Start Health uses a fixed indemnity reimbursement model, meaning you pay up front for care, submit an itemized bill to Start Health, and get reimbursed. Reimbursements are based on a set schedule tied to the medical service code, not the provider’s billed charge.
If you use our price transparency tools and care coordination services, you can often find providers whose prices match or fall below Start Health’s fixed reimbursement amount. But if a provider charges more, you’re responsible for the difference.
For Example:
If an MRI costs $2,000 at a hospital but only $600 at an outpatient imaging center, Start Health’s fixed reimbursement of $850 stays the same. That means:
- At the hospital, you’d owe $1,150 more.
- At the imaging center, Start Health would cover 100% of your charges
We understand you can’t always shop around—especially in emergencies or when a facility won’t negotiate a fair cash rate. That’s where Start Shield comes in.
What Start Shield Covers
Start Shield is an optional catastrophic rider designed to protect you from large, unexpected medical expenses that exceed your Start Health reimbursement amount.
Here’s how it works:
First: Meet Your Base Policy Deductible
You must first meet your Start Health deductible.
Second: Start Shield Activation
After that, Start Shield covers 80% of eligible costs that exceed your base policy’s reimbursement amount.
You’re responsible for the remaining 20% until you reach the cap on expenses you’re responsible for:
-
- $8,000 individual
- $16,000 family
Third: Full Coverage Beyond That
Once you reach your max out-of-pocket, Start Shield covers 100% of any remaining eligible costs above the base reimbursement.
Network Rules
- Planned procedures like scheduled surgeries must be performed by in-network providers to qualify for Start Shield coverage. You can search for in-network providers and facilities at healthutahnetwork.com.
- Our Member Support team can help you find top-rated providers at the best possible price.
- Emergency care is automatically considered in-network, even if you receive care in a different state or country.
In short: Start Shield adds an extra layer of financial protection—so even if a provider charges more than Start Health reimburses, you won’t be left with unmanageable bills.
