DirectCare

Offering Apex Direct Minimum Essential Coverage (MEC) Plans

Including Direct Primary Care, Urgent Care, TeleHealth & RxSaver4UNow
Offered through the National Consumers Benefits Association

We provide access to affordable healthcare and lifestyle benefits to the growing number of people who do not have access to employer-sponsored healthcare and benefits, including:

  • Individuals, families and seniors
  • Small Businesses
  • Service Industry Workers, Freelancers and the Self-Employed

Benefits4UNow offers only the most valuable solutions from trusted names in the benefits industry. We work closely with our business partners and vendors to ensure these products meet our extremely high-quality standards. These partners include:

  • Apex Management Group
  • DirectCare One Call Concierge
  • RxSaver4UNow
  • Healthcare2U

So why do you need Benefits4UNow? Not so long ago, the Apex Plans were Minimum Essential Coverage (MEC) Plans. MEC plans were implemented at the start of the Affordable Care Act (ACA). An employer group of 50 or more had to have a plan in place that provided Minimum Essential Coverage to satisfy Employer Penalty A. Individuals needed to be enrolled in a MEC Plan through an employer or were forced to pay the Individual Mandate Penalty. Thus, the core purpose of MECs was to meet ACA requirements.

To meet the Minimum Essential Coverage requirements, a MEC Plan was required to provide the preventive care services mandated by ACA. Today, the mandated preventive care services encompass 80 preventive care services, inclusive of 21 preventive care services for adults, 28 for women and 31 for children. To see a complete list of covered preventive care services, please visit:
www.healthcare.gov/coverage/preventive-care-benefits/

The Benefits4UNow plans, however, go much further.

Combining MEC with Direct Primary Care and robust RX coverage with Care Concierges who navigate to lowest cost and quality providers, our members have direct access to discounts on care beyond the simple stated benefits.

Our plans address the bulk of an individual’s or families day-to-day health care expenses by providing benefits for primary care, specialists, urgent care, lab, imaging and prescription drug coverage, all with a small Fee and 100% coverage through a national network of physicians and facilities.

For the unforeseen medical care that may involve hospital inpatient or outpatient care, emergency room, surgery, or a critical illness such as cancer, heart attack, etc., we have integrated a solution to purchase coverage specific to each members needs as well as a care concierge team to advocate on your behalf.

Take Control Of Your Healthcare

Round out your coverage with affordable and customized plan options, including:

  • Short Term Medical
  • Accident
  • Hospital & Surgery

In today’s environment of rapidly rising premiums, controlling your health benefit costs is a challenge. DirectCare’s non-traditional and innovative approach to healthcare rewards offers consumers more flexibility, more control, more transparency and more potential savings. To access and learn more, click Sign-Up For Direct+Care.

SIGN UP FOR DIRECT+CARE

All the Critical Components for Truly Affordable Healthcare

Benefits4UNow integrates and coordinates five major components to provide a premier customer experience.

1.RxSaver4UNow
Prescriptions, advocacy & nationwide access, including $1 generic drugs.

2. Direct Primary Care
Nationwide, Direct Primary Care membership that provides unlimited access to primary medical care, virtual DPC/telehealth, urgent care and chronic management for 13 disease states (disclaimers apply).

3. Alternative Medical Benefits
Minimum essential coverage (MEC) for preventive coverage, such as well visits and screenings, plus labs, imaging, urgent care and access to specialist care.

4. Concierge
Coordinated member support & advocacy, member app and ONE CALL coordination with on-demand contracting for access to care across the country.

5. Choice
Professional advocates to determine what level of coverage best suits your specific needs, including selecting ACA plans, indemnity plans, dental, vision or discount plans, or even alternative level funded group offerings.


Healthcare2U’s Direct Primary Care Membership

The Direct Primary Care portion of this membership is provided by Healthcare2U. Healthcare2U’s mission is to provide affordable and convenient access to excellent primary medical care, wellness and chronic disease management. We deliver the Direct Primary Care Plus (DPCplus) membership to individuals ages 2 to 65 and accept pre-existing conditions within manageable ranges. Through their proprietary Private Physician Network (PPN)TM, Healthcare2U is breaking down the barriers to convenient access to quality primary care with a focus on promoting healthy living while preventing disease. Members receive the unlimited services listed below by scheduling care during business hours (disclaimers apply).

Unlimited Direct Primary Care*

      • Unlimited doctor visits with a $10 visit fee
      • Unlimited urgent care visits with a $25 visit fee
      • Annual physical * with four labs: complete metabolic panel (CMP), complete blood count (CBC), thyroid stimulating hormone (TSH) and lipid panel
      • Patient navigation center staffed by bilingual medical assistants to schedule care for members and eligible participants

Unlimited Virtual DPC*

      • Unlimited access to bilingual licensed medical providers online or by phone, 24/7/365 for minor illnesses and injuries at $0 out of pocket cost to members

Unlimited Chronic Disease Management*

Unlimited treatment and management of 13 chronic disease states for the same $10 visit fee. Healthcare2U accepts pre-existing conditions within manageable ranges, including:

Anxiety Depression
Arthritis Diabetes
Asthma Fibromyalgia
Blood Pressure GERD
CHF Gout
COPD Hypertension
Thyroid

Healthcare2U Disclaimers (DPCplus):

* No walk-ins allowed. Unlimited services (including Virtual DPC/telehealth) must be accessed through Healthcare2U’s Central Scheduling Department (CSD). In-office appointments are only available within business hours (Monday through Friday, 7 AM to 6 PM CST). TheCSD may direct the member to another level of care if appropriate, depending on the member’s condition and utilization of services

-Healthcare2U’s Direct Primary Care is a healthcare membership. It is not insurance. 

-Well-woman pap smear pathology interpretation is not included. Annual physicals are only available to members with six consecutive months of membership.

**Telehealth services are provided through MeMD, a third-party provider. When medically necessary, MeMD’sproviders can submit a prescription electronically for purchase and pick-up at your local participating pharmacy; however, MeMDproviders cannot prescribe elective medications, narcotic pain relievers, or controlled substances. MeMD’sproviders are each licensed by the appropriate licensing board for the state in which they are providing services, and all have prescriptive authority for each of the states in which they are licensed. MeMDprovides access to online medical consultations with physicians, nurse practitioners, and physician assistants who can write prescriptions when medically necessary and permitted by state law. MeMDis not an online pharmacy, and medications cannot be purchased or dispensed from MeMDdirectly. MeMDis not a replacement for your primary care physician or annual doctor’s office visit. Subject to state regulations, MeMDis available nationwide with providers licensed to practice in your state who use video and/or audio technology.


 

RxSaver4UNow – Pharmacy Savings Program

RxSaver4uNow provides direct access to medications at negotiated PBM pricing and Home Delivery Pharmacy pricing on a pre-paid basis. Rx Savings4Unow offers solutions for high priced specialty drugs via an International Pharmacy of PAP service. This is a pharmacy subscription service. This is not insurance.
Benefits include:

      • 200 medications for $1, plus thousands more for just $10 and up
      • Diabetic supplies at deep discounts
      • Rx card to use at more than 65,000 pharmacies, including CVS, Walgreens, Walmart, Kroger and more
      • Deep discounts on name-brand medications exclusively through our international
        pharmacy
      • $1 Men’s Health Meds – generic Viagra® and Cialis® (terms and conditionals apply)
      • And more

 


 

Suite of Healthcare Solutions

Review the plans below, and determine what plan may be best for you and your family.

PPO Network Services: PHCS

Preventive Benefits –Covers all mandated Preventive benefits required by PPACA
Note: This list will be updated from time to time and a current list of covered preventive services is is available by visiting:

www.Healthcare.gov/center/regulations/prevention.html

Medical Benefits -Must utilize PHCS participating provider or facility






Apex Mgmt. Goup MyDPCPlus and RXSaver4UNow DirectMEC + Adv. Rx DirectMEC + Adv. DPCPlus
• 21 Preventive Services for Adults
• 28 Preventive Services for Women
• 31 Preventive Services for Children
Not Included:
See MyDPCplus Benefits
100% Coverage for Affordable Care Act Mandated Preventive Care Services 100% Coverage for Affordable Care Act Mandated Preventive Care Services
Virtual DPC / TeleHealth $0 Consultation Fee
Primary Care Office Visit $10 Visit Fee
(Unlimited DPCplus)
$20 Copay
(Max 3 visits per calendar year)
$10 Visit Fee
(Unlimited DPCplus)
Specialists Office Visit Not Covered $20 Copay
(Max 3 visits per calendar year)
$20 Copay
(Max 3 visits per calendar year)
Urgent Care $25 Visit Fee
(Unlimited DPCplus)
$20 Copay
(Max 3 visits per calendar year)
$25 Visit Fee
(Unlimited DPCplus)
Diagnostic X-Ray, Lab Not Covered
Call Care Concierge
SAVE 10% to 80%.
$50 Copay by DOS
(Max 5 services per calendar year)
$50 Copay by DOS
(Max 5 services per calendar year)
CT Scan or MRI Not Covered
Call Care Concierge
SAVE 10% to 80%.
$200 Copay
(Max 1 CT Scan or MRI per Calendar Year)
$200 Copay
(Max 1 CT Scan or MRI per Calendar Year)
**Hospital, Surgical, Ambulance, Emergency Room Not Covered
Call Care Concierge
SAVE 10% to 80%.
Not Covered
Call Care Concierge
SAVE 10% to 80%.
Not Covered
Call Care Concierge
SAVE 10% to 80%.
*3D MRIs or Contrast Services for MRIs and CT Scans are not covered, pre-authorization required prior to scans.
**Hospitalization services must be obtained at an authorized PHCS Facility.
Pre-authorization required prior to admission for all inpatient, outpatient and surgical procedures.
***Exclusions for Hospital Benefit: Radiation Oncology and Chemotherapy.
RxSaver4UNow (See Above)
Direct Primary Care powered by Healthcare2U - DPCplus Membership (See Above - disclaimers apply)
Contribution Schedule (Rates)
Four Year Rate Lock: Increase in years 2 through 4 cannot exceed 3% on an accumulative basis
Member Only $93.89 $142.23 $188.62
Member + One (Spouse or Child) $148.70 $200.30 $289.99
Member + Children $194.37 $214.36 $347.78
Member + Family $260.35 $271.94 $463.39
Disclaimer: Apex Management Group Suite of Healthcare Solutions are not insurance products, but self-funded plans.
Please see Plan Document and SPD for full details
SIGN UP FOR DIRECT+CARE

Steps to Use Direct Primary Care, RX, DirectMEC Advantage Benefits

Members make just one call to DirectCARE for all their benefits.
Everything begins with a phone call. 1-800-288-1349.

Based on the member’s needs and question our staff provide information and support including:

– One-call care concierge & advocacy
– Proactive provider scheduling
– Bill negotiation for non-covered services
– Discounts & payment terms for out-of-pocket
– Surgery saver for non-emergency procedures Up to 10% to 80% discounts!

If member is feeling ill when they speak with the care concierge, our staff will direct you accordingly.

DirectCare

 


Member Experience

DirectCare

The member experience aggregates medical benefits, pharmacy benefits, vendors, digital services, API services and contracts onto a central data repository that can be distributed through a single member app and portal.

Medical Benefits

One-stop location to find and access all medical benefits including enrollment, find a provider, claims, authorization access and savings.

Drug Benefits

One-stop location to access all drug benefits including price check, health savings, mail order, cash card, and medication therapy management.

Health Wallet

Document Library to Store ID Cards, Benefit Guides, FAQs, Receipts etc. Access Out of Pocket financing and extend payments over time for unexpected care.

FSA/HSA/ICHRA Receipts

Automatic or manual generation of health savings account receipts with API integration available.

TeleHealthPortal

One Call Telehealth services accessible through member App and coordinated through Care Concierge team of advocates.

Education / Enrollment Center

Access all of Benefits4UNow’s suite of valuable tools from lifestyle or financial wellness, to additional insurance coverage, to discounts on all your everyday needs.

WE’RE TRUSTED

Responsibility

WE’RE INNOVATIVE

Creativity

WE’RE CARING

Quality

We’re Here To Help Your Small Business

Through Creativity, Integrity & Innovation

LEARN MORE!

Meet Our Customers

OUR PROVIDERS DELIVER

TRUSTED SERVICES

OUR BENEFITS IMPROVE

QUALITY OF LIFE