🏗️ Concept Overview: “Bare-Bones HSA-Compatible Plan”

Let’s call this prototype ClearHealth Basic.

Goal: A portable, fully HSA-eligible, minimal-overhead, direct-pay plan that pairs transparent pricing with a clear member out-of-pocket maximum and program-level stop-loss protection (including prescriptions via Cost Plus Drugs).

This is the key premise: ClearHealth is not supposed to be another employer-owned benefits product. It is coverage built around the member, with an HSA that the member owns and can keep across jobs, employers, and life changes.

🧭 The Four Pillars

🧮 Step 1: Regulatory Foundation — HSA Compatibility

To qualify as HSA-eligible under IRS rules, your plan must be a High Deductible Health Plan (HDHP) that meets all of these:

So your plan:

• Covers preventive care at 100% (annual physicals, vaccines, screenings).
• Everything else (primary care, urgent care, prescriptions, imaging, etc.) is cash-price until the deductible is met.
• Once deductible is met → 100% coverage or 80/20 coinsurance up to OOP max.
• Pairs with a member-owned HSA. Eligible members can contribute directly, and employers can contribute where allowed under IRS rules.

That HSA portability is central. If a member changes employers, starts a company, leaves a job, or decides COBRA is too expensive, the healthcare savings strategy does not have to start over.

💊 Step 2: Prescriptions — Cost Plus Integration

Cost Plus Drugs:

• Sells generic medications at cost + 15% + $3 pharmacy fee + $5 shipping.
• No PBM middlemen, no formularies.

Integration options:

1. Direct link: Route all prescription fills to CostPlusDrugs.com — either paid directly by the member (pre-deductible) or reimbursed after deductible.
2. API partnership: Pull real-time price data via Cost Plus’ APIs → show users exact out-of-pocket prices in your app.
3. Optional concierge layer: let members prepay meds via the plan wallet (HSA-linked debit).

Result:

• No opaque PBM pricing.
• HSA-eligible because all spending pre-deductible is member-paid.

🏥 Step 3: Provider & Network Model

Go network-agnostic:

• Let members use any licensed provider.
• Reimburse at a reference rate (e.g., 120% of Medicare).
• Encourage use of direct primary care or telehealth with transparent cash pricing.

Example:

• Member sees Dr. Smith, who charges $120.
• Medicare rate = $100 → plan reimburses $120 once deductible met.
• Before deductible, member pays directly, ideally through HSA.

You can partner with vendors like:

• Sesame Care or MDsave for cash-priced care.
• Telehealth APIs (Wheel, Teladoc, SteadyMD, etc.) for virtual visits.

📱 Step 4: Member Experience Layer

A simple web + mobile portal:

• Tracks deductible + HSA balance.
• Shows who funded the HSA: member contribution, employer contribution, or both.
• Integrates with Cost Plus and DPC/telehealth APIs.
• Displays transparent procedure pricing.
• Offers digital receipts for HSA reimbursement.

Core tech stack:

• Micronaut backend with FHIR interface.
• PostgreSQL (claims + transactions).
• Cloudflare Workers / API Gateway for routing.
• React or Flutter for app.

💰 Step 5: Example Plan Structure

🧩 Step 6: Launch Strategy

Start as a self-funded plan administrator or MGA (managing general agent):

1. Partner with a stop-loss reinsurer for catastrophic claims.
2. Build out the PAS + HSA integration.
3. Offer to independent workers, families, small employers, freelancers, LLCs, and people facing COBRA or employer-plan disruption.
4. Position as “Portable health insurance that plays nice with your HSA.”

✳️ Add-Ons (Optional)

• Direct Primary Care (DPC) membership subsidy.
• Wellness Rebate: HSA bonus contribution for preventive screening.
• Transparent Imaging Add-on: pre-negotiated MRI/CT centers at fixed prices.