beCause health FAQs
Who is beCause health?
beCause health is an Independent Marketing Organization (IMO) offering healthcare solutions through self-funded and Medical Cost Sharing (MCS) programs. Our Co-Founders represent over 75 years of management, marketing, and sales within the employer group health space.
Is beCause health an Insurance Company?
No, beCause health offers multiple alternative healthcare solutions (not insurance) to employer groups with 5 to 49 employees.
Is beCause health available in all states?
Currently, beCause health does not offer products in the following states: CA, DC, IL, MA, MD, MT, NJ, NM, NY, PA, RI, VT, and WA.
What features are included in beCause health?
Our base product HealthEase includes general telehealth, primary care telehealth, behavioral telehealth, patient advocacy, and medical cost sharing for employee’s larger qualified medical expenses. Additional coverage can be added through two Minimal Essential Coverage (MEC) options, a Copay MEC and an HSA MEC.
Is beCause health compliant with the Affordable Care Act (ACA)?
Our base product HealthEase is not ACA compliant. However, since beCause health is only offered to employer groups with less than 50 (full-time equivalent) employees, there is no ACA Mandate. If the employer group adds the optional MEC (Minimal Essential Coverage) to their plan, then the ACA Penalty A will be satisfied.
Telehealth FAQs
What is Telehealth?
Telehealth (sometimes called Telemedicine) lets you see a health care provider without having to go to their office. You can access telehealth video or phone consultations via your computer, tablet, or smartphone.
What’s the difference between General Telehealth and Primary Care Telehealth?
General Telehealth is 24/7/365 access to a board-certified U.S. licensed physician for a quick diagnosis, treatment options, and prescriptions when medically necessary.
Primary Care Telehealth is where the member chooses a dedicated, board-certified U.S. physician for ongoing, personalized care. This is completely separate from any medical plan and allows you to build an ongoing relationship with a Virtual Primary Care Physician.
What is Behavioral Telehealth?
Members can schedule convenient, discreet consultations (typical virtual visits are 45 minutes) with Behavioral Health specialists, including psychiatrists, psychologists, counselors, clinical social workers, and therapists.
Is there a cost each time I use my Telehealth services?
No. General Telehealth, Primary Care Telehealth, and Behavioral Telehealth are available with no appointment fees.
Medical Cost Sharing (MCS)FAQs
What is Medical Cost Sharing?
Medical Cost Sharing is a non-insurance alternative healthcare approach to traditional health insurance. It involves a community of like-minded individuals and families who agree to share each other's medical expenses. Members typically pay a monthly "share" into a pool, which is then used to cover the medical expenses of other members as they arise.
Members agree to abide by certain guidelines, such as leading a healthy lifestyle and not engaging in certain high-risk behaviors. Additionally, pre-existing conditions may not always be shared.
Does Medical Cost Sharing charge a monthly premium?
No. Since medical cost sharing is a membership and not health insurance, there are no premiums. Members contribute a predetermined amount each month; called a monthly “Medical Cost Sharing Amount”, “Share", or "Contribution."
Does Medical Cost Sharing use deductibles and co-insurance like traditional health insurance?
No. When a member incurs an eligible medical expense that exceeds their Initial Unshareable Amount (IUA) of $500, $1,000, or $1,500 for a specific eligible Need, any remaining balance relative to that specific Need is eligible for sharing consideration once the IUA for that single Need has been paid by the member.
Can I choose my own doctors and hospitals?
Yes. Members are free to select their providers based on personal preference, value, cost, convenience, with no “out-of-network” penalties.
Is there yearly or lifetime sharing maximum per member?
No. There is no annual maximum dollar amount or lifetime maximum limits per Member. Note: there are certain dollar amounts and/or visit limits that apply to specific types of medical care and therapies.
How does Medical Cost Sharing (MCS) share expenses related to Pre-Existing Medical Conditions?
A Pre-Existing Medical Condition is any medical condition (diagnosed, suspected, or producing observable signs or symptoms) that existed prior to your membership.
No prospective member is denied membership based on having Pre-Existing Medical Conditions, but any conditions that existed within the 36 months immediately prior to your membership would:
· not be shareable during the first 12 months of your plan.
Then, from months:
· 13 to 24, your pre-existing condition would be shareable up to $25,000.
· 25 to 36, your pre-existing condition would be shareable up to $50,000.
· months 37 and after, your pre-existing condition would be fully shareable.
Minimum Essential Coverage (MEC) FAQs
What is an MEC?
Under the Affordable Care Act (ACA), minimum essential coverage (MEC) is any health insurance coverage that meets the individual shared responsibility requirement, also known as the individual mandate. While the federal tax penalty for not having MEC is no longer in effect for individuals (in most states), MEC is essential for various types of employer-sponsored healthcare benefits.
Do I have to stay within a provider network?
Yes and No. When choosing your Primary Care Physician for your preventative care, you may select the provider of your choice. For all other services, our Care Advocacy team will guide you to high quality, fair priced options, especially for certain specialists and procedures like mammograms and colonoscopies.
What’s the difference between the Copay MEC and HSA MEC?
Both MEC plans provide 100% coverage of the federally mandated preventive services at no cost to the member.
For sick services, the Copay MEC has low copay rates for primary care and specialist office visits, urgent care visits, and labs.
The HSA (Health Savings Account) MEC is an HSA compliant, high-deductible plan which allows the member to participate in an HSA. The money the member deposits into their HSA account can then be used to pay their qualified out-of-pocket medical expenses.
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