Medical: Health & Wellness Plan Summary

Plan Basics

• The Austin Stone provides medical coverage for you (and your family) in the ASCC Health and Wellness Plan at no monthly cost to you. 
• When communicating with providers, you explain that you are a cash pay / private pay patient and do not have medical insurance.
• This plan offers incredible flexibility for you to choose the health provider you want.  Licensed providers, such as MDs, RNs, DCs, and LPCs are all covered by our plan.  However, alternative providers, such as naturopathic, holistic, and acupuncturists are not covered by the plan.
• After you receive medical care, it is your responsibility to collect itemized statements from the provider showing the services that were rendered.
• Cash pay / private pay patients are often given big discounts off the cost of medical care.  Our plan works well when we take advantage of all discounts and financial aid available.

Coverage Components

The following two components make up the Austin Stone Health and Wellness Plan and are used to provide coverage of medical benefit claims.

• Christian Healthcare Ministries (CHM) Component
  • First Coverage Source for medical claims
  • Claims will be reimbursed by CHM in accordance with their Guidelines.  In the event that the Guidelines do not provide for payment of medical benefits, the second coverage source applies.
  • The first question you should always ask yourself is: Could this medical expense be part of a CHM-eligible incident?
• Austin Stone Component
  • The Austin Stone Community Church Health Reimbursement Arrangement (HRA)
    • Second Coverage Source for medical claims
    • Claims will be reimbursed from the staff member’s HRA. In the event that the staff member has exhausted their HRA, the third coverage source applies.
  • Staff Member Out Of Pocket
    • Third Coverage Source for medical claims
    • Claims will be paid by the staff member.  In the event the staff member has met their Out of Pocket maximum, the fourth coverage source applies.
  • The Austin Stone Health Fund
    • Fourth Coverage Source for medical claims
    • Claims will be reimbursed from the Health Fund as the final coverage source for this ACA qualified, self-insured health plan.

Summary of Benefits and Coverage

Christian Healthcare Ministries Component

• CHM provides reimbursement for medical claims based upon the requirements specified in their Guidelines. 
• Some notable items that are not reimbursed by CHM are:
  • medical bills that are part of incidents totaling less than $1,000
  • alternative medical care 
  • mental health needs 
  • chiropractic care and Airrosti treatment
  • immunizations
• Once the combined total of medical bills related to an incident reaches a pre-discount amount of $1,000 or more, you will submit your itemized statements to CHM and then be reimbursed for 100% of the cost.
• You have six months from the date of service to submit itemized statements to CHM. If a bill is eligible to be reimbursed by CHM, but you do not submit it in time, then this expense becomes your responsibility. You cannot reimburse the expense through any other part of our Health Plan.

Austin Stone Component - Health Reimbursement Arrangement

• Your Austin Stone HRA is administered by Employee Benefits Corporation (EBC).
• Your HRA balance will be prorated based on the following annual amounts:
  • You Only $1,650
  • You + Spouse or Child $2,750
  • You + Family (2 or more dependents) $5,500
• If you have a medical claim not reimbursable by CHM but covered by the plan, then you use your HRA funds to pay for it.
• You will be provided with a benefits debit card from EBC that you can use to pay for care.

Austin Stone Component - Staff Member Out of Pocket

• In the event you have an eligible medical claim that is not reimbursable by CHM and you have exhausted your HRA funds, you will pay for those claims using your personal funds. (If you spend all of your HRA funds, please notify Denise so that you can begin the correct tracking process for your out-of-pocket costs.)
• The total maximum you could pay is:
  • You Only $900
  • You + Spouse or Child $1,550
  • You + Family (2 or more dependents) $2,500
• Preventative Care items are always reimbursed by either CHM or the Health Fund and do not apply against the Out of Pocket total.

Austin Stone Component - Austin Stone Health Fund

• In the event you have an eligible medical claim that is not reimbursable by CHM and you have met your Out of Pocket total, you will be reimbursed from the Austin Stone Health Fund.
• Reimbursements are managed by Enterprise Group Planning (EGP).

Plan Exclusions

• Some notable items that are not eligible for coverage by any part of the Plan are:
  • alternative treatment
  • experimental / investigational treatment / clinical trials
    • treatment that is not generally accepted medical practice
    • connect with Denise before services are rendered to get a determination of eligibility
  • medical bills that are part of a CHM eligible incident that were not submitted to CHM within six months of their date of service
  • acupuncture
  • bariatric surgery
  • cosmetic surgery
  • marital and social counseling
  • private duty nursing
  • abortive procedures
  • embryo implant procedures
  • over the counter medications
  • nutritional supplements
• Some notable items that are not covered by CHM but are covered by your HRA are:
  • mental health needs
  • immunizations
  • eligible medical bills that are part of incidents totaling less than $1,000
• Some notable items that have limited coverage by your HRA are:
  • chiropractic care and Airrosti treatment
  • autism spectrum disorder care
  • infertility treatment
  • speech and occupational therapy
  • dental care
  • ambulance services 

Additional Features

• HealthiestYou by Teladoc - A free-to-use service that allows you 24-hour access to a physician over the phone.
• GoodRx, RXSaver – Prescription costs can be lowered by using the free Good Rx and RXSaver apps.