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        Included in the Program

 

1. Naturopathic /Alternative /Holistic Treatments.

Any licensed natural medicine practitioner may serve as your primary care physician. An initial scheduled visit does not need co-op pre-approval for reimbursement. Once a diagnosis is reached then your provider will submit to the dianosis and the treatment plan for pre-approval and provider reimbursement as long as the following criteria is met:

 

a. Diagnosed by a state licensed practitioner; MD, DO, ND, Chiropractor, Nurse Practitioner, etc. 

 

b. Natural treatment must be less invasive than conventional for the diagnosed condition

 

c. Natural treatment(s) must cost less than a conventional equal 

 

d. Natural treatment(s) must prevent more costly conventional expense

 

e. Natural treatment(s) must be co-op pre-approved

 

f. Member must agree to other procedure if a lower cost treatment achieves the same result

 

Approved Natural Treatments Include:

·   Acupuncture

·   Chiropractic (12 treatment cap unless pre-approved)         .    Alternative Clinics

.    Kinesiology

·    Herbal Regimes

·    Massage Therapy

·    Homeopathy

·    Colonics

·    Emotional Clearing

·    Detoxification Protocols

·    Holistic Clinics

·    Energy Therapy

·    Chinese Medicine

·    Energy Healing

·    Intravenous Vitamin C

·    Curaderm cream

·    RGCC ONCOSTAT PLUS Test

·    ONCOblot Blood Test

·    Hemp Oil 

.    Hemp Oil Cancer Treatments

·    GcMAF

·    Rife Technology

·    Reflexology

·    Essential Oils

·    Chelation

·    Oxygen Therapy

·    IV Therapy

·    Essiac 

.    Intravenous Sodium Bicarbonate

.    Stem Cell Treatments

·    Herbs & Supplements

·    Neurotransmitter Testing

·    Micronutrient Testing

·    Food Allergy Testing

·    Hormone Testing

·    Inflammation Testing

·    Lab/blood work

·    Thermography​

·     Isador (Mistletoe)

·     Heavy Metal Testing

·     DCA IV

·     LDN

·     Virus Therapy

·     Medical Tourism          

Plus even more with the science to back it up! 

 

2. Lifetime Limits. None

 

3. Experimental, Investigational or Unproven Services. Care and treatment experimental, investigational or unproven by the American Medical Association, FDA, or other industry recognized authoritative bodies, or illegal by U.S. law may be reviewed and approved on a case by case basis.

 

4. Pre-Existing.  Pre-existing exampt is a diagnosis or treatment in your medical record in the last 24 months. 

 

Pre-existing costs are NOT shared until a full year of continuous monthly membership. Benefits begin the 13th month to the 24th month at $25,000 for the pre-existing where all other health costs are day 1 - $1,000,000.00 health plan benefit.* Compare cost and value as follows;

 

Members with a pre-existing benefits apply month 13 - 24 

Single - Annual cost $4,259.88 = $25,000.00 in benefits

Married - Annual cost $5,959.88 = $25,000.00 in benefits

Family - Annual cost of $6,459.88 = $25,000.00 in benefits

 

Any health issue outside of pre-existing, member benefit is $1,000,000.00 per issue.

 

Month 25 of continuous membership  to month 36

pre-existing is $50,000 health plan benefits.

Single - Annual cost $4,259.88 =  $5o,000.00 in benefits

Married - Annual cost $5,959.88 = $5o,000.00 in benefits

Family - Annual cost of $6,459.88 = $50,000.00 in benefits

 

All health issues outside of pre-existing, member benefit is $1,000,000.00 per issue.

 

Month 37 there is no pre-existing

$1,000,000.00 limit applies per incident to all health issues including former pre-existing.

 

5. Eye care. Cataract removal and initial permanent lenses following cataract removal.

 

6. Braces. Original and replacement braces of the leg, arm, back, neck, or artificial arms or legs, unless there is sufficient change in the Member’s physical condition to make the original device no longer functional.

 

7. Pre-Notification of Medical Expense. Pre-Notification services for State exempt business or enterprise from participation in Workers Compensation. Documentation of exemption may be required and submitted in writing by the business owner and verified.

 

8. Cosmetic procedures. Cosmetic care and treatment provided for disfiguration caused by amputation, disease (including Acne), accident or breast reconstruction following a mastectomy, all eligible for sharing. 

 

9. Home Health Care. Skilled care services at home for up to 30 days by a Home Health Care Agency for each related medical incident provided such home care reduces the expected medical expense and replaces hospital or nursing home services.

 

10. Hospice Care. Hospice Care is limited up to 5 days of respite and /or comfort care in any 30-day period. Charges for Medical Social Services are limited to $200 of eligible expense.

 

11. Hysterectomy. Expenses related to a Hysterectomy are eligible for sharing only when a second opinion is received from a physician approved by the Co-op. The physician rendering a second opinion must examine the patient prior to surgery and must find that a hysterectomy is medically necessary. The Member must pre-notify the Co-op prior to surgery for referral to the second physician.

 

12. Occupational or Work Related Injuries. 

Expenses arising from the care and treatment of an injury or illness that is occupational, or arises from work for wage or profit, including self-employment, not eligible for sharing. However, such expenses will be considered for sharing if:

 

a. the State in which the injuries occurred has no Worker’s Compensation laws or 

 

b. State law defining participation in Worker’s Compensation system for costly future conventional treatment

 

c. the business owner has an objection to participation in insurance based on religious reasons 

 

13. Organ Transplant Limits. Expenses incurred in connection with any organ or tissue transplant may be shared among the members up to a maximum of $1,00,000 per organ per lifetime. 

 

This includes, but is not limited to, expenses incurred in evaluation, screening, transportation, candidacy determination process, organ transplantation, organ procurement, donor expenses, follow-up care, immunosuppressant therapy, and re-transplantation. This organ transplant limit includes, but is not limited to, transplantation of the heart, lungs, kidneys, liver, pancreas and bone marrow. 

 

14. Per Incident limits. The maximum amount to be shared among members for any one medical expense incident is up to $1 million per incident.

 

15. Physical Therapy.   Up to 20 visits per calendar year for physical therapy by a licensed physical therapist in accord with a Physician’s order to improve body function. The limit of 20 visits per membership year is combined with speech, and/or respiratory, and/or physical therapy, and/or occupational therapy visits.

 

16. Medical Necessity to help ensure cost-effective care. Pre-Notification can eliminate unnecessary services, hospitalizations, and shorten inpatient confinements, while improving quality of care and reducing expenses shared by the members. Certification of Medical Necessity by the Pre-Notification Staff does NOT establish eligibility for sharing nor guarantee that your needs will be met. To be considered for cost sharing, all inpatient hospital admissions MUST be notified IN ADVANCE (Pre- notification) by calling the Pre-Notification hotline, except for emergencies.

 

The term "Inpatient" includes any hospital admission that lasts more than 23 hours. The Sharing Member, their Physician, or their representative should call the Pre-Notification hotline at least seven (7) days prior to admission. To contact Pre-Notification, refer to the toll free number on the Member’s Welcome Packet. It is the responsibility of the Member to ensure that the Pre-Notification staff is contacted in order to be eligible for cost sharing. Pre-Notification is required for the following:

 

a. Charges for all Inpatient Hospital Confinements (including Hospital, Skilled Nursing,

b. Organ/Tissue Transplant Services

c. Emergency Admissions

d. For all Home Health Care Services

e. Outpatient Surgery

 

After admission to the Hospital, we evaluate the length of hospital stay to ensure proper care and make a recommendation as to the maximum days of stay. The Member and his/her Physician will be advised. If hospital confinement is no longer necessary, additional days will not be eligible for cost sharing among the members. 

 

All Emergency Hospital admissions AND Maternity admissions MUST be reported within forty-eight (48) hours following admission, or on the next business day after admission, for eligible sharing. If the Sharing Member is unable to Pre-Notify due to severity of the Illness or Injury, then a Physician, or a responsible party representing the member should Pre- Notify at the earliest time reasonably possible. 

 

To determine eligibility for sharing, all Emergency Admissions are reviewed retrospectively to determine if the treatment received was medically necessary, appropriate, and for emergency services.

 

17. Provisional Member Expenses.

Members with certain pre-existing conditions who are responsive to lifestyle changes are accepted as a member based on a mutually agreed upon treatment plan between the provisional member and the Co-op.

 

Certain expenses associated with a customized treatment plan may be eligible for sharing based upon review on a case by case determination of the Co-op to include, but not limited to,

 

smoking cessation

weight loss

dietary control

diabetic testing supplies 

other costs as incentive to lifestyle change

 

The normal pre-existing guidelines may be altered at the discretion of the Co-op to encourage participation in the Provisional Membership program as conducted, revised and implemented by the Co-op.

 

18. Wellness Visits.

Each member is given one wellness exam or physical per membership year. This is not part of the out-of-pocket unshared amount and is included as part of the health plan for health and wellness;

 

  • routine check-ups

  • labs

  • x-rays

  • pap smears

  • blood tests

 

Over age 50 members are eligible every two years and not subject to the annual unshared out-of-pocket amount for:

 

  • screening colonoscopies

  • PSA tests

  • mammograms or thermography

 

​Plus the health plan includes every year

 

  • Well baby visits

 

19. Maternity.

For a mother who has been a Sharing Member prior to conception, medical expenses for maternity are eligible for sharing up to the per incident limit per pregnancy (whether for a single or multiple birth pregnancy), subject to the applicable Annual Unshared Amount, including, but not limited to, charges and expenses arising from physician care, hospital or birthing center admissions, attendance by midwives, or home deliveries accompanied by a midwife or physician.

 

Medical expenses for maternity ending in a delivery by cesarean section that is medically necessary because of complications that arise at the time of delivery are eligible for sharing up to the per incident limit per pregnancy (whether for a single or multiple birth pregnancy), subject to the applicable Annual Unshared Amount.

 

Needs for maternity ending in a natural delivery but with complications that threaten the life of the mother or infant and requiring care or services not normally rendered at the time of delivery are eligible for sharing up to the per incident limit per pregnancy (whether for a single or multiple birth pregnancy) subject to the applicable Annual Unshared Amount.

 

20. Medical expenses for a newborn. Complications at the time of delivery, including, but not limited to, premature birth, are treated as a separate incident.

 

21. End of Life Assistance. For a Sharing Member, and/or his or her dependents, who dies after two years of uninterrupted participation as a Member, financial assistance to the surviving family is provided according to the following schedule:

 

Primary Applicant: $10,000.00

Dependent Spouse: $5,000.00

Dependent Child: $3,000.00

 

Financial assistance is for the surviving family end of life expenses, for medical, pharmacy, ambulance/emergency transportation, funeral/burial expenses. All members must list the benefactor and then notify the co-op in writing after 24 months of membership which is placed in the members file. Benefactor must notify the co-op and provide a hospital death certificate for assistence, 

 

A child applicant enrolled by a parent or guardian whose enrollment application is signed on behalf of the child by a parent or guardian, and who at the time of death is younger than 18 years of age, will be assisted at the same amount as a dependent child. 

 

*the co-op may disqualify select medical conditions from sharing

 

 

To Enroll Click Here

 

Co-op 2 Health Program Details

For Questions See FAQ's

Not Included

 

1) Abortion. Services, supplies, care or treatment in connection with an abortion unless the physical life of the mother is endangered by the continued pregnancy, and treatment via a cesarean section has been determined by a neonatologist to be inadvisable.

 

2) Alcohol/Drug Services, supplies, care or treatment to a Sharing Member for an Injury and/or disease and/or bodily malfunction which occurred as a result of that Sharing Member’s abuse and/or use of alcohol or drugs/pharmaceuticals, including Drug and/or Alcohol Rehabilitation Treatment.

 

3) Breast Implants. The placement, replacement or removal of breast enhancement devices and complications related to breast implants unless related to reconstructive mammoplasty.

 

4) Charges before or after Membership. Medical care, treatment or supplies for which a charge was incurred before a person was a Sharing Member or after membership ceased or became inactive.

 

5) Complications of non-eligible treatments. Care, services or treatment required as a result of complications from a treatment not eligible for sharing.

 

6) Custodial care. Services or supplies provided mainly as a rest cure, maintenance, custodial care or other care that does not treat an illness or injury.

 

7) Dental Care. Dental prostheses and care or treatment of the person’s teeth above or below the gums, except: the repair of sound natural teeth due to injuries that occur while the person is a Sharing Member. A dental plan is in development.

 

8) Durable Medical Equipment. The purchase, rental or replacement of durable or reusable equipment or devices, including, but not limited to, orthotics, prosthetics, hearing aids, tubing, masks and their associated expenses.

 

9) Emergency Room Charges When Not an Emergency. When treatment at an emergency room is not judged to be an emergency by normal standards of medical care and when less costly treatment was available by taking reasonable measures to seek such care.

 

10) Excess Charges. The part of an expense for care and treatment of an injury or illness that is in excess of the Usual, Customary and Reasonable Charge. Co-op has the discretion to decide, based on techniques and knowledge known to Co-op whether charge is Usual, Customary and Reasonable. Member does not share this expense among the members and advocates on behalf of the member against any healthcare service provider demanding payment of such Excess Charges.

 

11) Exercise programs. Exercise programs for treatment of any condition, except for Physician-supervised cardiac rehabilitation and or physical therapy.

 

12) Experimental, Investigational or Unproven Services. Care and treatment that is either Experimental, Investigational or Unproven by the American Medical Association, FDA, or other industry recognized authoritative bodies, or that is illegal by U.S. law. Eligibility for sharing of such expenses may be reviewed on a case by case basis.

 

13) Eye care. Eye exercise therapy, radial keratotomy or other eye surgery to correct near-sightedness. Also, routine eye examinations, including refractions, lenses for the eyes and exams for their fitting. This exclusion does not apply to the initial permanent lenses following cataract removal. (see the discount plan) 

 

14) Hair loss. Care and treatment for hair loss, hair transplants or any drug that promises hair growth, whether or not prescribed by a Physician.

 

15) Hearing aids and exams. Charges for services or supplies in connection with routine hearing exams, hearing aids, or exams for their fitting.

 

16) Hazardous Hobbies. Care and treatment of an injury or illness that results from engaging in a hazardous hobby. A hobby is hazardous if it is an unusual activity which is characterized by a constant threat of danger or risk of bodily harm. Examples of hazardous hobbies include, but are not limited to, rock/cliff climbing, spelunking, skydiving, or bungee jumping.

 

17) Hospital employees. Professional services billed by a Physician or nurse who is an employee of a Hospital or Skilled Nursing Facility and paid by the Hospital or facility for the service.

 

18) Illegal acts. Charges for services received as a result of Injury caused by engaging in an illegal act or occupation; by committing or attempting to commit any crime, criminal act, assault or other felonious behavior; i e, drug, hallucinogen or narcotic not administered as prescribed by a Physician.

 

19) Impotence. Surgical and non-surgical services for the treatment of impotence.

 

20) Infertility. Diagnostic, surgical repair, non-surgical repair, surgical impregnation and Prescription Drugs for the treatment of infertility.

 

21) Mental Health Services. Charges for psychiatric or psychological counseling, mental disability, learning disability, bereavement counseling, biofeedback therapy, psychological testing, treatment, medication and hospitalization.

 

22) Negligent Acts. Expenses resulting from an illness or injury for which the Sharing Member has acted negligently as documented by medical records and as determined by the Co-op.

 

23) Non-Emergency Transportation. Expenses resulting from transportation by ambulance for conditions that will not seriously jeopardize the Sharing Member's health or life are not 

eligible for sharing. Also, the additional expense for transportation to a facility that is not the nearest facility capable of providing medically necessary care is not eligible for sharing. 

 

24) No obligation to pay. Charges incurred for which the Sharing Member has no legal obligation to pay.

 

25) Not Medically Necessary. Care and treatment that does not meet the criteria of a Medically Necessary Service or is not specified as a Medically Necessary Service, or care, treatment, services or supplies not recommended and approved by a Physician; or treatment, services or supplies when the Sharing Member is not under the regular care of a Physician. Co-op reserves the right to review billing submitted by providers for payment, and upon review by a qualified medical professional, decline to share expenses deemed to be Not a Medically Necessary Service.

 

26) Outpatient prescribed or non-prescribed medical supplies. Outpatient prescribed or non-prescribed medical supplies including, but not limited to, over-the-counter drugs and

treatments, elastic stockings, tubings, masks, ostomy supplies, insulin infusion pumps, ace bandages, gauze, syringes, diabetic test strips and similar supplies.

 

27) Personal comfort items. Personal comfort items or other equipment, such as, but not limited to, air conditioners, air-purification units, humidifiers, electric heating units, orthopedic mattresses, blood pressure instruments, scales, elastic bandages or stockings, non-prescription  drugs and medicines, and first-aid supplies and non-hospital adjustable beds. This includes, but is not be limited to, outpatient prescribed or non- prescribed medical supplies, over-the-counter drugs and treatments, tubings, masks, ostomy supplies, ace bandages, gauze, syringes, diabetic test strips and similar supplies.

 

28) Professional Racing or Competitive Events. Charges for treatment of injuries or illness while racing or competing as a professional. Professional racing means that such activity is one’s primary vocation and means of financial support. Professional racing and competitive events include, but are not limited to, automobile, motorcycle, watercraft, ski or rodeo races or competitions.

 

29) Relative giving services. Professional services performed by a person who ordinarily resides in the Sharing Member’s home or is related to the Sharing Member as a Spouse, parent,

child, brother or sister, whether the relationship is by blood or exists in law.

 

30) Replacement braces. Replacement of braces of the leg, arm, back, neck, or artificial arms or legs, unless there is sufficient change in the Sharing Member’s physical condition to make

the original device no longer functional.

 

31) Self-Inflicted. Any medical expense due to an intentionally self-inflicted Injury, while sane or insane.

 

32) Sex changes. Care, services or treatment for non-congenital transsexualism, gender dysphoria or sexual reassignment or change. This includes medications, implants, hormone

therapy, surgery, or medical or psychiatric treatment.

 

33) Sports-related safety/performance devices and programs. Devices used specifically as safety items or to affect performance primarily in sports-related activities. All membership registration or participation costs related to physical conditioning programs, such as athletic

training, bodybuilding, exercise, fitness flexibility and diversion or general motivation are not eligible.

 

34) Surgical sterilization or reversal. Charges for care and treatment for, or reversal of, surgical sterilization, including vasectomy and tubal ligation.

 

35) Travel or accommodations. Charges for travel or accommodations, whether or not recommended by a Physician.

 

36) Other Sources of Medical Expense Payment. Needs do not qualify for sharing to the extent that they are discountable by the health care provider or payable by any other source, either private, governmental or institutional, such as insurance, Medicare/Medicaid, Veterans Administration, Champus, private/public grants, or, in the event of an accident, by any liable third party. If the Sharing Member does not cooperate fully and assist Co-op in determining if his/her need is discountable or payable by another liable party, the need will become not eligible for sharing. And to the extent that such expenses are then subsequently paid by insurance, Medicare, Worker’s Compensation, Medicaid, or any other liable third party, such expenses will be regarded as not eligible for sharing. Please note that it is the official policy of the Co-0p to never require or ask a Sharing Member to seek assistance from government taxpayer supported aid programs. However, in order to conserve the giving of the Members, it is the obligation of the member to pursue payment from any other responsible payer before submitting such medical expenses to Co-op for assistance. If a governmental, insurance, religious, liable third party, fraternal organization or any other financial assistance source will pay any portion of the qualifying medical bill, that amount will offset any unshared and/or shared amounts applied to the members needs up to the total amount of the need. If the Sharing Member refuses to accept such assistance, then that portion of the medical need also becomes ineligible for sharing. This limitation applies to the Sharing Member in question unless the member declares, in writing, that accepting such assistance would violate his deeply held religious or ethical convictions. If the Sharing Member is 65 years of age or older, this limitation also includes needs that are payable by  Medicare Parts A or B or D, whether the Sharing Member is enrolled in Medicare or not.

 

37) War. Any loss that is due to a declared or undeclared act of war.

 

38) Cosmetic Treatment. All other elective cosmetic treatment including but not limited to; pharmacological regimens; nutritional procedures or treatments; plastic surgery; salabrasion, chemosurgery and other such skin abrasion procedures associated with the removal or revision of scars, tattoos or actinic changes, are not eligible for sharing.

 

39) Depending on certain health issues, a decline or an exclusion may be placed on a person for sharing select health conditions. These are made case by case and are made in the best interest of the co-op members as a whole. 

Co-op 2

Health Program

Details

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