Welcome to Stratus Health

The Cooperative Difference

Stratus Health Guidelines 2020

I. Requirements

a. Maintain an active membership in the Stratus Health Cooperative.


b. Pay $120 Annual Membership Fee.


c. Make monthly contributions according to need analysis.


d. Membership begins on receipt of Membership Fee. 

image77
image78

II. Application for Membership

a. Each person(s) applying for membership must submit a Member Enrollment Application, pay the $120 membership fee and be accepted into the Program by the Stratus Health Cooperative.


b. If a person(s) does not qualify for membership, the fee will be returned.


c. Applications received after the 5th of the month will be effective on the 1st day of the following month

III. Membership Eligibility

a. Cooperative members of any age may apply for Stratus Health benefits

alone or combined with qualified dependent(s) provided all other qualifications are met.


b. Once an application is accepted, there is a 3-month waiting period before the Member

and qualified dependents are eligible for sharing assistance.

image79
image80

IV. Qualified Dependents

a. Member Spouse and unmarried dependent child(ren) up to age 25 may participate in

the Stratus Health Cooperative with a Dependent Membership as long as the Member is active.


b. Newborns must be added to by the Member to qualify for assistance.


c. Married dependents and unmarried dependents over the age of 25 must apply for their

own membership in the Stratus Health Cooperative.

Site Content

V. Financial Participation

a. The Annual Membership Fee of $120 due on 1st day of anniversary month each year.


b. The Monthly Contribution to Stratus Health, according to need analysis, is due on the 1st day of each month.


c. Monthly contributions are voluntary contributions that are non-refundable.


d. Once your membership is active, if your recurring monthly contribution is not received by the 15th of a participating month, your 3-month waiting period will restart.


e. Any returns by your financial institution will be assessed a $50 administrative fee.

image81
image82

VI. Needs Analysis

a. The voluntary monthly contribution of each member is based on a needs analysis that determines anticipated need based on the member age, medical condition, health

habits and desired plan.


b. The Member needs may be reevaluated on an annual basis at the request of the

member, or at any time deemed necessary by the Stratus Health Cooperative.


c. Inaccurate or missing information left out of the Member Application may cause ineligibility for assistance or loss of membership.

VII. Member Rights

a. You have the right to receive considerate, courteous service that respects your dignity

and personal privacy.


b. Your personal information and medical records will be handled in a confidential manner.


c. Your medical needs will be processed promptly and accurately once documentation is

received.


d. You will receive eligible sharing or assistance for medical treatments in a timely manner.


e. You will be informed of eligibility guidelines to help make educated choices about your

treatment.


f. You have the right to file an appeal whenever sharing is determined ineligible.

image83
image84

VIII. Member Responsibilities

a. You have the responsibility to treat medical professionals and personnel in a courteous manner.


b. You are responsible to maintain courteous and respectful communications with Stratus

Health employees.


c. Express opinions, concerns or complains constructively to the appropriate people.


d. Take charge of your own health, make positive decisions, seek appropriate care and

follow your medical professional’s instructions.


e. Communicate openly with your medical professionals. Provide accurate and pertinent

information to help them provide thorough assessment and proper treatments.


f. Participate in understanding and managing your health problems.


g. Understand the consequences of refusing recommended medical treatments.


h. Understand that refusing treatment may make future medical needs ineligible for

assistance.

Current Plan Options

Platinum

Gold Plus

Platinum

image85

  • Available only to healthy individuals with no chronic medical conditions requiring prescription care, no poor health habits (tobacco or drug use, overconsumption of alcohol, obesity as defined by BMI)
  • Annual Unshared Amount $10,000 per individual followed by 80/20
  • No coverage for accidental injury secondary to high risk activities
  • Use with Health Savings Account (HSA)

Gold

Gold Plus

Platinum

image86

  • Available to all Stratus Members
  • Annual Unshared Amount $5000 per individual followed by 80/20
  • Eligibility based on needs analysis
  •  Use with Health Savings Account (HSA) 

Gold Plus

Gold Plus

Gold Plus

image87

  • Available to all Stratus Members
  • First $1000 per individual covered at 100% for eligible medical care
  • (Includes dental cost sharing, chiropractic care, holistic medicine and up to $300 of nutritional supplements.
  • Annual Unshared Amount $5000 per individual followed by 80/20
  • Eligibility based on needs analysis
  •  Use with Health Savings Account (HSA) 

IX. Eligible Medical Needs

a. Stratus Health utilizes an Open Network. This means that the Member is free to

choose any licensed medical provider or facility for medical treatment.  There may be cost savings by selecting a Preferred Stratus Network Provider, if available in your area.


b. To request assistance for eligible medical needs, the Member is responsible to submit

standard billing forms and receipts to their personal Stratus Health advocate. Further

medical records may be required depending on the nature of the medical need.


c. Each request for assistance will be assessed based on the Member status, membership

plan, membership limitations and nature of the need.


d. Any medical records received greater than 90 days after treatment will be ineligible for

assistance.


e. Stratus Health is secondary to any health coverage or other forms of assistance

available to the Member.


f. Members are responsible for annual office visits to maintain a healthy relationship with

their licensed medical professional and to receive timely tests and procedures to

optimize their best health. Failure to do so may make advanced medical care ineligible

for assistance.


g. Assuming all criteria for eligibility are met, the following medical needs are considered

eligible for assistance;


  • Office visits
  • Urgent Care visits
  • Maternity
  • Medically necessary emergency room visits, tests and treatments
  • Medically necessary surgery
  • Physical therapy associated with eligible surgery or accidental injury
  • Preauthorized tests and procedures
  • Prescription costs
  • Limited chiropractic care with Gold Plus plan


h. Maternity care eligibility starts after the Member has been active for 10 consecutive

months prior to conception. Eligibility for assistance starts at the time of conception

and continues through delivery for the mother and newborn. After delivery, the

newborn must be added to the Member plan to be eligible for continued assistance.


i. Preexisting conditions are evaluated during the Member needs analysis to determine

eligibility. Some conditions that put the cooperative sharing fund at risk may require a

waiver for membership.

image88
image89

X. Distribution of Cooperative Funds

 a. All contributions accepted by Stratus Health are distributed according to participation and need. Stratus Health functions as a not-for-profit cooperative meaning that 100% of funds go to administration of the plan and member benefits.


b. The bulk of monthly Member contributions goes to the Stratus Cooperative Fund used to cover eligible requests for assistance from Members with excessive medical costs.


c. To protect the fund, no request for assistance may exceed 10% of the available fund. As

the fund grows, monies that exceed the group’s anticipated needs are returned to Members that made no requests for assistance during the previous fiscal year.