In the Zion HealthShare community, medical expenses are eligible for sharing, provided they align with the Member Guidelines and adhere to the sharing process. Below is a general overview of what is typically shareable with Zion HealthShare:

 

1. Medical Expenses After the IUA

After a member meets their Initial Unshareable Amount (IUA), the following types of expenses may be eligible for sharing:

• Hospital visits and treatments (inpatient and outpatient care)

• Emergency room visits

• Surgeries and medical procedures prescribed by licensed medical professionals

• Prescription medications related to shareable conditions

• Maternity care, including prenatal, postnatal, and delivery-related expenses

• Specialist visits when recommended by a primary care provider

• Durable medical equipment (DME) like crutches, wheelchairs, and oxygen tanks, when prescribed

• Diagnostic testing and laboratory work related to eligible medical needs

 

2. Preventive Services (Add-on or Direct Membership)

Certain preventive services are shareable without requiring the IUA:

• Annual provider visits (up to $175 per year)

• Screenings such as mammograms (starting at age 40), colorectal cancer screenings, and cervical cancer screenings during the annual visit

• Youth immunizations as outlined by CDC guidelines, including vaccines like HPV, DTaP, and MMR for members under 18 years old

 

3. Maternity Services

• Routine office visits and lab work

• Up to three standard ultrasounds

• Delivery costs for ob-gyn, hospital, or midwife-assisted home births

• Postpartum checkups

 

4. Emergency and Acute Care

Emergency medical expenses, whether they occur in or outside of the U.S., may be eligible for sharing, particularly when they involve sudden onset conditions requiring immediate care.

 

5. Specialized Treatments

• Therapeutic treatments such as physical therapy, chiropractic care, acupuncture, and massage therapy, when related to a shareable condition, up to $7,500 or 35 treatments per request.

• Genetic testing related to treating shareable conditions like cancer.

 

6. Additional Treatments

• Alcohol and drug abuse treatment (limited to $3,000)

• Organ transplants (subject to pre-existing condition phase-in limitations)

• Home healthcare when prescribed by a physician

• Hospice care with certification of terminal illness

 

No Overall Annual or Lifetime Maximums

Zion HealthShare does not impose annual or lifetime maximum limits on the total amount of medical expenses that can be shared within the community. However, certain specific types of medical expenses or conditions may have limits or restrictions, especially when related to pre-existing conditions or certain treatments.

 

There are no lifetime or annual caps on the total amount of eligible medical expenses that can be shared for an individual or household. This applies to medical needs such as surgeries, hospital stays, or long-term treatments, as long as the expenses meet Zion HealthShare’s guidelines.

 

Each shareable expense must follow the submission guidelines for timely requests and documentation, and Zion HealthShare requires transparency regarding any other insurance or third-party assistance to prevent overlapping coverage.