HealthShare Terminology

Let’s clarify the distinction between HealthShare communities and traditional insurance. While they both aim to help with medical costs, they operate under very different principles. HealthShare communities are not regulated like insurance companies. Instead, they are community-driven, which often makes them more affordable. With fewer regulations and less bureaucracy, HealthShare options typically involve less paperwork and simpler processes, reducing confusion for members.

 

Insurance Terms vs. HealthShare Terms

Understanding the different terminology between these two systems can help clarify how HealthShare best fit your needs.

 

Insurance Plan vs. HealthShare Membership
In traditional insurance, you purchase a plan that outlines your coverage and benefits. With HealthShare, you're not buying insurance but rather becoming a member of a community that agrees to share healthcare costs. Instead of a plan, you have a membership that comes with specific guidelines.

 

Plan Outline vs. Membership Guidelines
Insurance plans come with an outline detailing what's covered and how much it will cost. HealthShare memberships, on the other hand, follow guidelines that define what kinds of medical expenses are eligible for sharing and how members can make a sharing request for support in sharing those costs.

 

Benefits vs. Shared Services
Insurance offers specific benefits to its policyholders, such as covering certain medical treatments. In a HealthShare community, these are referred to as shared services—costs that the community agrees to help cover for its members.

 

Coverage vs. Eligible for Sharing
In insurance, coverage refers to the medical expenses that the insurance company will pay. In HealthShare, instead of coverage, you have medical expenses that are "eligible for sharing" among the community. This is a defining term between insurance and HealthShare, one that insurance boards want us to stay away from. 

 

Covered vs. Shareable
Similarly, if a medical expense is "covered" by insurance, the company will pay for it. In a HealthShare, an expense is "shareable" if it meets the community’s guidelines and member submits appropriate documentation, helping the community perform the due diligence around pricing.

 

Premium vs. Monthly Contribution
In traditional insurance, you pay a monthly premium to maintain your plan. In a HealthShare, you contribute a monthly amount to support the community, and this contribution is often lower than a typical insurance premium.

 

Deductible vs. Initial Un-Sharable Amount (IUA)
Insurance deductibles are the out-of-pocket costs you must pay before your insurance kicks in. In HealthShare, the Initial Un-Sharable Amount (IUA) is similar—it's the amount you are responsible for before your expenses can be shared with the community. IUA applies per medical need.

 

Claim vs. Sharing Request
With insurance, you file a claim to have your medical bills paid. In a HealthShare, you submit a sharing request to have your medical expenses considered for sharing by the community.

 

Pre-existing vs. Pre-Membership Condition
Insurance often has restrictions on pre-existing conditions, meaning conditions you had before enrolling may not be covered. HealthShare communities use a similar system regarding pre-membership conditions, which outline how or when those costs could be shared.