Plan Summary
Solo Health — Nationwide PPO Health Plan for the Self-Employed
Solo is a self-funded major medical plan built for people who work for themselves. Your coverage is administered by Vault Admin Services and backed by a Medical Reimbursement Policy through Vault Health Captive, LLC – Series C — the structure that funds your eligible claims once you've met your deductible. It's designed for entrepreneurs and self-employed owners who want comprehensive care, dependable financial protection, and a support team that actually knows your plan. This page walks through how everything works, what's covered, and where to turn when you need help.
- Nationwide PPO network. Your plan runs on the Multiplan PHCS (now Claritev) network, one of the largest PPO networks in the country, with participating providers in all 50 states. You're free to see the doctors and specialists you choose, and you never need a referral.
- Emergency care, always covered. Emergencies are treated as in-network no matter where you are. If something serious happens, go straight to the nearest ER — there's no need to check the network first.
- Deductible choices that fit how you use care. Pick a $2,500, $5,000, or $10,000 deductible per individual. The family aggregate is twice the individual amount ($5,000, $10,000, or $20,000), so your whole household is protected once combined spending reaches that cap.
- Preventive care from day one. The plan pays 100% of preventive services with the deductible waived. Everything else applies toward your deductible until you reach it.
- 100% after your deductible. Once you meet your deductible, the plan covers 100% of your eligible medical care for the rest of the plan year. There's no added percentage to cover on top — your deductible is also your out-of-pocket maximum.
- Simple prescription copays. Copays apply only to prescriptions, and only after you've met your deductible. Preventive medications on Tier 1 are always $0.
- Prior authorization on select services. A few services — certain inpatient admissions, procedures, surgeries, and some mental health treatments — need approval in advance. The Plan Brief outlines what requires it, and the full Summary Plan Description has the complete list.
Solo is an open-network plan, which means you're never locked into a narrow list of providers. You'll get the most predictable costs by staying in-network, but you can see anyone willing to work with your plan.
- In-network (Multiplan PHCS). When you see providers in the Multiplan PHCS network, your care is handled at negotiated in-network rates, which keeps your out-of-pocket costs as low as possible.
- Out-of-network. You can still see providers outside the network. Out-of-network care is covered under Reference-Based Pricing (RBP), which reimburses a fair, benchmarked amount for each service. You may owe more than you would in-network, so it's worth confirming a provider's status before you receive care.
- Emergency services. In a true emergency, your care is always processed as in-network — regardless of which hospital you end up at.
Search the Multiplan PHCS network to confirm whether your doctor participates.
Here's how your plan handles the core categories of care. Preventive services are covered in full from the start, and most other care is covered at 100% once you've met your deductible.
| Care Type | Coverage |
|---|---|
| Preventive ServicesAge- and gender-appropriate screenings, annual wellness visits, routine immunizations, and certain preventive medications. Solo follows the federal ACA preventive care guidelines. | 100% deductible waived |
| Primary & specialist visits | 100% after deductible |
| Emergency room | 100% after deductible In an emergency, go to the nearest ER — your care is always processed as in-network, even if the hospital is out-of-network. |
| Urgent care | 100% after deductible |
| Inpatient hospitalization & surgeries | 100% after deductible Planned admissions and surgeries require prior authorization. |
| Mental health & substance use treatment | 100% after deductible Prior authorization may apply. Outpatient therapy is covered up to 40 visits per year per covered individual. |
| Imaging & advanced diagnosticsX-ray, MRI, CT, PET, and diagnostic lab work. | 100% after deductible |
Out-of-network services are subject to Reference-Based Pricing and may cost more, especially if you pay the provider in full up front. When you can, let the claim process first so it's applied at the plan's allowed amount.
Until you meet your deductible, you'll pay the plan's discounted cost for most medications. Tier 1 preventive drugs are the exception — they're always $0. Once you've met your deductible, prescriptions move to the flat copays below.
| Tier | 30-Day 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 | Up to $1,000/Rx | Up to $1,000/Rx | After deductible |
| Tier 6 – Not Covered | Not covered | Not covered | Excluded |
Non-specialty drugs over $1,000 for a 30-day supply (or $3,000 for a 90-day supply) aren't covered. When the covered drug list changes, you'll get at least 30 days' notice. You can always check current coverage and participating pharmacies through the FairosRx portal or app.
Your membership includes a set of services designed to make care easier to manage — especially when a situation gets complicated.
- Solo Concierge. Your first stop for almost anything — questions about your plan, benefits, claims, or getting set up. Send a request and a real person on our team will help or point you to the right place.
- Vault Cares Network. Expert second opinions, care navigation, and an advocate in your corner — plus hands-on coordination for complex or high-cost care, including support with prior authorizations.
- OccuNet Balance-Bill Support. If you ever receive an unexpected balance bill, OccuNet steps in to review it and help resolve it on your behalf.
No plan covers everything. Here are some of the services Solo doesn't typically cover, so there are no surprises later:
- Acupuncture, massage, and other alternative therapies
- Cosmetic procedures
- Dental and vision care (available separately as optional add-ons)
- Infertility and surrogacy services
- Vitamins and supplements
- Marriage and couples counseling
- Experimental treatments
This is a sample, not the full list. The Summary Plan Description (SPD) is the complete and controlling source for what's excluded — start with the Plan Brief, and the full SPD is available on request.
- Medical Reimbursement Policy. After you meet your deductible, your eligible claims are reimbursed through the Medical Reimbursement Policy issued by Vault Health Captive, LLC – Series C.
- Eligibility. Enrollment requires an honest health attestation. Inaccurate or incomplete information can lead to a denial of coverage.
- Captive participation. As a member, your plan participates in Vault Health Captive, LLC – Series C and shares in the captive's claims risk — the structure that makes Solo's coverage possible.
- Governing document. This page is a plain-language summary. The Summary Plan Description (SPD) is the official, controlling document for all coverage determinations — the Plan Brief covers the essentials, and the full SPD is available on request.
Still have questions about your plan? Our team can walk you through it.
Downloadable Resources
Keep these key documents on hand. Each one opens as a PDF you can save or print for reference anytime.
Summary of Benefits
A quick, plain-language look at what your plan covers.
Prescription Drug Formulary
The full list of covered medications and the tier each one falls under.
Plan Brief (Summary Plan Description)
A condensed overview of the plan's governing details and rules. The complete SPD is available on request.