Employee Health Connection
W P Hickman Co., Eblen Charities, Western Carolina Industries and Three Streams have crafted a unique program to help small business owners provide a valuable benefit to their employees. More and more businesses are unable to provide health benefits for their employees due to the escalating cost of medical insurance.
Our Employee Health Connection (EHC) is a plan whereby an employer can offer a shared, affordable medical benefit to their employees.
HOW THE PROGRAM WORKS:
• Eligible employees: Those who are not eligible for the company’s offered health insurance plan or those whose company offers no health plan, and are under certain income levels.
• Costs: Patients will pay a $10 copay at the time of their office visit at Three Streams. The participating employer will pay $35 billed after the visit.
• Caps: There is a $540 employer cap per year. Once the employer has reached this cap, they are no longer responsible for additional costs. (12 visits per year)
• Once the cap is reached, the employee will be required to pay full price for additional visits, or provide proof of household income to qualify for our discounted sliding scale.
• The plan provides a visit with a medical practitioner, either MD, PA or Nurse Practitioner.
• If needed, enrollment in our Medication Assistance Program and fees will be covered.
• Comprehensive Annual Preventive Health Exam
• Free in-house lab collection
FREQUENTLY ASKED QUESTIONS:
• Can the employees sign up for this themselves?
No, this contract is between employers and TSFHC as a service to their employees, not with individuals.
• How do we pay for this?
Three Streams Family Health Center will bill the employer after the patient/ employee office visit. The employee will pay their copay ($10) at time of service. Three Streams will bill the employer for the balance of $35 per visit. Three Streams will need a monthly list of employees from your company to verify their employment before their visits.
• What if the employee reaches the cap before the year is up?
Additional visits after the cap is reached are billed per our regular billing protocol using a sliding scale based on household income. This is generally more than the $10 copay.
• Does the plan include prescriptions?
Three Streams has several methods of helping people obtain medications, and this contract allows free enrollment in our Medication Assistance Program. However this program does not pay for prescriptions.
1. Three Streams keeps samples of many medications used at the facility for our patients limited to availability.
2. For individuals who meet income guidelines, the MAP may be used to obtain specific medications for a one-year period.
3. Three Streams assists our patients in making application to other services available in the county.
• Why is this different from insurance?
The Wellness plan provides low cost visits to a primary care office, nothing else. We are not offering to pay any medical bills, prescription costs, or costs outside of our office including emergency care, urgent care or surgery.
• Does this include emergency care?
Three Streams can handle minor emergency problems only. Patients in the Wellness plan can call and ask to be seen urgently during our regular hours and we will make every attempt to meet these needs, at the discretion of the medical practitioner. Three Streams does most visits by appointment only. Any emergency care rendered at any other facility, (ER, Urgent Care Center, etc.) will not be covered by the Wellness plan and the client will be fully responsibility for payment.
• Does the Wellness plan cover hospital care or visits?
No. Three Streams does not offer any hospital care. Patients who need hospitalization will have to be seen in the emergency room and admitted by a doctor on-call at their own expense. Mission Hospital System offers many payment options for inpatients. If you have a problem, Three Streams can direct you to a knowledgeable Mission billing employee.
• What if the employee cannot afford the $10 copay?
Since this is a collaboration, one of our partners, Eblen Charities, has agreed to pay the $10 copay for an employee who cannot afford the $10 copay.
• Can employees include their families in this plan?
Yes. Up to 3 additional family members who are uninsured can be added at the discretion of the employer. The employer can offer this as an additional incentive. The cap for a family is $1200 per year that the employer would pay. (Three Streams does not offer comprehensive pediatric services because of the excellent availability of state sponsored health insurance for children.)
