Align Health
Frequently Asked Questions

A smart alternative to traditional insurance

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General Questions

Yes. Providers are usually board-certified physicians. In some instances, a practice may offer a nurse practitioner (NP) or physician’s assistant (PA)

If emergency or life threatening, seek a hospital or call for an ambulance. In most cases, your DPC or VPC should be accessible via text, email or virtual to help advocate, navigate and coordinate care. If needed, the Medical Cost Share program would kick in once the member pays their Initial Unshareable Amount (IUA) coordinating with Zion Health using their customer service and ID card.

No. Typically membership rates do not change with DPC unless a provider re-negotiates their contract for some unexpected reason. Members would be notified in the event this occurs.

No. At this time, DPCs are not recognized by IRS to be paid with pre-tax or HSA payments.

No. This program is NOT insurance and does not qualify for the employer tax credits.

Our programs do not accept members 65+ however, some DPCs standalone may allow for 65+. Members would need to check with individual providers to identify.

Not unless combined with a qualified Minimum Essential Coverage (MEC) plan. Associations and groups may qualify for our MEC options. Individuals are not allowed on our MEC plans.

Yes. We have 1-888 numbers and help desks for member convenience.

Yes. We offer both digital and hard copy formats.

There is no “open enrollment” since these are month to month programs.

Termination can be done at anytime up till the 21st of the month at midnight just like enrollment.

This is a healthy consumer advantage healthcare plan compared to traditional insurance.

Direct Primary Care (DPC)

In the United States, direct primary care (DPC) is a type of primary care service, billing and payment arrangement made between patients and medical providers, without sending claims to insurance providers.

Understanding DPC: What is Direct Primary Care?– YouTube

Understanding Align’s DPC Program: Understanding Aligns’ Direct Primary Care Program – YouTube

No. Membership is not insurance. Align provides a healthcare membership based on the direct primary care (DPC) payment model – an innovative alternative payment model that consists of a flat and affordable membership fee. This membership provides unlimited access to primary care.

The Align Health Advantage: HEP’s Self-Insured Advantage – YouTube

No. However, a few select providers may limit or cap the number of annual visits per member. New members should check the provider notes upon enrollment to confirm.

No. Members can select from our national directory where contracted providers are located. Also, if members have an existing primary care provider interested in working with our program, we can arrange to contract with them.

Direct primary care providers accept members regardless of any pre-existing conditions.

DPCs often coordinate care and refer to specialists when needed. No network required allowing members freedom to choose any specialist desired worldwide. This allows members to utilize their Medical Cost Sharing program once they have paid their initial unshareable amount (IUA) – (See Medical Cost Sharing)

Yes. With our Silver and Gold Plans combining the Medical Cost Sharing benefit which pays for medical needs once a member has paid their Initial Unshareable Amount (IUA).

Some DPCs offer x-ray in-house where others refer or recommend local arrangements at significant discounts. Members with Medical Cost Share program may choose to submit for payment if more than their Initial Unshareable Amount (IUA).

Our programs have partnered with Quest Diagnostics thru Akos MD to offer a significant direct pay national discount. Members would just need to contact Akos MD to coordinate discount at point of service.

Our Gold and Gold Plus programs are DPC programs.

Virtual Primary Care (VPC)

VPC is a new genre of primary care. It is an ongoing relationship members enjoy with the same doctor offering 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

DPC is considered “hands on” or onsite primary care where VPC is “virtual” or mobile interaction with primary care. Most DPCs offer both “hands on” and virtual services.

Virtual primary care providers often refer to “fee for service” doctors near members’ needs when required at discounted direct pay (cash pay) rates. Members also submit medical needs to be paid through their Medical Cost Sharing plan once they have paid their Initial unshareable Amount (IUA) first.

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. 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.

When medically necessary, Akos physicians are able to prescribe a wide range of medications to treat your condition. Akos physicians do not prescribe or renew a prescription for controlled substances regulated by the U.S. Drug Enforcement Agency that have been designated as U.S. controlled substances.

If our physician determines a medication is medically necessary, they can write a prescription for non-controlled medications which will be sent electronically to the pharmacy of your choice.

Our Basic, Silver, and Silver Plus Programs are VPC programs.

Medical Cost-Sharing

A membership-based non-insurance arrangement established for the purpose of sharing legitimate healthcare expenses between members.

Understanding Medical Cost Sharing: Zion Health Introduction on Vimeo

Intro Slide: Resources | Zion Health | Medical Cost Sharing

IUA is the amount paid by the Member before the Zion Health community shares in Medical Expenses. This amount is also known as your personal responsibility. Zion Health has three primary levels of personal responsibility. $1,000, $2,500 and $5,000. The lower the Initial Unshareable Amount, the higher the monthly sharing contributions.

Understanding the IUA: IUA 01 – How the IUA Works on Vimeo

Benefits of the IUA: IUA 02 – Why You Benefit From IUAs.mp4 on Vimeo

Member households that experience multiple needs within a 12-month rolling membership year are asked to pay up to three Initial Unshareable Amounts per year. Additional needs that meet a $500 threshold would be considered fully shareable with the Zion Health community.

Pre-existing conditions have a waiting or phase in period. Zion Health attempts to negotiate all medical bills received and many membership types include the PHCS network for pre-negotiated medical expenses.

  • 1st Year of Membership – Waiting period of all pre-existing conditions
  • 2nd Year of Membership – Up to $25,000 of sharing for pre-existing conditions
  • 3rd Year of Membership – Up to $50,000 of sharing for pre-existing conditions
  • 4th Year of Membership and Beyond – Up to $125,000 of sharing for pre-existing conditions per year

Zion Health recognizes that every situation is different. Zion Health reserves the right to make exceptions for certain medical conditions on a case-by-case basis provided it serves to benefit the membership as a whole. Exceptions for high blood pressure, high cholesterol and diabetes (type 1&2) will not be considered a pre-existing condition as long as they have not been hospitalized for the condition in the past 12 months and able to control through edication or diet.

No. This is not an insurance plan and is not compliant with the ACA.

Member households that experience multiple needs within a 12-month rolling membership year are asked to pay up to three Initial Unshareable Amounts per year. Additional needs that meet a $500 threshold would be considered fully shareable with the Zion Health community.

Processing a Need: Zion Health and Member Needs on Vimeo

Typically, eligible reimbursement is made to Members or payment to the providers from the Benevolent Fund is completed within 5-7 days once all documentation has been received.

There are no lifetime or annual maximum amounts eligible for sharing for most medical needs. There is no limit on the number of needs that an individual Member or household may have.

For Health Care Providers

Yes. Align has a basic scope of services template. DPCs have the option to upsell additional services once members are established. These financial arrangements would be between the DPC and the member.

There are two options. Providers can be paid either through HintOS (preferred) or directly from Align Health.

There truly is no flexibility on pricing for our “basic” DPC offerings through this association opportunity. If a provider chooses to participate in our “core” DPC options down the road, we have more leeway in pricing.

There is no set yearly open-enrollment time period. Member enrollment is on a rolling monthly basis. Members must sign up by the 20th of the month in order to have an effective date of the 1st of the following month.

Unfortunately, we do not have exact figures from the association. Depending on rural vs. metro areas there are hundreds up to thousands of eligible members in the various locales across the nation.

Align Health has a single sign-on portal which handles onboarding and enrollment, resulting in a seamless, user-friendly member and provider experience.

No. There is no administrative bureaucracy or reporting requirements in order to participate in our program.

Processing a Need: Zion Health and Member Needs on Vimeo

No. This program is completely free for DPCs to join.

No. If you are not currently a Hint client, Hint can create a basic, free portal for member eligibility and tracking.