Plan Summary
Solo Health Collective – Nationwide PPO Health Plan
Solo is a self‑funded major medical plan administered by Vault Admin Services and backed by a Medical Reimbursement Policy through Vault Health Captive, LLC – Series C. It’s designed for entrepreneurs and self‑employed owners who want high‑quality care, concierge support, and strong financial protection.
- Network:
Access the MultiPlan PHCS nationwide PPO (all 50 states).
- Emergency care:
Always treated as in-network—go to the nearest ER.
- Deductible choices:
$2,500 / $5,000 / $10,000 individual; $5,000 / $10,000 / $20,000 family.
- Before deductible:
Plan pays 100% of preventative services only.
- After deductible:
Plan pays 100% of covered medical services (no coinsurance).
- Copays:
Only apply to prescriptions after the deductible (preventive Rx $0).
- Prior authorization:
Required for certain inpatient admissions, procedures, surgeries, and some mental health treatments (see SPD details).
- In‑Network (Multiplan PHCS):
Use Multiplan PHCS providers for the lowest out‑of‑pocket costs.
- Out‑of‑Network:
Covered under Reference‑Based Pricing (RBP); you may pay more—confirm status before care.
-
Emergency Services:
Always handled as in‑network.
Search the Multiplan PHCS network.
| Care Type | Coverage |
|---|---|
|
Preventive Services (age/gender-appropriate screenings, annual wellness, certain vaccines/Rx, well-child) Note: Solo follows the ACA guidelines of preventive care |
100% (deductible waived) |
|
Primary & specialist visits |
100% after deductible |
|
Emergency room |
100% after deductible (closest ER) |
|
Urgent care |
100% after deductible |
|
Inpatient hospitalization & surgeries |
100% after deductible (Prior authorization required) |
|
Mental health & substance abuse treatment |
100% after deductible (Prior authorization may apply) |
|
Imaging & advanced diagnostics (X-ray, MRI, CT, PET, labs) |
100% after deductible |
Note: Out‑of‑network services are subject to RBP and may result in higher costs, especially if you prepay the provider.
Members pay full cost until the deductible is met, except Tier 1 preventive drugs (always $0). Then the following copays apply:
| Tier | 30-Days Retail | 90‑Day Mail | Notes |
|---|---|---|---|
|
Tier 1 – Preventive |
$0 |
$0 |
Deductible waived |
|
Tier 2 – Preferred Drugs |
$15 |
$30 |
After deductible |
|
Tier 3 – Preferred Brand & Non‑Preferred Generics |
$50 |
$100 |
After deductible |
|
Tier 4 – Non‑Preferred Brand |
$100 |
$200 |
After deductible |
|
Tier 5 – Specialty Drugs |
Covered up to $1,000/Rx |
Covered up to $1,000/Rx |
Covered up to $1,000/Rx |
|
Tier 6 – Non‑Formulary |
Not Covered |
Not Covered |
Excluded |
Important Rx notes:
Non‑specialty drugs over $1,000 (30‑day) or over $3,000 (90‑day) are excluded; formulary updates are communicated 30 days in advance. Use the FairosRx portal/app to check coverage and pharmacies.
- Vault Cares Network:
Second opinions, care navigation, member advocacy.
- MedWatch Case Management:
Coordination for complex/high‑cost care (and prior auth).
- Occunet Balance‑Bill Support:
Help if you receive an unexpected balance bill.
- Not typically covered:
acupuncture/massage/alternative therapies, cosmetic procedures, dental & vision, infertility/surrogacy services, vitamins/supplements, marriage therapy, experimental treatments. See the Summary Plan Description (SPD) for the full list.
- Medical Reimbursement Policy:
After you meet your deductible, eligible claims are reimbursed by Vault Health Captive, LLC – Series C.
- Eligibility
Health attestation required; inaccuracies may lead to denial.
- Captive Participation:
Members share claims risk as part of the Vault Strategies small‑employer group.
- Governing Document:
This page is a summary; the Summary Plan Description (SPD) controls.
Vault Admin Services (claims & benefits):
- Phone: 888‑211‑5706
- Email: claims@allthingsvault.com
Healthy Business Group / Solo Support:
- Call/Text: : 888‑655‑4053
- Email: support@hbgnow.com
Downloadable Resources
Here are a few important files you may want to keep handy offline. Use the buttons below to access them.
Summary of Benefits
Understand what your plan covers whenever you need it.
Prescription Drug Formulary
Easily check which medications are covered under your plan.
Summary Plan Description
Understand the full details and rules of your coverage.