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Navigating Pre-Membership Conditions with a HealthShare Membership

When considering a HealthShare Membership, understanding the intricacies of pre-membership medical conditions is crucial. HealthShare memberships are committed to keeping member contributions affordable for all. To achieve this, there are specific guidelines around sharing medical expenses for conditions that existed before a member joins. Let's delve into what pre-membership medical conditions entail and how the phase-in period works to gradually integrate these conditions into the sharing community.

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What is a Pre-Membership Medical Condition?

A pre-membership medical condition refers to any health issue for which a member has:

  • Been examined,

  • Been diagnosed,

  • Taken medication,

  • Had symptoms, or

  • Received medical treatment

All within the 24 months preceding their membership start date. Essentially, if you have interacted with a healthcare provider or received treatment for a condition in any of these ways within the specified period, it is considered a pre-membership medical condition. (Link)

To be eligible for sharing requests, the condition must be deemed cured and should not have required any treatment or exhibited symptoms for 24 months prior to the start date of your membership. This ensures that only stable and non-recurrent conditions qualify for sharing.

The Pre-Membership Medical Condition Phase-In Period

With a HealthShare membership, transitioning into a new health share plan can be daunting, especially with pre-existing conditions. To manage this, a phase-in period has been instituted that gradually increases the shareable amount for pre-membership medical conditions over time. Here’s how it works:

  1. Year One:

  • There is a mandatory waiting period during the first year, and no expenses related to pre-membership medical conditions are shareable.

  1. Year Two:

  • After the initial year, members can share up to $25,000 per sharing request for pre-membership medical conditions.

  1. Year Three:

  • The shareable amount increases to a maximum of $50,000 per sharing request.

  1. Year Four and Beyond:

  • From the fourth year onwards, members can share up to $125,000 per sharing request for pre-membership medical conditions. This limit applies within a 12-month period and resets with each new membership year.

This phased approach helps maintain the sustainability of the community fund while gradually increasing support for members with pre-existing conditions.

Special Considerations for Certain Conditions

HealthShare memberships recognize that some chronic conditions, such as high blood pressure, high cholesterol, and diabetes (types 1 and 2), are common and manageable with the right care. Therefore, these conditions are not categorized as pre-membership medical conditions under specific conditions:

  • The member has not been hospitalized for these conditions in the 12 months prior to joining the HealthShare membership.

  • The condition is controllable through medication or diet.

By exempting these conditions from the pre-membership category, immediate support can be provided to members managing these prevalent health issues, reflecting a commitment to holistic and inclusive health care.

Final Thoughts

The goal of a HealthShare membership is to create a caring and supportive community where health care costs are manageable for everyone. Understanding the guidelines for pre-membership medical conditions is an essential step in making informed decisions about your health share plan. Through the structured phase-in period and specific exceptions, there is a balance between affordability and comprehensive care, ensuring that all members can access the support they need over time.

For more details or to speak to a HealthShare Coach on any aspect of your membership, feel free to reach out to visit us at Where your health and well-being are the priority.

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