Assisting Health Insurance Brokers with Start Health

A reimbursement plan, or fixed indemnity plan, is a type of health plan where you pay for care upfront—often at discounted cash rates—and then your health plan pays you back at set rates based on care received (regardless of your provider’s charges).

With Start Health, members pay cash rates for care on the date of service, then submit their itemized bill for reimbursement. The fixed reimbursement amount for any qualified expense is credited toward the deductible. Once the deductible is met, Start Health reimburses members directly via standard ACH bank transfer. Preventive care like routine cancer screenings, annual physicals, and vaccinations is reimbursed pre-deductible.

This approach puts members in control of their care, helping them find the best care at the best price and maximize their savings.

Start Health is ideal for healthy individuals who don’t qualify for significant subsidies through the marketplace or an employer-sponsored plan. Start Health plans cover all the same services you’d expect a traditional plan to cover (including preventive care and prescription medications) for a fraction of the price of marketplace plans.

Start Health is also an ideal plan for anyone who wants to maximize tax savings and investment potential through HSA benefits.

Start Health qualifies applicants based on a medical questionnaire. 

Any affirmative response (“Yes”) to the following questions will result in the applicant being deemed ineligible for qualification.

• Any tobacco use in the past 12 months?
• Are you currently pregnant or have reason to suspect you might be pregnant?
• In the past 24 months, have you been recommended to have, or been scheduled for, diagnostic testing, treatment, or surgery that has not been completed?
• Within the past 24 months, have you had a health related condition for which you have not sought medical advice or treatment?
• Within the past five years, have you received any abnormal test results, medical or surgical treatment, healthcare professional consultation, or prescribed medication for any of the following conditions?

Please indicate ALL that apply:

• Arthritis, Rheumatologic disorder or any disease or disorder of the joints, bones, muscles or back. (Indicate if any condition that has lasted more than one month or that you have been prescribed anything other than over the counter pain relievers.)
• AIDS or tested positive for HIV
• Asthma, Emphysema, COPD, TB, or any other disease or disorder of the respiratory system
• Cardiovascular disease or disorder of the heart, arteries, blood vessels, or blood. (Indicate for any condition for which you were treated with any procedure or prescribed a medication other than statins.)
• Cancer or tumor
• Chemical dependency, drug or alcohol abuse, or any other mental health disease or disorder
• Crohn’s disease, ulcerative colitis, hepatitis, or any other disorder of the liver, stomach, colon, or intestines. (Indicate for any condition for which you received a treatment or prescribed a medication other than over the counter medications.)
• Diabetes or any other pancreas disorder
• Immune system disease or disorder
• Kidney disease or disorder
• Brain or nervous/neurological system disorder
• Stroke

Yes, Start Health plans are designed to be HSA-eligible*. It meets IRS and Department of Insurance (DOI) requirements for High Deductible Health Plans (HDHPs), including covering preventive care pre-deductible. While our plan doesn’t follow the traditional out-of-pocket maximum structure, once your deductible is reached, Start reimburses 100% of eligible healthcare costs at our set rates. This design offers strong financial protection and meets the criteria for HSA eligibility, allowing you to contribute to and use a Health Savings Account.

Yes, Start Health has set reimbursement rates based on medicare rates for generic prescription medications.

Yes, Start Health provides set reimbursement rates for pregnancy and birth-related care. However, if a member is pregnant at the time of renewal, they won’t be eligible to renew their plan, as pregnancy is considered a disqualifying condition. Members due to deliver after their Start Health coverage expires are encouraged to explore an ACA plan or another alternative until after the baby is born.

Learn more here. 

Yes, Start Health has set reimbursement rates for some alternative modalities like Chiropractic Procedures, Osteopathic Manipulative Treatment, Physical Therapy, Allergy Testing, and more.

Start Health does not reimburse for other forms of alternative (or experimental) treatments like acupressure, acupuncture, aroma therapy, hypnotism, massage therapy, and rolfing.

Start Health reimburses fixed rates based on billed service codes. We’ve determined our fixed rates based on Medicare case data and reimburse a much higher percentage than what Medicare covers for tests, procedures, and prescription medications.