Your member benefits
Your member benefits enable you to get the medical help you need, when you need it. To utilize your member benefits, each member must contact each provider directly.
It is important to note that One Care does NOT have any contracts or agreements with any hospitals (KRH, NVH), or any other organization not on our provider list. Any services received (i.e. x-ray, emergency room, labs, etc.) at these entities will not be reimbursed by One Care. Only the services rendered by our partners will be included in your monthly fee.
One Care memberships include primary care services such as:
- Annual physicals
- Problem visits
- Wellness exams
- Well child
- Annual male and female exams
- PFT (pulmonary function testing)
- Rapid strep
Any service not covered by your One Care membership will be presented as such at time of service and it will be left to the member to decide if they would like to pay for that service at a cash pay/discounted rate. Best efforts will be made by providers to provide transparent pricing for services not covered in your membership.
Your One Care membership covers all medications listed on our comprehensive formulary. Any medication/prescription that is not listed on our formulary will be charged to the member at cost + 10%.
To fill your prescriptions each member will go to the pharmacy Alpine Apothecary in Whitefish at Super One.
For all medical needs/questions outside of provider hours of operation you will call Heavens Peak Healthcare. They provide on call One Care Member Support simply just state you are a One Care member.
One Care memberships include therapy services, such as:
- Manual therapy
- Work comp injuries
- Pain management
- Dry needling
- Strength rehabilitation
Your One Care membership covers X-Rays on a "medical necessity" basis, performed by Flexible Mobile Imaging. At this time, MRI is not covered in any capacity in your membership. Any MRI received by a One Care member will be billed to the member in full at time of service by the organization performing the service.
X-ray's are an additional cost over $50. Ultrasounds are an additional cost.
One Care cover’s up to $50 worth of labs, per medical encounter. Anything above and beyond that will be the member’s responsibility. The charges above $50 will be added, plus an additional 10%. We use Quest labs and Unipath for cytology.
Prices will be supplied if the cost is over 50.00 so you know/anticipate the additional cost.
Any treatment received in an Emergency Room will not be covered in any capacity with your One Care membership. This would be classified as a “catastrophic need” and that does not fall into your member benefit.
For catastrophic needs, One Care has teamed up with Sedera.