FAQ & Glossary

To enroll in a ClearShare membership, only the primary member must have a Social Security Number. Dependents are not required to have a Social Security Number.

To enroll in a Major Medical plan, all members must have a Social Security Number.

No, you do not need a medical checkup to enroll, but you will be asked specific questions about your medical history on the enrollment form to ensure the membership or plan you are enrolling in will be a good fit for you.

Yes, you can enroll in dental and vision plans without bundling them with medical.

Details about dental and vision plans will be available soon.

HSA plans from Clearwater com with a free Clearwater HSA! You can enroll in your Clearwater HSA when you enroll in the plan. With Clearwater’s HSA, you get:

• One card for all your healthcare-related needs
• Integration with Clearwater’s member portal
• Physical & virtual HSA debit cards
• Simplified claims process with online tools
• A platform that supports English and Spanish languages
• Integrated investment tools for accounts over the minimum threshold

Learn more: 

• Clearwater HSA
• Funding your HSA Account

If you already have an HSA plan and don’t want to switch, you can opt-out of the Clearwater HSA at enrollment.

Contact us at members@clearwaterhealth.com

Clearwater Benefits is a healthcare vendor. Clearwater Benefits offers a wide variety of high quality, highly affordable healthcare solutions tailored to meet individuals’ unique needs via traditional insurance plans, healthshare-based solutions, and supplemental insurance offerings.

Clearwater Benefits offers ClearShare memberships and Major Medical plans.

ClearShare is a great fit for individuals and families who are looking to lower their monthly costs and out-of-pocket expenses as much as possible. Because ClearShare is not insurance, some administrative work will fall on members and some limitations apply, as outlined in the Member Guidelines. These guidelines keep costs low for the whole community.

Basic ClearShare Membership:
Low costs for doctor visits and prescriptions, plus no visit limits or maximum payouts.

HSA + ClearShare membership:
Pairs an HSA Minimum Essential Coverage (MEC) plan with a ClearShare membership. This plan is for those interested in having and contributing to a Health Savings Account.

ClearShare memberships:
A healthshare-only plan that helps provide members a safeguard against unexpected medical expenses including accidents or illnesses. It does not provide any day-to-day coverage such as preventive or primary care doctor visits, diagnostics, and drugs.

Major Medical are all-insurance plans, offering lower costs and better benefits than most plans found in the Marketplace. Agents can enjoy a range of deductible options, low copays, lower max out-of-pocket, and affordable premiums. All major medical plans require members to be an active participant in their care by engaging with our care coordination team. 

You can enroll during open enrollment from November 1 through December 31, or if you have a qualifying life event during the year.

For Major Medical plans, open enrollment is November 1 through December 31. Your plan effective date during open enrollment is January 1. For those that have a QLE and enroll outside of open enrollment, your effective date is on the first of the month following timely notification of your QLE.

You will keep your healthcare plan until the end of the calendar year, regardless of when you enroll. If there is a qualifying life event, you may be eligible to update or cancel your plan before Open Enrollment.

You can switch plans during Open Enrollment. To switch before then, you must have a qualifying life event.

To cancel your plan, contact members@clearwaterhealth.com. In order to cancel your plan, you must have a qualifying life event. You have 31 days from the date of your qualifying life event to notify us of the qualifying life event in order to cancel your plan. Your policy will terminate at the end of the month from the date we receive your qualifying life event documentation.

At the age of 18 a child is eligible to enroll in their own individual plan.  However, a child can stay on a parents plan until the age of 26.  At the age of 26, a child must enroll in their own plan. If someone is 65 or older they are eligible, however, Medicare will likely be a cheaper option with a broader network.

Yes.

No.

Yes! To learn about the services covered at $0, visit https://www.healthcare.gov/coverage/preventive-care-benefits/.

Yes. However, your current providers, treatments and medications may not be covered under the plan. To ensure continuum of care and avoid treatment disruption, schedule a meeting with one of our expert Benefits Consultants before enrolling.

Yes.

Seek care and show your member ID card. For ER visits we request that you notify us within 48 hours of discharge or when reasonably appropriate. If you visit the ER and it is not an emergency you will be subject to a penalty.

Find a participating provider using the 6 Degrees Health network.  Book a call to find participating providers near you. If you are a member, log in to your member portal to find a provider.

Major Medical Copay plans provide access to Tier 1 In-Network Preferred Benefits. In order to access these benefits for no out-of-pocket cost, you MUST call our care coordination team BEFORE obtaining services. Our Care Coordination team will find you high-quality, lower cost providers for eligible services. When you use a provider we recommend, your care is completely free. While Care Coordination strives to find Tier 1 providers, it's not always possible, so Tier 1 benefits aren't guaranteed.

Care Coordination access depends on the plan you have selected.

On ClearShare plans, you can use Care Coordination to find providers for imaging tests, surgeries, and other major procedures. In addition, Care Coordination can help you find local providers if the primary network doesn’t provide the coverage you need in your area, but these costs would not be waived

On Major Medical Copay plans, Care Coordination is embedded in the plan as a Tier 1 Preferred Provider. Services like imaging tests, surgeries, and major procedures are eligible, and you can reference your plan documents for a complete list.

On plans with Tier 1, when Care Coordination is able to find a provider in your area that we recommend, your care is completely free. Our team will work diligently to find you a recommended provider, however there are instances where no provider is available. Care Coordination benefits are not guaranteed.

On the Major Medical HSA 10000 plan, Care Coordination can be used for imaging tests, surgeries, and major procedures to pay significantly less out-of-pocket. Costs are not completely waived on this plan.

When you need a service that is eligible for Care Coordination, we recommend contacting us at least 21 days before obtaining services. When you choose to see the provider we recommend, your care can cost significantly less, and on some plans will be completely free.

Our team will work diligently to find you a recommended provider, however there are instances where no provider is available. Care Coordination benefits are not guaranteed.

You can use Care Coordination by contacting our team or submitting the Care Coordination request form online in your member portal.

Care Coordination does not have a doctor lookup. The providers we recommend depend on a variety of factors. 

No, Care Coordination works to find and recommend you a fair-priced, high quality provider.

If you want to choose your own provider, you can use your plan’s applicable in-network or out-of-network services.

Yes, we can recommend providers for a second opinion.

Yes, Care Coordination must be contacted and a provider must be recommended for each service in order to be eligible for waived out-of-pocket costs.

If you have commonly bundled services such as, but not limited to, maternity or oncology, Care Coordination can coordinate all services in advance. Tell your care coordinator about the services you may need so they can coordinate effectively.

Use of Care Coordination for lower cost care is an added benefit and is not required. If you want to choose your own provider, you can use your plan’s applicable in-network or out-of-network services.

Orders from your doctor are required for Care Coordination to determine the correct imaging/radiology center to recommend you to. 

Contact Care Coordination to find out what specific documents are required for the service(s) you need. Medical records may be required.

Submit a request online in your member portal, call 877-405-2926, or email members@clearwaterhealth.com