FAQ & Glossary
Enrollment
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.
About Clearwater
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.
Plan Information
ClearShare Memberships
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.
A healthshare, also known as medical cost sharing, is a nonprofit program that provides an organized structure for a community of members to contribute toward each other’s medical costs.
Major Medical Plans
Major Medical are all-insurance plans, offering lower costs and better benefits than most plans found in the Marketplace. Members can enjoy a range of deductible options, low copays, lower max out-of-pocket, and affordable premiums. These plans have no limitations, such as pre-existing conditions or age, and have the most robust coverage of all our products.
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 enroll outside of open enrollment, your effective date is on the first of the month following a full 60-day waiting period.
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.
Holistic
You can cancel your current plan, which may require a Qualifying Life Event or a 30-day notice, and then re-enroll in the Holistic plan you are interested in. Please be aware your monthly price and coverages may change. Before canceling your plan and re-enrolling, please speak with your benefits consultant to understand how your benefits may change.
For members already on a ClearShare plan, as long as the membership does not lapse it will be considered continuous. Your Annual Max and pre-membership condition waiting periods will not reset. Any medical needs that occur between the time when a member cancels their plan and enrolls in a new plan are not shareable. If a person chooses to re-enroll at a later date, they will be subject to the limitations associated with pre-membership medical conditions.
ClearShare plans include therapeutic massage if the therapy is related to an eligible need and prescribed by a licensed medical provider. Massage therapy is shareable for 25 sessions per need, up to $3,000. Learn more in the ClearShare Member Guidelines.
On the Holistic Premium plan: If your chiropractor or acupuncture offers massage, it can be included in those visits under the applicable costs and limits.
Glossary
Annual Maximum
The annual maximum is the amount that a member will pay before the ClearShare community shares in medical expenses. The annual maximum is also known as your personal responsibility. ClearShare has three primary levels of personal responsibility: $1000, $2500, and $5000. The lower your personal responsibility, the higher your monthly contribution will be.
All qualifying medical expenses submitted after the Annual Maximum is met are shareable with the ClearShare community up to 100% of the usual and customary charge determined by ClearShare. There is no annual or lifetime limit. You will not need to pay the Annual Maximum again until the new calendar year begins. Additionally, you are only responsible for the Annual Maximum once each calendar year.
Service copays are not included in the annual maximum. Members who are also part of an HSA MEC, service related costs that apply to the member’s deductible are not part of the annual maximum.
Dependent
The head of the household’s spouse or unmarried child(ren) under the age of 26, who are the head of household’s dependent by birth, legal adoption, or marriage, and who are participating under the same combined membership. Unmarried children under 26 years of age may participate in the membership as a dependent.
Effective Date
The date a person’s membership begins.
Healthcare Sharing
Healthcare Sharing, also known as medical cost sharing or a healthshare, is a nonprofit program that provides an organized structure for a community of members to contribute toward each other’s medical costs.
Health Savings Account (HSA)
A Health Savings Account (HSA) is a tax-advantaged savings account you can use to pay for qualified medical expenses.
Licensed Medical Professional
An individual who has successfully completed a prescribed program of study in a variety of health fields and who has obtained a license or certificate indicating his or her competence to practice in that field (MD, DO, ND, NP, PT, PA, DC etc.)
Minimum Essential Coverage (MEC)
Minimum essential coverage is the minimum amount of coverage that is considered essential by the Affordable Care Act. Things that are not considered minimum essential coverage include only supplemental plans, coverage for only a specific condition, and worker’s compensation.