HealthShare and traditional insurance differ significantly in their terminology and operational models. HealthShare is not insurance and because it doesn't want to be mistaken as such requires different terminology. Here's a breakdown of those distinctions:
HealthShare Membership vs. Insurance Plan:
HealthShare operates on a membership basis, where individuals join a community that shares healthcare costs collectively.
Insurance involves purchasing a plan from an insurer, which provides coverage for specific healthcare services.
Membership Guidelines vs. Plan Outline:
HealthShare communities have membership guidelines that outline the requirements and expectations for members participating in cost-sharing.
Insurance plans provide a detailed plan outline that specifies the covered services, copayments, deductibles, and other terms of coverage.
Shared Services vs. Benefits:
HealthShare involves shared services where members contribute to covering each other's healthcare expenses.
Insurance provides benefits, which are the specific services or treatments covered under the plan.
What is Eligible for Sharing vs. Covered:
HealthShare determines what medical expenses are eligible for sharing among the community members based on established guidelines.
Insurance plans specify what services or treatments are covered under the policy.
Monthly Contribution vs. Premium:
HealthShare members make monthly contributions to the community fund to cover the shared healthcare expenses.
Insurance requires payment of premiums to the insurer to maintain coverage.
Initial Un-shareable Amount (IUA) vs. Deductible:
HealthShare has an Initial Un-shareable Amount (IUA), which is similar to a deductible but operates differently in that it's not an accumulative annual deductible but applied to each medical need.
Insurance plans often have an annual deductible, which is the amount the insured individual must pay out of pocket before the insurer starts covering expenses.
Medical Need Request vs. Claim:
In HealthShare, members submit a medical need request when they require assistance with healthcare expenses, which is then evaluated by the community.
In insurance, individuals file claims to request reimbursement or payment for covered services.
Pre-membership condition vs. Pre-ex Condition:
HealthShare communities may consider pre-existing conditions differently from traditional insurance, often with less stringent restrictions. HealthShare offers a phase in period helping members with financial support for pre-membership conditions.
Insurance plans typically assess pre-existing conditions and may impose waiting periods or exclusions for coverage related to those conditions.
Overall, the differences between HealthShare and traditional insurance lie in their operational models, terminology, and approach to covering healthcare costs. HealthShare is often touted as being more community-driven, affordable, and with less bureaucratic paperwork compared to traditional insurance. However, it's essential for individuals to understand the nuances of each option before deciding on their healthcare coverage.
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