The plan pays for eligible care
Rubicon makes direct agreements with healthcare facilities. A self-funded group health plan can use those agreements to offer a preferred care option with no deductible, copay, or coinsurance for eligible care. The member pays $0; the plan pays the agreed amount.
The option must be included in the member’s plan, and the particular care episode must qualify. It is one part of the health plan, alongside the benefits that apply to other care.
A complete eligible episode
A care episode is the planned care and its associated services. For a confirmed eligible $0 episode, the member pays nothing out of pocket for the facility and professional services included in that episode.
This does not make every visit, service, or independent appointment with a clinician at that facility eligible. Before planned care, the navigation team should confirm the complete arrangement for that episode.
Start with care navigation
Use the care navigation contact in the plan materials. The plan’s third-party administrator, or TPA, helps members check the participating option and arrange appointments. Specific steps vary by plan and facility.
If an appointment is already scheduled, contact the team to ask what options remain. Do not cancel or postpone care based on a general website explanation.
If a separate bill arrives
Contact the TPA’s navigation or claims team using the details in the plan materials. Explain that the bill relates to a confirmed eligible $0 care episode, and ask for it to be reviewed and resolved. Keep the bill and the details of the care arrangement available for that conversation.
Where to begin
Exploring benefits for an organization? Talk with Rubicon or your advisor. Planning care for yourself or a family member? Use the care navigation contact in your plan materials.
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