What is HIPnation-PrimaryCarePlus?

It is a new model for delivering primary care that gives the patient 24/7 access (via phone and telemedicine) to their primary care provider and gives the physician more time and resources to devote to the patient. It’s a participant-based model that eliminates the complexities, the resource drain, and the restrictions imposed by insurance on primary care.

The “Plus” in HIPnation-PrimaryCarePlusSM consists of a special connection with HIPnation team specialists and low, rates for medications, labs, and imaging, as well as lower rates on optional coverages such as dental, vision, and indemnity insurance to protect you in the event of a catastrophic accident or illness.

What makes HIPnation-PrimaryCarePlus different from healthcare insurance?

HIPnation-PrimaryCarePlus is not insurance, and HIPnation is not an insurance company. The biggest difference is that HIPnation-PrimaryCarePlus removes insurance, its restrictions, and complexities from primary care. With HIPnation-PrimaryCarePlusSM the relationship is between you and your primary care physician – the way it should be. Today, many physicians serve 3,000 or more patients – some see 35 or more patients a day! The current, insurance-driven healthcare model is so broken physicians are forced to increase patient load in order to make their practices work.

Because the HIPnation-PrimaryCarePlusSM doctor has a much smaller patient load, the doctor has the time to give you the preventative services that will help keep you well. And if you need your doctor, you can get the care you need by making an appointment – usually for the same day – or by phone or telemedicine. The additional time also gives your doctors the time to apply a range of preventive services. You can also make same-day appointments, and have 24/7 access via phone and telemedicine.

Who is behind HIPnation-PrimaryCarePlus?

HIPnation-PrimaryCarePlusSM was started by a group of concerned, practicing physicians who believed they had the answer to the US healthcare problems that politicians have been trying to solve for 30 years. Members of the team have testified before Congress, as well as spoken across the US for the last 8 years. The Physicians take care of patients every day and know the burden of the broken US healthcare system on an individual in the actual treatment room. See our founders’ credentials in the section below.

How can I learn more about HIPnation-PrimaryCarePlus?

If you would like to get answers to your questions or connect with a HIPnation representative, see the links below.

Is HIPnation-PrimaryCarePlusSM ACA compliant?

The answer to this question is a little complicated, mainly because the Affordable Care Act (“ACA”) is complicated.  The ACA requires that everyone who meets certain income levels purchase “minimum essential coverage” for healthcare.  You can get this coverage in a variety of ways:  from an employer, on the healthcare exchange, or by being a member of a special type of association.  We favor the last option.  We have partnered with Employers Business Alliance (“EBA”).  By being a member of this association, you satisfy the ACA’s requirement and have access to HIPnation-PrimaryCarePlusSM with its outstanding healthcare services.

What types of benefits does HIPnation-PrimaryCarePlusSM offer?

You will receive all of your primary care through HIPnation-PrimaryCarePlusSM. You will also have access to additional low cost options for healthcare beyond primary care. This does not mean, however, that membership in HIPnation-PrimaryCarePlusSM means you get “free” mammograms, birth control, or addiction treatment like the insurance offered by employers or on the exchange. Under the ACA, those products must include such benefits (sometimes referred to as “minimum essential benefits”), which makes them very expensive. We have chosen a different model – one that focuses on what a particular patient really needs. But rest assured, if you do need a mammogram, your primary care physician will arrange for you to get it at a low cost.

What makes HIPnation-PrimaryCarePlusSMunique?

HIPnation-PrimaryCarePlusSM gives its members outstanding access to care that is affordable through a system that is not based upon insurance.  Please remember: we are not an insurance product!  Instead, we function as a “medical home” in which a primary care physician coordinates all of a patient’s care.  This means that your primary care doctor will work with a team of specialists to address whatever medical issues you may be facing.  You – and not an insurance product – are the focus.

How do I comply with the ‘Individual Mandate” under the Affordable Care Act?

First, the fate of the “Individual Mandate” to purchase minimum essential coverage for healthcare is a bit in flux.  Currently, the Senate version of the tax reform bill before Congress repeals this provision.  For now, however, a person must meet this requirement by filing a completed IRS Form 1095.  As a HIPnation-PrimaryCarePlusSM member receiving our services through EBA, you will receive this form no later than March 2, 2019 (either from us or EBA).

Why does compliance with the Affordable Care Act seem so complicated and hard to understand?

This is a very good question!  We think this is largely because the ACA assumes an insurance based model for healthcare.  Yet, it also encourages innovation in looking for new and better ways to provide healthcare, such as through associations like EBA and “medical homes” like HIPnation-PrimaryCarePlusSM.  This tension creates some ambiguity in just what arrangements meet the requirements of the ACA.  Providers like us are seeking to comply with the law yet provide a better level of care at a lower cost than traditional insurance products.   We believe our approach meets both the spirit and the goals of the ACA.

How does self-funding save me and my company money?

Self-Funding is a method for employers to be able to gain control of the yearly double-digit insurance increases in the traditional insurance model.  The HIPnation model with our partners allows for self- funding with limited employer risk.  We have designed a system that permits smaller companies to adopt a self-funded model.  Contact us today for a free consultation.

How does HIPnation help a small business 2-25 employees?

The small group market is severely affected by the lack of cost effective choices for providing insurance coverage for employees.  The HIPnation solution has been shown to be 30-50% less for employees which translates to great employer savings.  You can pair our HIPnation solution with several different insurance options provided by our partners to give better healthcare at less costs.  Contact us today for a free consultation.

How can I calculate the savings for my business and employees?

There are many different hidden fees within a traditional insurance plan, both for employers and for employees.  HIPnation can significantly limit specialist visits, eliminate primary care copays, and eliminate all deductibles in the primary care space. Contact us today for a free consultation.

How do you help me explain the change in thinking to my employees?

For your employees, the enrollment will be very similar to what they have done in the past.  The difference they will immediately see is that there will be no co-pays and no deductibles for primary care services.  Your employees will appreciate that they will have the cell phone of their primary care physician.  60% of medicine can be done the primary care level so you, as an employer, have provided them with convenient access, better care, and less costs for the majority of their healthcare.

What if one of my employees has a catastrophic event under the HIPnation model?

HIPnation partners with employers in two different ways depending on the size of the company. Both options provide for coverage for catastrophic events for employees in different ways. Contact us today for a free consultation.

Do I need to wait until my open enrollment period to switch to the HIPnation model for my business?

With health insurance, you can actually switch at any time during the year.  We have shown businesses how they can save thousands of dollars per month on their insurance costs while giving better healthcare to their employees.  People can switch to HIPnation any time; however, you will only be able to purchase insurance products on the individual exchange during open enrollment.

What can you do for my 1099 independent contractors?

The HIPnation solution fits well with 1099 independent contractors and with our partner products provides them with a plan that is compliant with the individual mandate (remaining in effect until 2019) and costs approximately 50% less than insurance exchange plans.

I have more than 50 FTE’s, and I am required to provide insurance coverage under the ACA (Obamacare). How does the HIPnation solution help me with that?

The HIPnation solution was built specifically to partner with employers to provide an ACA compliant plan, with products offered by our partners, that will give employees better healthcare, better access, and less costs.

What is the tax treatment for the HIPnation membership fee if an employer pays the fee as an employee benefit?

The employer should consider including the HIPnation membership payment in the employees’ W2 as a taxable fringe benefit. This payment is treated similarly to a payment that an employer would make for an offsite gym membership on behalf of an employee. HIPnation membership does not fall into the health insurance exclusion since HIPnation is not insurance.

Note: The above information is from our HIPnation CPA but we encourage you to consult your tax advisor. We are not giving tax advice. Members are encouraged to speak with their personal tax advisor.

What is my monthly membership cost for children?

You have 2 options from which to choose:

  1. You can choose to have 24/7 access to our Primary Care Physicians for your children aged middle school and older for $100/month with no copays; OR
  2. You can choose from one of our HIPnation partnered pediatricians for your children for the individual membership fee of $60/month and a $40 copay per visit.
How are costs handled inside the Pediatrician's office?

HIPnation has worked closely with our Pediatric partners to produce a cash pay list for all procedures in their office. This will be a “pay as you go” system in partnership with your Pediatrician. You will receive this detailed information from the pediatric office after signing up with HIPnation.

How will vaccines be handled for my children?

HIPnation has worked with our Pediatric partners to provide you with two options for vaccines:

  1. In the office, you will pay for all vaccines at a pre-negotiated cash rate. The full schedule of vaccines, and their costs, are listed below; OR
  2. For our members who do not have insurance, there is a state program that can provide vaccines at reduced rates at local health departments. There are state and insurance guidelines that apply. Our Pediatric partners will help you with the paperwork as you navigate the system. There is a fee for the paperwork completion.
What if my child is sick in the middle of the night?

All of our Pediatric practices have on-call schedules and numbers that you can call. You may not speak with your personal doctor but will be cared for by one of their partners. This is standard pediatric practice.

Is the specialty care covered in my monthly fee?

No. It is, however, billed at a rate far below the individual rate, at about the same rate as the Medicare schedule. For most office visits, the rate will be $120.00 initial Specialist office visits vs. $350.00 to $400.00 billed through insurance.

The great news is that 80-90% of your health care can be managed by your personal Primary Care Physician.

Does the monthly fee cover my annual physical?

Yes, the annual physical and associated lab tests are covered by the monthly fee.

How much does HIPnation-PrimaryCarePlus cost?

For participants the cost is $100 per month. Additional family members may be added for the same low fee. Family discounts also apply.

Is hospitalization or catastrophic care included in my membership?

No, HIPnation-PrimaryCarePlusSM membership provides primary care and access to specialty care at low rates. Individuals can purchase additional affordable supplemental health insurance products from our partners.

Why do I have to join for at least 6 months?

The relationship between your personal primary care physician, and you as a patient, is the foundation of HIPnation. While we provide acute “urgent sick care” needs, our focus is engaging intimately with you as a member. Because of the care we provide and our affordable rates, some had started to utilize our services as an urgent care center. To avoid this, we have a minimum 6-month membership requirement.

How much is a Family membership with HIPnation?
No. of Family Members

Subscription price​

1 – 3

$100 per month per person

4 – 5

Additional $75 per month per person

6 +

Additional $50 per month per person
Is the HIPnation access to my personal doctor similar to telemedicine?

Telemedicine is an offering in many insurance-based plans where you can contact a doctor via telephone.  With HIPnation, however, you will contact your personal physician on their personal cell phone.  You will speak to a doctor with whom you have a relationship.  Your doctor will know you and will see your medical history.

Can I still see my personal OB/GYN?

Yes, you can continue to see any specialist physician you choose; however, you will not receive the prices we have arranged with our specialists to see HIPnation patients. At HIPnation, we have built a team of specialists who are specifically partnering with our primary care physicians in the care of our members and who have agreed to care for you at low rates, in most cases, available only for our members.

Can I keep my primary care physician?

Our unique, membership model with HIPnation does not work in the current volume-based, insurance-driven system.  Our HIPnation primary care physicians care for approximately 75% less patients than would be considered normal today in an insurance-based system.  The HIPnation model allows you to have your physician’s cell phone, same day access for appointments, as well as full care coordination with our specialist teams.  This experience is just not available in most offices that accept insurance.

How does the HIPnation solution work for specialists in areas where HIPnation does not currently have a provider?

If you need to see a specialist who is not currently a HIPnation specialist, your primary care physician can still initiate the referral.  Depending on your insurance options, the visit could be cash pay, partially reimbursable through the indemnity plan, or a copay depending on your company insurance or the HIPnation self-insured plan.  Contact us for more details.

How do HIPnation primary care physicians reduce specialist visits?

In today’s high volume, insurance-based system, many primary care physicians are overloaded with visits and administrative tasks that do not allow them to adequately spend time with patients and fully care for them.  The average doctor visit in the US is less than 8 minutes which results in many unnecessary specialist visits.  This increases your costs, time away from work, etc.  Our HIPnation Specialists are excited to partner with our HIPnation primary care doctors to limit these unneeded appointments, which allows the Specialists to see the patients who truly need their expertise.  This is another key way we put you at the center of your care.

I have Medicare as my insurance. How does the HIPnation solution work with Medicare?

Your monthly membership fee will give you 24/7 access to your primary care physician but is separate from Medicare. Your HIPnation primary care physician will not be a participating provider with Medicare.  However, they can refer you to specialists who are Medicare providers, continue to write prescriptions, and coordinate your healthcare.

I have health insurance through my employer. How does the HIPnation solution work with this?

You can join the HIPnation solution for the monthly membership fee; this is separate for your health insurance. HIPnation has partnered with the primary care physicians listed on our website.

What if I have already enrolled in an open enrollment insurance plan? Can I switch?

Health insurance is like car insurance in that you can shop for better rates and switch at any time.  With HIPnation, we encourage you to get a quote any time in the year as often premium savings are 50% and without a deductible. Individuals may switch to HIPnation at any time; however, individuals will only be able to purchase insurance products on the individual exchanges during open enrollment periods.

How do I apply for the Catastrophic Indemnity plan mentioned on the HIPnation site?

Fill out a Contact Us form on our site, and we will introduce you to an insurance broker who can walk you through the process.  The indemnity plan, provided by our partner entity, is underwritten so you will be required to provide answers to medical history questions regarding preexisting conditions.  It takes about 2 weeks to know if you have been approved for the indemnity plan.

How do I add dental and vision plans mentioned on the HIPnation site?

Fill out a Contact Us form on the website and we will be happy to help you connect with our partner entities to provide such coverage.

Where is HIPnation-PrimaryCarePlus available?

HIPnation-PrimaryCarePlusSM is available in metro Atlanta.

What if there isn’t a HIPnation office that is close to my home?

With our unique membership model, after your initial visit to your primary care physician, you have 24/7 access to your primary care physician via phone, secure video, text, and email.  When you have a relationship with your physician, your primary care doctor can handle much of your care over the phone or by video.  Please remember that you must visit your primary care physician once each year for your annual wellness visit before such 24/7 access is available.

Can I switch physicians when an office closer to me opens?

As we expand our HIPnation offices and clinics, you are welcome to switch to a doctor closer to you at any time.  This is easily done via a Contact Us form.  Please remember, however, that you will need to see your new physician before you will receive 24/7 access.

What if have the Catastrophic Indemnity coverage, and I have an accident outside of Atlanta? Am I covered?

New Era, our insurance partner, uses the largest physician network in the country, PHCS, so it is highly unlikely you will be in an area that doesn’t accept your insurance with New Era.

Can my child who is in college in another state be a HIPnation member?

Yes.  Our primary care physicians will need to see them for an initial wellness visit to initiate the relationship and fully understand their medical history.  In the HIPnation model there is no cost for the wellness visit.

Dental Coverage

Almost everyone has a dental problem at some point, but only half see their dentists for regular visits. Instead, they wait until the problem gets bigger and more costly. All because they don’t have dental insurance. That doesn’t have to happen with a Voluntary Dental plan from American Benefit. American Benefit offers two voluntary dental plans – the Premier Plan and the Advantage Plan. Both plans feature a lifetime deductible of only $100 per person and covers 100% of Preventative, 80% of Basic and 50% of Major Services after the deductible. These plans offer a takeover benefit for employees already on a dental plan and eliminates any benefit waiting period. There is no network, you can visit the dentist of your choice! If your children need orthodontia coverage, no problem, it is optional under the Premier Plan.

Eligibility: Both dental plans are available to groups with 1-99 eligible employees. Minimum enrolment is based on 1 employee or 20% of the eligible group whichever is greater.

How are claims filed? Your dentist’s office will file your claim for you. American Benefit accepts claims by internet mail or fax.

Extensive Provider Network: Use your own dentist! The plan works with any dentist nationwide.

Plan Features

Deductible: $100 lifetime deductible, once met you will never have another deductible.

Preventative Care: Plan pays 100% after deductible for exams, cleanings and x-rays, no waiting period.

Basic Care: Plan pays 80% after deductible for fillings, sealants and space maintainers, no waiting period.

Major Care: Plan pays 50% after deductible for anesthesia, endodontics, extractions, periodontics, oral surgery, crowns, bridges and dentures with a 12 month waiting period, unless member qualifies for take-over benefit.

Maximum Plan Benefit: Advantage Plan – $1,000/Year/Family Member; Premier Plan – $1,500/Year/Family Member

Optional Child Orthodontic Coverage (Premier Plan Only): Pays 50% of orthodontia services, no deductible, $1,000 lifetime/child maximum benefit and 12 month waiting period, unless member qualifies for take-over benefit.

Monthly Premium – Advantage Plan:

Employee: $34.87
Employee + Spouse: $69.86
Employee + Children: $74.38
Employee + Family: $110.89

Monthly Premium – Premier Plan: Without Child Orthodontia Coverage

Employee: $44.00
Employee + Spouse: $92.10
Employee + Children: $96.24
Employee + Family: $144.32

Monthly Premium – With Child Orthodontia Coverage

Employee + Children: $102.49
Employee + Family: $150.80

Easy Enrollment: Click to download Company or Individual Membership Information and Employee Enrollment Form

Vision Plan

American Benefit’s Vision by Design plan cover exams and eyewear, including frames, lenses and contact lenses. Thousands of providers, including; LensCrafters®, Target Optical®, and most Sears Optical® and Pearle Vision® locations.

Eligibility: This vision plan is available to groups with 1-99 eligible employees. The minimum enrolment requirement is one employee or 20% of the eligible group whichever is greater. All employees enrolled in a Companion Vision Plan are also eligible to enroll in an American Benefit Dental Plan.

How are claims filed? At the time of service, present your ID card or simply provide your name and ID number to the provider who will confirm eligibility and apply applicable discounts. You will not have to submit a claim form as you will pay based on the discounts given to you for services at the time of your visit. If you or a family member receives services out of the network of providers, then you will pay for services without discounts applied to your amount due. Once you pay in full, you will send in a claim form showing you paid full price and send that to Companion and they will reimburse you only the amount due you had you received services at an in-network provider. This form is available online at http://americanbenefitllc.com/.

Extensive Provider Network: Vision by Design offers a nationwide network of convenient, accessible options for eye care offered through EyeMed Vision Care. Enjoy easy access to thousands of conveniently located vision care providers, including optometrists, ophthalmologists, opticians and many leading optical retailers, such as LensCrafters®, Target Optical®, and most Sears Optical® and Pearle Vision® locations.

  • Access to more than 35,000 vision care providers at 18,000 locations nationwide
  • Evening and weekend hours at many locations
  • Choice of thousands of fashionable, designer frames
  • No appointment necessary
  • Convenient mall or nearby mall location
  • Service in “about an hour” at most locations
Plan Features

The American Benefit program offers unlimited choice with quality and value. Providers are given the freedom to recommend whichever lens brands or options they believe offer the best ocular clarity. They are also free to choose any fabrication laboratory, assuring quality, service, and convenience. Vision by Design provides total flexibility to choose eyeglass frames that meet any taste, need or lifestyle. You can choose from any available frame at your provider location. Most providers carry frames by Luxottica, the world leader in eyeglass design and manufacturing. The Luxottica collection of eyewear includes the most reputable and prestigious names in the optical fashion world.Deductible:

Exam Co-Pay: $10

Eyeglass Frame Allowance: $130

Contacts Allowance: $120

Plan Covers Regular Visits:

  • Eye Exam: Every 12 months
  • Lens or Contacts: Every 12 months
  • Frames: Every 24 months

Monthly Premium – Vision by Design
(Rates for 100% Group or Vision Plan Participation)

Employee Only: $6.88
Employee + One: $12.95
Employee + Two: $15.33
Employee + Three or More:$20.40 $20.40

*To qualify for the group rate, either the group needs 100% of their eligible employees to enroll in the vision plan or 100% of their dental plan members to enroll in the vision plan.
Monthly Premium – Vision by Design
(Rates for 100% Group or Vision Plan Participation)

Employee Only: $9.74
Employee + One: $18.39
Employee + Two: $21.76
Employee + Three or More:$20.40 $28.97

Easy Enrollment: Click to APPLY

Term Life and AD&D Coverage (Guaranteed Issue)

Life is priceless. Maybe that’s why life insurance can be a little expensive. But not with Americas Benefit. Our Voluntary Group Term Life Insurance plan is never out of reach for employees – whether their businesses are small or large. The Americas Benefit Plus plan is a Guaranteed Issue Term Life insurance policy for employee groups of all sizes. For added protection and value the coverage includes our Accidental Death and Dismemberment (AD&D) coverage. Accidents happen when we least expect – you can’t prevent them, but you can plan for them. With AD&D coverage, you and your family can have additional protection when you need it most

What does a life policy do for me? A life policy provides a death benefit equal to your life insurance coverage amount in the event you were to pass away. All plans also feature an Accelerated Benefit payment where you can receive up to 75% of the face value of your policy to help cover medical and living expenses if you became terminally ill.

What is AD&D coverage? AD&D (Accidental Death and Dismemberment) insurance is a policy that pays benefits to the beneficiary if the cause of death is an accident. Coverage includes the loss of, or the loss of use of body parts or functions; limbs, speech, eyesight or hearing, or in the case of permanent paralysis. Typically, specified circumstances are covered under the accidental death term, including exposure to the elements, traffic accidents, homicide, falls, drowning and accidents with heavy equipment.

Plan Features

The AD&D option includes these valuable benefits:

  • Seat belt provision – an additional amount equal to the lesser of the AD&D benefit or $10,000 is payable
  • Common disaster provision – the benefit will be two times the principal sum
  • Spouse education benefit – additional $3,000 for a year’s study
  • Paralysis benefit – up to AD&D amount

Eligibilty: Groups or individuals with 1-99 employees. Groups with less than two employees are only eligible for the $10,000 plan (see plan options below). Groups with two or more enrolled employees can enroll in the $10,000, $25,000 or $50,000 benefit option. All plans include AD&D coverage at no additional charge at the same coverage levels ($10,000, $25,000, $50,000). This is a ‘Guaranteed Issue’ policy – No medical questions or exams!

Participation Requirement: All eligible employees must be enrolled in the plan chosen by the employer.

Coverage Costs (monthly):

$10,000 Benefit: $3.00
$25,000*: $7.50
$50,000*: $15.00

* Only for two or more enrolled employees. Groups with less than two employees are only eligible for the $10,000 plan.

Easy Enrollment: Click to download Company or Individual Membership Information and Employee Enrollment Form

What type of care can I expect via a phone call with my personal HIPnation doctor?

With the HIPnation model, your physician can care for you in a way that is best for you in your particular circumstance.  Most care at the primary care level can be done remotely using available technology (phone, email, secure video). If they feel that is best for you to have an in-office visit, that will be arranged quickly.  Please remember that you must see your primary care physician in person at least once every year for your annual wellness visits.