Flow

Yes, but on a phased in approach. Pre-existing conditions in the 1st year are capped at $5000 and then have the following progression: 2nd year $30,000, 3rd Year $75,000, 4th year $150,000, and 5th year and beyond is unlimited. However, these limits are cumulative through the 4th year. For example, if a member receives $5,000 in sharing for a pre-existing condition during Year 1, they would have up to $25,000 of additional sharing available for that same pre-existing condition in Year 2. If they use the $25k in Year 2, then in Year 3, they have $45k toward the same pre-existing need. In Year 4, for the same pre-existing need, they will be eligible for $75K in sharing. If a member has more than one unrelated pre-existing condition, the phase-in schedule applies separately for each condition.

Pre-existing conditions are defined as any health issue you were diagnosed with, or for which you had symptoms, during the 'lookback period'. The lookback period is 1 year for EverTrust except in cancer related conditions which have a 3 year lookback. Further, the following are not eligible for sharing if signs, symptoms, diagnosis, or treatment occur within the first 90 days of membership: gallbladder-related care, kidney stones, cancer diagnosis or staging, tumors (benign or malignant), or kidney disease. For example, if you went to the ER with chest pains during the 1 year lookback period and you later have a heart attack, it will likely be considered a pre-existing condition and covered based on the phased-in approach discussed in the FAQ above. What is considered pre-existing varies between the Zion, Sedera, and EverTrust backed plans. For example, Zion and EverTrust do not consider high blood pressure, high cholesterol, and diabetes as pre-existing as long as they are managed (i.e. you are taking your medications) and you have not been hospitalized for the condition in the prior 12 months. It is important that you read the plan guidelines found under the Details section of each plan for specifics if you believe you may have a pre-existing condition. See our pre-existing conditions guide for a general overview.

The dental savings plan is provided by the Careington Dental Network. This is a savings plan rather than insurance. To utilize, you will locate a participating dentist via the MPB portal or mobile app and then provide your dental ID card when scheduling an appointment with the provider. The savings plan covers routine, basic, and major procedures.

Just like with virtual primary care, you will use the MPB portal or mobile app to connect with a dentist via an audio or video call. This service is designed for non-emergency needs.

You are eligible for a $200 discount on your next membership contribution after 12 months of being a member. At that time, you can submit a gym membership discount request via the MPB portal or mobile app. You will need to include proof of gym membership at that time. You are eligible for this discount once per year starting in year 2.