would like help locating a provider, contact Impact Health Sharing and ask to speak with a Care Navigator.
2. Show Your Member Card
At every appointment, show your member card with Impact’s billing information. If the provider isn’t familiar with Impact or asks you to self-pay, don’t worry. Both situations occur, and neither prevents using your Impact membership or seeing your chosen provider.
3. Pay Your Provider Fee
You’ll have a small provider fee to pay at each visit. This fee is part of your agreement with Impact and is not part of the costs that are shared.
The provider fee is $0 for Urgent Care Telemedicine, $50 for each primary care visit, $75 per specialist or urgent care visit or $150 for an emergency room visit or hospitalization.
Steps to Sharing
When you get medical care with Impact Health Sharing, your doctor may bill Impact directly or ask you to self-pay.
Whether you submit your bills for sharing directly to Impact or your provider submits them to us, you are still saving with Impact and seeing the provider you choose.
- OPTION A: DIRECT ELECTRONIC BILLING
Some doctors bill Impact directly. They handle the billing, and Impact coordinates the healthcare costs with them. Your bills must be eligible for sharing, and your PRA must be met before any costs can be shared. The exception here is your annual physical and a $150 lab allowance, which are shared fully, even if you haven’t met your PRA.
- OPTION B: SELF-PAY
If your healthcare provider requests payment in advance, proceed with the payment and then submit your receipt and bill to Impact using the Medical Expense Form. When you pay cash, ensure you obtain a HCFA, UB, or at the very least, an itemized bill. Don’t forget to ask for a ‘cash pay’ discount or ‘self-pay’ discount, as these can significantly reduce your out-of-pocket expenses.
Eligible medical bills will either be applied towards your Personal Responsibility Amount (PRA) and co-share or, if your PRA has already been met, they will be published for sharing and subsequently reimbursed.
If these costs are from your annual physical or $150 lab allowance, you will be reimbursed once the bill is processed. No need to meet your PRA first.
In the end, whether your doctor bills Impact directly, or you pay first, your medical needs can be shared through Impact Health Sharing, as long as your costs are eligible for sharing and your PRA is met. Both methods are just different ways to handle payment.
Impact Health Sharing Provider Education.
Provider Outreach Request
If your provider is unsure or unwilling to accept Impact, please fill out the form below and we will reach out to them.
To ensure that our team can contact your provider, please make sure you have a scheduled appointment that is at least 72 hours after the submission of this form.
*Not applicable to participants of the Senior Program.
Provider Outreach Form
Click Here to View
Click Here to Download
Telemedicine
Telemedicine
Steps to Care
Using urgent telemedicine is easy, convenient, and revolutionizing the way we receive medical care. With just a few clicks, you can connect with a healthcare professional from the comfort of your own home. Say goodbye to long waiting times and the hassle of traveling to the doctor’s office.
1: Log In
Log in to the Member Center and click on MDLive/My TeleHealth on the menu.
*Note, if you go directly to the MDLIVE site and not through the member center, you will be charged a consultation fee.
2. Schedule an Appointment
You can visit a doctor right away or schedule an appointment – all by phone or video on your computer or mobile device.
You will be asked to complete some basic medical history before your visit and choose your preferred pharmacy.
3. Feel Better
Get reliable care from board-certified doctors.
MDLIVE is dedicated to helping you get better and stay well. No surprise costs. No hassle.
If your provider prescribes a prescription, be sure to use your member card to access your savings.
There are no states where we don’t offer telemedicine, but some states have different video/audio visit requirements. When a visit geolocates to a state that requires video conferencing, the audio option will not be available.
Virtual Mental Health Care
Virtual Mental Health Care is eligible for sharing through a teletherapy provider approved by Impact.
Members must pay 100% of the session consult fee at the time of service and may submit proper receipts to Impact for processing via the Medical Expense Form.
Virtual Mental Health is considered a Specialist for provider fee purposes and is subject to the PRA and co-share.
Can a doctor prescribe medications through telemedicine?
Yes. When the doctor considers that medication is warranted, they can write a prescription for a non-narcotic medication (i.e., non-controlled substances), which can be sent directly to the pharmacy of your choice.*
As soon as your consultation is over, your prescription will be sent electronically to your pharmacy. If for any reason, your pharmacy is unable to receive e-prescriptions, a traditional prescription will be generated for the doctors to sign and fax. All prescriptions are fully compliant and include all of the required information.
Is there a list of conditions and medications that a doctor won’t treat or prescribe through telemedicine?
Yes, currently, our providers do not currently treat the following conditions through urgent care telemedicine.
Children under 3 with a fever need to be seen immediately by a doctor in an office setting.
Children under 12 years with ear pain can be treated through telemedicine if the pain is due to a virus (e.g.,colds) allergies, or external infection.
When the likelihood of an internal bacterial infection is high, which may require antibiotics, children should be seen immediately by a doctor in an in-office setting.
It is recommended that you contact your primary care doctor, go to an urgent care center, or the nearest emergency room, depending on the severity of the condition.
Medications which are unable to be prescribed through telemedicine:
Pricing
How Much Does It Cost?
The monthly cost is based on the age of the oldest person in your household, the number of people applying, and the Primary Responsibility Amount that you choose.
