How can we help you?

First, this is a program that members will have a stake in, and you stand to benefit directly from the performance of the program in the form of better or more affordable premiums and healthcare each year going forward.   Second, the program uses an “open-network”.  If your provider is not in the PHCS network, the plan coordinates payment with any doctor.   

Finally, plan designs are simple. Your deductible and out-of-pocket maximums are the same – once you hit your deductible, claims are paid at 100% and you meet your out-of-pocket maximum for the year.   

Start by searching the PHCS network by clicking here. If your provider does not appear, no problem!  You use any doctor you choose.  Simply provide your card to your physician’s office and have them contact the claims team to coordinate payment. Contact information will be on the back of the card, just like other insurance cards you are used to using.

Yes, you can go to any provider you choose, even if s/he is not in the PHCS network.  The same goes for hospitals and other in and outpatient care facilities.  Simply provide your medical card and have them contact the claims team to answer questions and coordinate payment.

Similar to ACA plans, qualified preventative services are not subject to the deductible, and are covered 100% by the program.

There are three plan designs to choose from when you enroll. Once contracts are signed, you will have to wait until your renewal to select a different plan design.

• Two of the three plans ($2,500 and $5,000 deductibles) are HSA eligible.  There is no sponsored HSA vendor, but you can set up your own individual HSA account through a number of sources. Your bank or credit union may offer individual HSA accounts, or use an internet-based HSA provider, such as ConnectYourCare or HealthEquity.

Similar to ACA plans, there are no annual or lifetime limits on benefits. This is NOT a limited medical or short-term medical plan.   

Depending on the plan design you choose and whether you have dependents covered, your deductible will vary. One of the key features of these plan designs is that the deductible and out-of-pocket maximum are the same, so once you meet your deductible, qualified benefit services are covered at the 100% level.

Prescription coverage is detailed in the plan summaries, and the pharmacy formulary can be found here.  Please read the formulary carefully.

Simply provide your coverage card to the provider’s office staff.   

You can choose any provider you wish; your benefits are not different if you see a PHCS provider or a non-PHCS provider.

Reference-Based Pricing is a healthcare cost containment model provided by AMPS that reviews claims, adjusts for errors, and provides fair pricing recommendations based on several benchmarks, including Medicare, cost of care, and regional cost data. This model is used to eliminate the fraud, waste, and abuse that is prevalent in the healthcare billing system today. Participating members and the Captive will benefit from this solution.

We recommend Members contact the AMPS Care Navigation Team to find the best facilities based on quality and cost metrics. This team, in collaboration with the Member, uses the Provider Finder to locate a “friendly” provider for medical care, based on cost, quality, location, and prior utilization. You can reach the AMPS Care Navigation Team at 800-425-9374 (this number will also be on your card).

Yes. The AMPS Care Navigation Team can facilitate access to Members’ healthcare resources by ensuring personalized services that support their healthcare needs. One of the benefits of the Vault/Captive relationship is a partnership with Edison Health. Members have preferred pricing and access at Mayo Clinics, The Cleveland Clinic and many more leading medical facilities.

Yes – we recommend the Member contact the AMPS Care Navigation team, as many providers require authorization prior to some procedures and surgeries.

Medical equipment is reimbursed at 100% after the deductible is reached. Durable Medical Equipment is defined as: able to withstand repeated use; primarily and customarily used to serve a medical purpose, and not generally useful to a person in the absence of sickness or bodily Injury.