Each member contributes an assigned amount each month and those contributions are shared, to meet each members medical expense NEEDS in full!
Monthly Contribution Amount
Members freely choose to assist other members with their medical expenses by contributing a predetermined amount each month; called a “share.”
IUA – Initial Unshared Amount
An IUA is a financial portion ($500 or $1000 U.S. dollars) that members are required to pay prior to any amount being eligible for sharing. After the IUA has been satisfied a qualified NEED, becomes eligible for sharing consideration. If a medical expense for an event (need) doesn’t exceed the IUA that expense is borne by the Member.
Needs-Based – Not Annually Based
Unlike Health Insurance, which has an Annual Deductible or Out-of-Pocket, Medical Cost Sharing is based on a medical event, symptom or incident (NEED) which after your selected initial unshared amount ($500 or $1000) is covered at 100% regardless of the amount until the member is symptom free for a year.
Defining a “NEED”
How it Works
Expenses related to the same medical condition, including those for separate incidents, (e.g. separate treatments or episodes of symptoms) will be shared as one need and accumulate towards the total need amount. When12 consecutive months have passed without any symptoms, medication, or other treatment for the condition that originally created the need, or related subsequent conditions, and the condition recurs, it will be treated as a new need.
Members that experience multiple needs within their 12-month membership year are required to pay the first three IUAs at the selected amount ($500 or $1000). If there is a fourth need during the same membership year, no IUA would apply. The fourth need, and any subsequent need(s) would be eligible for immediate sharing; subject to any stated restrictions or limitations in the Guidelines.
For households with multiple members (2 or more), a maximum of five IUAs apply per 12-month membership year. Beginning with the sixth need during the same membership year, medical expenses would be eligible for immediate sharing; subject to any restrictions.
PLEASE NOTE: No one person within a multiple household will be required to share more than three IUAs in a given 12 month membership year.
Limitations and Restrictions
Most conditions are fully shareable in accordance with the Membership Guidelines, but the Guidelines place some limitations on types of physical maladies and medical services for which Needs are shared, and certain conditions are excluded from sharing. See Sections 8.B and C of the Membership Guidelines for details. Some conditions which are usually totally excluded from sharing under individual health sharing programs are included in the list of restricted conditions. Examples include ADD, ADHD and SPD treatment; alcohol or drug abuse treatment; medical equipment; nutritionists; vision therapy; orthotics; psychiatric care; and weight reduction. Prospective members should make sure they read the Membership Guidelines so they understand all the provisions of the program before enrolling.
Continue to “Medical Cost Sharing Principles”
