Vital Health Program
Vital Health Program
Give your team access to an affordable healthcare benefit that combines ACA-compliant preventive care with a health sharing program for eligible major medical expenses, helping provide support for hospitalization, surgery, and emergency care without the cost of traditional major medical insurance.
Individuals & Families
The Vital PPO plan offers individuals and families an affordable, all-inclusive solution that blends the flexibility of a PPO network with tailored major medical, surgical, and emergency care.
Why employers choose VitalCover
- Predictable monthly costs
- Nationwide PPO provider network for preventive care
- Affordable copays for employees
- $0 telehealth
- Prescription savings
- Designed to help with eligible major medical expenses
3 Main Components of the Vital PPO Plan
Preventive &
Sick Care
ACA preventive care (immunizations, mammogram, check-ups, etc.) plus primary care, specialists, and $0 telehealth
Rx, Labs, & Imaging
Retail and mail order pharmacy,
$0 generics, labs, and imaging
Major Medical & Emergency Care
Surgery, hospitalization, maternity, and worldwide emergency care
Plan Highlights
Preventive Care
Covered at 100% per ACA guidelines
- Annual wellness exams
- Immunizations
- Preventive mammogram
- Preventive colonoscopy
Prescription Savings
Save money on your prescriptions
- 1,000+ generic drugs
- 70,000 pharmacies
- Mail-order available
- Rx look up in personal Health App
Major Medical
Health Share for eligible major medical events
- Emergency
- Hospitalization
- Surgery
- Maternity
Everyday Healthcare
Care when you need it
- $25 primary copay / $35 specialist copay
- FREE 24/7/365 Telehealth
- Virtual counseling
- Find care, plan info, & more in Health App
*This does not represent a complete summary of plan benefits. A full SBC document will be provided.
*Plan not available in WA, MA, or VT
*VitalCover reserves the right to update its vendor arrangements from time to time in order to maintain
high-quality services and competitive pricing for members. Members will be provided advance notice of
any material changes affecting their benefits or services.
Compare costs. Discover your savings!
See how a typical unsubsidized Silver PPO plan compares with VitalCover for a family of three.
While every situation is different, many families can significantly reduce their monthly healthcare costs with VitalCover.
Typical Silver PPO
Monthly premium – $2,300
Family deductible – $8,000
Total annual premium – $27,600 per year
VitalCover
Monthly membership – $1,466
$1,500 Unsharable Amount (UA)*
Total annual premium – $17,592
Illustrative comparison only. Actual premiums and deductibles vary. VitalCover combines PPO medical benefits, including ACA-compliant preventive care, with a health-sharing program for eligible major medical expenses. Benefits, eligibility, and cost-sharing differ from traditional ACA Marketplace plans.
*Similar to a deductible, the Unshared Amount, or UA, is the amount a member will pay per incident before medical expenses are shared. The lower your UA, the higher your monthly contribution will be.
How it works
- Use the cost calculator for an estimated cost for an employee
- Speak with a benefits advisor
- Employees enroll by the 20th of the month
- Employees enjoy their benefits the first of the following month
Health Cost Calculator
*Similar to a deductible, the Unshared Amount, or UA, is the amount a member will pay per incident before medical expenses are shared. The lower your UA, the higher your monthly contribution will be.
Vital PPO Benefit Highlights
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First Health PPO Network
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Preventive / Wellness / Immunizations
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Covered at 100% per ACA Guidelines
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Primary Doctor & Pediatric-Sick Visits
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$25 copay in-network
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Specialist Doctor
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$35 copay in-network (3)
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Urgent Care
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$50 copay in-network for in person (3), Unlimited $0 telehealth in HealthWallet
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Diagnostic Tests (Labs, Xrays, Etc.)
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$50 copay in-network - outpatient & basic diagnostic labs only (at lab Quest/LabCorp)
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Virtual Urgent Care by Lyric, 24/7/365 with Licensed, Board- Certified Physicians |
$0 copay unlimited when using HealthWallet
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Mental Health & Wellness
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Mental Health, Substance Abuse Consultation. Virtual Counseling - Consult with a Master-level Therapist/Counselor. Limitations apply. |
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Preventive Screenings - Mammography, Cervical, and Colorectal Cancer |
Plan pays 100% for Preventive
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Rx Program
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Provides over 1,000 routinely prescribed ACUTE and CHRONIC generic drugs at no cost. Plus, access to thousands of other medications at the fraction of retail cost. Over 70,000 in-network retail pharmacies and mail-order available. |
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Emergency, Surgery, Diagnostic Imaging, Hospitalization, and Other Medical Expenses |
Health Share covers your emergency, surgery, hospitalization, and other medical expenses. No annual caps or lifetime limits. Includes some holistic and alternative care options. There are some pre-existing condition benefit limitations. Further information available upon request. |
Rates starting from:
*additional $100/mo for tobacco
*This does not represent a complete summary of plan benefits. A full SBC document will be provided.
*Meets Part A of the Affordable Care Act (ACA) Preventative Services Requirements
*Plan not available in WA, MA, or VT
*VitalCover reserves the right to update its vendor arrangements from time to time in order to maintain high-quality services and competitive pricing for members. Members will be provided advance notice of any material changes affecting their benefits or services.
The Vital PPO Difference
Frequently Asked Questions.
You can join anytime of the year. Sign-up by the 20th of the month for benefits to be effective by the 1st of the following month
No. Notify VitalCover by the 20th of the month to end your benefits for the following month.
Yes. The VitalCover plan includes preventive care per ACA guidelines.
For preventive care, we use the First Health Network. Providers can be found at firsthealthlbp.com
For the Health Share (major medical), you can see any provider.
Similar to a deductible, the Unshared Amount, or UA, is the amount a member will pay per incident before medical expenses are shared. The lower your UA, the higher your monthly contribution will be.
There are some pre-existing limitations for major medical and some conditions. If you’d like to discuss pre-existing condition sharing options, please contact our team.
If you’re diagnosed with cancer, medical expenses are eligible for sharing. However, if it’s a pre-existing condition diagnosed within 36 months before joining, sharing limitations apply. For specific details, contact us.
Yes. Many members spend just a fraction of what’s typically owed under traditional methods. The maternity program includes prenatal, delivery, postnatal, homebirth, midwives, and doulas. Members who help keep costs down for the community may be eligible to have part of their UA responsibility waived, and they can use a wide variety of prenatal and postnatal services that aren’t often covered by traditional plans. (If you are already pregnant when you sign up, or become pregnant within the first 30 days of joining, maternity expenses for that pregnancy are not eligible.)
The preventive care benefits included in this plan complies with ACA (Affordable Care Act) Part A preventive care requirements.
The Health Share for eligible major medical, emergency, and surgery part of this plan is not health insurance.
Yes. When using the HealthWallet app, there is unlimited 24/7/365 a $0 copay with a board-certified provider.
Program provides over 1,000 routinely prescribed ACUTE and CHRONIC drugs at no cost. Plus, access to thousands of other medications at the fraction of retail cost. |
Offer your employees great health benefits today!