This is a program that covers a single individual.
Member
This program primarily covers a member and a family member.
Member + Spouse
This program is for a Member and 1 or more child(ren)
Member + Child(ren)
This program is for a family consisting of 1 or 2 parents and up to 5 of their children. Additional fees for more members.
Member + Family
BENEFITS
PREVENTATIVE VISITS ARE THE PILLARS AND THE FOUNDATION FOR A
VIBRANT AND A HEALTHY COMMUNITY!
EARLY DETECTION IS THE KEY!
OFFICE/WELLNESS VISITS
MAMMOGRAM SCREENINGS
COLOGUARD SCREENINGS
BONE MASS DENSITY SCREENINGS
IN-PATIENT
COLONOSCOPY
PROSTATE SCREENINGS
DIABETIC SCREENINGS
IMMUNIZATIONS
URGENT CARE
PAPS SMEAR SCREENINGS
EKG TESTS
CARDIOVASCULAR
OUT-PATIENT
AMBULATORY CARE
HOSPITAL OBSERVATION
EMERGENCY ROOM
MRI/CAT SCAN/PET SCAN
Discount Benefits:
Medications, Dental, Vision and Telemedicine
***YOU HAVE THE FREEDOM AND FLEXIBILITY TO CHOOSE YOUR OWN PHYSICIANS***
***PREVENTIVE SCREENINGS DO NOT REQUIRE A SHARING REQUEST FORM, UNLESS SPECIFIED. MAMMOGRAM AND COLONOSCOPY***
PROGRAM POLICIES
IUA means Initial Unshared amount & is the amount you pay before sharing starts. MSA means your Maximum Sharing Amount or your sharing limit. All plans have a membership fee.
Members are responsible for all charges below their IUA (Initial Unshared Amount) or for any charges above the members MSA (Maximum Shared Amount)
You must submit a Needs Request form? Contact Customer Service. This form must be completed by your Provider and returned to Ansari office before the procedure is done.
You should Notify Ansari Healthshare within 48 hrs. or as soon as possible after a hospital observation or an ER visitor.
You are eligible to obtain any procedures/services independently that you deem necessary. If these procedures do not fall under Ansari Healthshare guidelines or policies, it is your responsibility for service, payments, and claims.
Discount Benefits are a separate entity from Ansari Healthshare, and we are not responsible for their operation. This should be obtained independently,
MONTHLY CONTRIBUTION COST
MONTHLY CONTRIBUTIONS
| Ansari Basic |
Ansari Premiere |
Ansari Supreme |
Ages 18-29 Years of age
|
Most Popular
IUA – $1000
|
IUA – $2500 |
IUA – $5000 |
|
| Member | $180 | $170 | $150 |
| Member & Spouse | $345 | $238 | $182 |
| Member & Child(ren) | $345 | $238 | $182 |
| Member & Family | $513 | $403 | $293 |
Ages 30-39
| Member | $211 | $178 | $152 |
| Member & Spouse | $413 | $320 | $310 |
| Member & Child(ren) | $413 | $320 | $310 |
| Member & Family | $569 | $457 | $399 |
Ages 40-49
| Member | $217 | $188 | $163 |
| Member & Spouse | $429 | $345 | $340 |
| Member & Child(ren) | $429 | $345 | $340 |
| Member & Family | $622 | $512 | $455 |
Ages 50-64
| Member | $299 | $275 | $195 |
| Member & Spouse | $568 | $465 | $370 |
| Member & Child(ren) | $568 | $465 | $370 |
| Member & Family | $826 | $699 | $525 |
Program Policies
You have the Freedom to go to the Provider of your choice and let them know that you are a Self-Payer.
Most procedures must take place in Your primary care office, or an Ambulatory Center. (Exception; emergency or urgent care, hospital)
Any service, procedure or treatment that is not medically necessary is the member’s Responsibility.
A “Need” is a procedure or treatment that you want to have.
Before scheduling an appointment, call customer service to if you need help in submitting a Sharing Request Form.
While visiting your doctor and before a procedure, have him/her to complete the CMS 1500 Form/UB92 and submit it to Ansari Healthshare so we can Negotiate the Charges for you. You can get a copy of the Sharing Request Form & the Prenotification Form under “Members” after scrolling down and clicking on Sharing Request Form.
Your IUA is separate from your Monthly contributions. Once you reach your IUA for an eligible benefit and whenever you request another eligible benefit for a need this process starts over again from “0”. You must reach your IUA again for each eligible or qualifying benefit that’s greater than your IUA.
Member is responsible for a procedure if a needs request form is required and the member failed to get a pre-notification which is an authorization for service. *Each membership requires a 12-month continued commitment in order to participate in Ansari Healthshare programs. AnsarihealthShare is designed to work only with self-paying members medical expenses. AnsarihealthShare reserves the right to make changes any time as they see fit to enhance the programs and in making business decisions.