MPB.Health Members

• Available Immediately: Sharing up to $175 per person/ per year for an annual provider visit is available upon membership start date and every 12 months from the shareable visit date. This can be any office visit. Naturopath, Dental, Vision, Mental Health encounter, etc.
•  Any additional services provided during the visit will be considered the member’s responsibility, including X-rays, lab/blood work, and other services.
• For these services, members may seek assistance from MPB Health Concierge  1-800-519-2969
• Huge Discounts on Lab Cost can be found via Ulta Lab 
• Jason Health is delivering great prices

• Sharing for a screening colonoscopy is available every 10 years beginning at the age of 45 and after six months of continuous membership. Sharing is limited to $5,000 for the screening colonoscopy, anesthesia, diagnostic testing, biopsies, and pathology performed as a part of the screening. Any additional costs, services, or follow-ups will be the member’s responsibility. For high-risk members under 45, this service may be shareable with prior written approval. (Please contact concierge for assistance if approval is needed). 
• Cologuard is an acceptable screening substitution if a member chooses this method as their screening modality.
• All other colonoscopies are not shareable as a preventive service but may be considered for sharing as a separate sharing request dependent upon the reason and only with prior written approval from Zion HealthShare. All non-preventive colonoscopies are subject to the IUA.
   
• Sharing for a mammogram is available after six months of continuous membership and every year beginning at the age of 40. Sharing is limited to $600 for a 2D or 3D mammogram. The exam, appointment, and evaluation of imaging performed as a part of the screening will count toward the $600 limit. Any additional services provided will be the member’s responsibility. For high-risk members under the age of 40 this service may be considered for sharing with prior written approval.
  
  If the finding of the screening mammogram warrants an ultrasound, Zion HealthShare will consider sharing in the cost.
  
  All other mammograms are not shareable as a preventive service but may be considered for sharing as a separate sharing request dependent upon the reason and only with prior written approval from Zion HealthShare. All non-preventive mammograms are subject to the IUA.

• No network restrictions. Pre-payment is an option. Call Concierge at 1-800-519-2969 if you have any questions.

• Youth Immunizations
• Sharing for youth immunizations is available upon membership start date for members born in connection with an eligible maternity sharing request, and after six months of continuous membership for all other members up to the age of 18.
   
• Sharing is limited for each immunization dose as outlined below:
  ·       HPV (Human Papilloma Virus) – $254
  ·       Men (Meningococcal) – $202
  ·       PCV (Pneumococcal) – $227
  ·       RV (Rotavirus Immunization) – $131
  ·       IPV (Inactivated Polio Immunization) – $39
  ·       HIB (Haemophilus Influenza Type B) – $29
  ·       Hep A (Hepatitis A) – $36
  ·       Hep B (Hepatitis B) – $27
  ·       VAR (Varicella) – $151
  ·       DTaP (Diphtheria, Tetanus, acellular pertussis) – $35
  ·       Tdap (Tetanus, Diphtheria, acellular pertussis) – $35
  ·       MMR (Measles, Mumps, Rubella) – $251
• For more information please click here
• Well Child Visits
• Sharing for well child visits is available upon membership start date for members born in connection with an eligible maternity sharing request and after six months of continuous membership for all other members. Sharing is limited to $175 for the office visit costs, and associated immunizations are limited as outlined above and in the Youth Immunizations section.
  Qualifying visits are for children at the following ages:
• Birth
•  1 Month
• 2 Months
• 4 Months
• 6 Months
•  9 Months
• 12 Months
• 15 Months
• 18 Months
• 30 Months
• 36 Months
• Blood Tests: Any blood work that is not part of a new "Needs Case" is not included. MPB Health Concierge Team is very helpful in assisting you, Here are some great resources though for you to begin with:
• Jason Heatth
• Ulta Lab 
• Quest Direct

• Immediate Access to all 93 Preventative Services and Screenings: This is the one time where you WILL show your card (Planstin) 
• Option 1 - If your provider is within the PHCS Multiplan network they can bill that way 
• Option 2 - You may use ANY provider that is able to bill by simply saying this, "my self funded insurance plan utilizes Reference Based Pricing. They should be familiar with RBP but suggest that they contact Planstin (number on card) if they have any questions.
• Keep any Preventative Visit strictly visits strictly Preventative.
• Any Diagnostic coding will make this visit a sick visit and not eligible as a Preventative visit. Communicate this to your provider. They will understand.
• Reference the list of Preventative services prior to your visit as things do change with the government dictates as to what is or what isn't included. 
• The major items include: Annual Wellness, Well Woman, Pap Smears, Generic Birth Control options, 2D Mammograms, Well baby, Vaccinations, Colonoscopy.

For the blood work you desire that are included as part of the insurance:

1. Cholesterol screening for adults of certain ages or at higher risk This includes Total cholesterol, LDL (bad) cholesterol, HDL (good) cholesterol, Triglycerides
2. Diabetes Blood Test
3. HIV Test
4. Hepatitis B screening for people at high risk

Three Options to keep costs down for additional blood tests: 

1. Ulta Lab - You will choose the tests you want, pay online and then go to a local lab for the draw. In my experience this offers the best prices, convenience & simplicity
2. LabCorp has a Self Pay rate structure called a LAP rate. 
3. Quest also has a Self Pay rate structure within their company called Quest Direct. 
4. Jason Health is delivering great prices

Co-Pay Visits as follows: In PHCS Multiplan Network

• Primary Care Office Visits - $20 Co-Pay - Unlimited Visits
• Specialist Office Visits - $50 Co-Pay - Unlimited Visits
• Lab/Blood Work - $10 Co-Pay- 10 per member/ per year
• X-rays -$50 Co-Pay - 5 max per plan year/ per person
• Urgent Care - $50 Co-Pay - 5 max per plan
• This Secure Option is NOT HSA compatible
• Stay within the PHCS MultiPlan Network for these 

Out of Network

• Primary Office Visit $50 - Max 5 visits per year
• Specialists Visit $100 - Max 5 per year
• Urgent Care $100 - Max 5 per year
• Xray $100 - Max 5 per year
• Labs $25 - Max 10 tests per year
• CAT/ MRI $400- Max 2 per year