a health plan solution for employers & employees€¦ · families, and employers. our...

A Health Plan Solution for Employers & Employees

Minimum Value Plans | MVP

Why do employers prefer AlieraOne?

Why do employees prefer AlieraOne?

What does AlieraOne cover?

As a level-funded minimum value plan (MVP), AlieraOne • Gives employers a secure foundation for self-funding their groups’ health

insurance • Uses a captive affiliate to facilitate cost-effective risk ratio programs for all types

of employers • Includes both specific and aggregate stop-loss accommodations • Promotes stable monthly costs and potential for premium ROI year-over-year• Meets the requirements for both Penalty A and Penalty B as defined by the IRS

and ERISA• Simplifies the complexities of traditional group health insurance• Provides affordable comprehensive plans that feel like traditional health insurance• Improves employee participation rates and overall workforce health

As a level-funded minimum value plan (MVP), AlieraOne • Gives employees affordable quality coverage that looks and feels like

traditional health insurance • Puts the power of choice back in their hands with a full spectrum of affordable

health plans for every need and budget• Provides a complimentary Member Concierge Service that confirms network

participation, verifies health plans, ensures proper claims submission and billing

AlieraOne is an affordable comprehensive group health insurance plan designed to meet the unique needs and budgets of nearly any kind of employer and employee. These plans cover 60-90% of healthcare costs and meet all of the government mandates for employer healthcare.

AlieraOne provides both preventive and emergency coverage, hospitalization, primary care, unlimited telemedicine, urgent care, laboratory/diagnostic services, both in-patient and out-patient surgical procedures, and prescription benefits.

AlieraOne is a comprehensive level-funded group insurance plan that puts the control of costs and administration back into the hands of the employer.

What is AlieraOne?

41 plus statesand growing

1,000,000 healthcare professionals

Aliera Healthcare is pioneering new and innovative healthcare programs that put the power of choice back in the hands of individuals, families, and employers. Our nationwide healthcare programs improve access to affordable, high-quality healthcare plans for a wide variety of needs and budgets – from comprehensive to catastrophic, to short-term medical, vision, dental, and more. With a network that includes over one million providers nationwide, Aliera is simplifying the complexities of modern healthcare and leading a new era of individual and group insurance.

AlieraHealthcare.com | 844-834-3456

Note: All rates are subject to medical underwriting.

Terms and ConditionsThe minimum enrollment in AlieraOne is 25 employees.

Health Plan and Network Fees include – medical administration, prescription benefit manager, PPO access, broker, telemedicine, implementation, SPDs, ID cards, COBRA/HIPAA, and utilization review. Large case management fees are $135 per hour.

Specific and Aggregate – covers medical and Rx claims and includes specific and monthly aggregate advancement protection.

Final acceptance is subject to the approval of Stop-Loss and will be based on data required, Individual Health Questionnaires and/or Disclosures. Individual Health Questionnaires will not be required for final acceptance for 50+ eligible employees enrolled in the health plan with claims experience submitted and utilized to produce rates. Note: All plans are set up on plan year basis.

State ExclusionsDue to state laws governing Stop-Loss insurance policies, the employer must have a minimum of 26+ eligible employees for the following state: ID, KS, ME, NC.

Due to state laws governing Stop-Loss insurance policies, the employer must have a minimum of 51+ eligible employees for the following states: FL, MD, MT, ND, NJ, OR, RI , CO, and UT.

Due to state laws governing Stop-Loss insurance policies, the employer must have a minimum of 101+ eligible employees for the following states: CA and NY.

PPO Network Cigna / Multiplan / First Health

PHCS Practitioner & Ancillary

Plan Benefits Network Non-Network RBPWellness and Preventive Benefits 100% Not Covered 100%

Deductible – Individual / Family $6,000 / $12,000 $12,000 / $24,000 $6,000 / $12,000

Out-of-Pocket Maximum – Individual / Family $7,150 / $14,300 $14,300 / $28,600 $7,150 / $14,300

Co-insurance (Plan Pays) 60% after deductible Not Covered 60% after deductible

Hospitalization In-Patient 60% after deductible Not Covered 60% after deductible

Hospitalization Out-Patient 60% after deductible Not Covered 60% after deductible

Telemedicine Unlimited Not Applicable Unlimited

Emergency Room Services 60% after deductible Not Covered 60% after deductible

Primary Care 60% after deductible Not Covered 60% after deductible

Specialty Care 60% after deductible Not Covered 60% after deductible

Urgent Care 60% after deductible Not Covered 60% after deductible

Imaging 60% after deductible Not Covered 60% after deductible

Laboratory Out-Patient and Professional Services 60% after deductible Not Covered 60% after deductible

X-rays and Diagnostic Imaging 60% after deductible Not Covered 60% after deductible

Generic Prescription Drugs 60% after deductible Not Covered 60% after deductible

Preferred Brand Drugs 60% after deductible Not Covered 60% after deductible

Non-Preferred Brand Drugs 60% after deductible Not Covered 60% after deductible

Mail-Order and Specialty Brand Drugs 60% after deductible Not Covered 60% after deductible


AlieraOne MVP | Bronze




Plan Benefits Network Non-Network RBPWellness and Preventive Benefits 100% 50% after deductible 100%



Co-insurance (Plan Pays) 70% after deductible 50% after deductible 70% after deductible

Hospitalization In-Patient 70% after deductible 50% after deductible 70% after deductible

Hospitalization Out-Patient 70% after deductible 50% after deductible 70% after deductible


Emergency Room Services $500 co-pay 50% after deductible $500 co-pay

Primary Care $35 co-pay 50% after deductible $35 co-pay

Specialty Care $55 co-pay 50% after deductible $55 co-pay

Urgent Care $55 co-pay 50% after deductible $55 co-pay

Imaging 70% after deductible 50% after deductible 70% after deductible

Laboratory Out-Patient and Professional Services 70% after deductible 50% after deductible 70% after deductible

X-rays and Diagnostic Imaging 70% after deductible 50% after deductible 70% after deductible

Generic Prescription Drugs $10 co-pay $10 co-pay $10 co-pay

Preferred Brand Drugs $50 co-pay $50 co-pay $50 co-pay

Non-Preferred Brand Drugs $100 co-pay $100 co-pay $100 co-pay

Mail-Order and Specialty Brand Drugs $200 co-pay $200 co-pay $200 co-pay









AlieraOne MVP | Silver






























AlieraOne MVP | Gold




Deductible – Individual / Family $500 / $1,000 $1,000 / $2,000 $500 / $1,000


























AlieraOne MVP | Platinum

1. Alcohol and Drug Use assessments2. Autism screening for children, limited to two screenings up

to 24 months3. Behavioral assessments for children, limited to 5

assessments up to age 174. Blood Pressure screening5. Cervical Dysplasia screening6. Congenital Hypothyroidism screening for newborns7. Depression screening for adolescents ages 12 and older8. Developmental screening for children under age 3, and

surveillance throughout childhood9. Dyslipidemia screening for children10. Fluoride Chemo Prevention supplements when prescribed

by a physician for children without fluoride in their water source

11. Gonorrhea preventive medication for the eyes of all newborns

12. Hearing screening for all newborns13. Height, Weight, and Body Mass Index measurements for

children14. Hematocrit or Hemoglobin screening for children15. Hemoglobinopathies or Sickle Cell screening for newborns

16. HIV screening for adolescents17. Immunization vaccines for children from birth to age

18; doses, recommended ages, and recommended populations vary: Diphtheria, Tetanus, Pertussis, Hepatitis A & B, Human Papillomavirus, Inactivated Poliovirus, Influenza (Flu Shot), Measles-Mumps-Rubella (MMR), Meningococcal, Pneumococcal, Rotavirus, Varicella, Haemophilus influenzae type b

18. Iron supplements when prescribed by a physician for children up to 12 months

19. Lead screening for children20. Medical History for all children throughout development

(Ages 0–11 months, 1–4 years, 5–10 years, 11–14 years, 15–17 years)

21. Obesity screening and counseling22. Oral Health Risk assessment for young children up to age

1023. Phenylketonuria (PKU) screening in newborns24. Sexually Transmitted Infection (STI) prevention counseling

and screening for adolescents25. Tuberculin testing for children26. Vision screening for all children under the age of 5

Services for Children (0–18)

1. Anemia screening on a routine basis for pregnant women2. Bacteriuria urinary tract or other infection screening for

pregnant women3. BRCA counseling and genetic testing for women at higher

risk4. Breast Cancer Mammography screenings every year for

women ages 40 and over5. Breast Cancer Chemo Prevention counseling for women6. Breastfeeding comprehensive support and counseling

from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women

7. Cervical Cancer screening8. Chlamydia Infection screening9. Domestic and Interpersonal Violence screening and

counseling for all women10. Folic Acid supplements when prescribed by a physician for

women who may become pregnant11. Gestational Diabetes screening

12. Gonorrhea screening13. Hepatitis B screening for pregnant women14. Human Immunodeficiency Virus (HIV) screening and

counseling15. Human Papillomavirus (HPV) DNA testing every three

years for women with normal cytology results who are 30 or older

16. Osteoporosis screening ages 65 and older and younger women with a fracture risk greater than that of a 65-year-old woman

17. Rh Incompatibility screening and follow-up testing for all pregnant women

18. Tobacco Use screening, intervention, and expanded counseling for pregnant tobacco users

19. Sexually Transmitted Infections (STI) counseling20. Syphilis screening21. Well-woman visits to obtain recommended preventive

services (includes routine prenatal visits for pregnant women)

Preventive Services for Women, Including Pregnant Women

1. Abdominal Aortic Aneurysm one time screening for ages 65–75

2. Alcohol Misuse screening and counseling3. Aspirin use when prescribed by a physician to prevent CVD

for men ages 45–79 and women ages 55–794. Blood Pressure screening5. Cholesterol screening6. Colorectal Cancer screening for ages 50–75 limited to one

every 5 years7. Depression screening8. Type 2 Diabetes screening

9. Diet counseling 10. HIV screening11. Immunizations vaccines: Hepatitis A & B, Herpes Zoster,

Human Papillomavirus, Influenza (Flu Shot), Measles-Mumps-Rubella (MMR), Meningococcal, Pneumococcal, Tetanus, Diptheria, Pertussis, Varicella

12. Obesity screening and counseling13. Sexually Transmitted Infection (STI) prevention counseling14. Tobacco Use screening and cessation interventions15. Syphilis screening

Preventive Services for Adults (18+)


Preventive & Wellness

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Your x-ray is covered 100% at your in-network Urgent Care facility with an additional $25 read fee for each x-ray. Your plan does not include an x-ray from outside sources. For these services there is an additional $25 read fee for each x-ray.

X-rays5

Labs and Diagnostics

Blood work covers tests such as Complete Metabolic Panel, Complete Blood Culture, Hemoglobin, Cholesterol, and hundreds of others. Your plan covers over 180 different lab tests including most biologic testing.

1. Most lab tests at your PCP and Urgent Care provider are covered2. Lifestyle tests are not included

4

At Aliera we think it is important to have access not only to your Primary Care provider, but also to Urgent Care for those occasional unexpected medical events. It is important to understand that while Preventive Care is important, accidents do happen and you need coverage for those occasions. A few of our Urgent Care services include:

1. Access to Urgent Care facilities, including some locations with extended hours2. No waiting time for most visits (be sure to call ahead to your local Urgent Care to inquire about wait time)3. No appointment necessary–Walk-ins welcome4. Durable Medical Equipment (DME) is not included5. X-rays (see x-rays below)6. Labs and Diagnostics (see labs and diagnostics below)

Urgent Care Services*2

With your Aliera MVP plan, you receive the core primary care medical services you need to remain healthy, avoiding unwanted and catastrophic health concerns. At Aliera Healthcare we believe every individual should have access to quality Primary Care without regard to the minimum requirements of the ACA and should take advantage of the services of our plan. A few of the features include:

1. No deductible or co-insurance required2. Episodic Primary Care services with all AlieraOne Plans3. Unlimited Primary Care visits4. Concierge services for every plan to ensure a smooth healthcare experience5. Appointments made through Aliera to ensure efficient and homogeneous medical services

Primary Care Services*1

The benefits listed below are in addition to the required benefits of the ACA.

Telemedicine3Every enrolled employee receives unlimited access to a telemedicine provider to help reduce the cost of healthcare and act as your 24/7/365 access to care. All doctors in our national network are U.S. board-certified family practitioners, PCPs, pediatricians, or internists who use electronic health records to diagnose, treat, and write prescriptions when necessary. Our quality process meets National Committee for Quality Assurance (NCQA) standards. A few features include:

1. 24/7/365 access to U.S. board-certified doctors2. No consultation fees3. Available to all family members in the plan4. 96% resolution of most medical issues5. Access via phone or video conference

*Employees are required to contact a telemedicine provider before visiting a Primary or Urgent Care provider

AlieraOne_SellSheet_020719_FINv5

Additional Benefits of AlieraOne

a health plan solution for employers & employees€¦ · families, and employers. our...

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