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Health Shares typically have limitations on what they will and will not share in, including Pre-Existing Conditions.
What is a Pre-Existing Condition?
Most of the Health Shares will define a pre-existing condition as:
“Any illness or accident for which a person has been diagnosed, received medical treatment, been examined, taken medication, or had symptoms prior to the effective date.”
Health Shares may require you to be symptom-free for a certain amount of time prior to joining for it to no longer be considered a pre-existing condition.
Learn all of the details about pre-existing conditions for each of the top 10 Health Shares.
Altrua HealthShare
Altrua HealthShare defines a pre-existing condition as an illness or medical condition for which you have received medical advice or treatment at any time during the ten-year look back period preceding your membership effective date that would result in a two-year, five-year or lifetime limitation.
Altrua HealthShares states that “if the need is related to a pre-existing condition or limitation, it is unlikely it will be eligible for sharing.”
Here is a list of the two-year, five-year, and life-time limitations for pre-existing conditions at Altrua HealthShare:
Two-year Limitations:
- Addison’s Disease
- Angina Pectoris (stable or unstable)
- Asthma
- Benign Prostate Hyperplasia
- Calcium Deficiency
- Calculus of Kidney (Kidney Stones)
- Cardiac Dysrhythmias
- Carpal Tunnel Syndrome
- Cataract
- Chronic Kidney Disease
- Coronary Artery Disease
- Cushing’s Disease
- Endometriosis
- Epilepsy
- Gallstones
- Glaucoma
- Grave’s Disease
- Hashimoto’s Disease
- Hemorrhoids
- Hyperglycemia
- Hyperlipidemia
- Hypertension
- Hyperthyroidism
- Hypothyroidism
- Iodine Deficiency
- Malaria
- Migraines
- MRSA
- Osteoarthritis
- Osteoporosis
- Ovarian Cysts
- Pelvic Inflammatory Disease
- Polycystic Ovary Syndrome
- Prolapsed Bladder
- Pulmonary Hypertension
- Radiculopathy
- Rectal Prolapse
- Rheumatoid Arthritis
- Scoliosis
- Shingles
- Sleep Apnea
- Spinal Stenosis
- Spondylosis
- Tendinitis
- Tuberculosis
- Type II diabetes
- Uterine Fibroids
- Uterine Prolapse
- Vitamin A Deficiency
- Vitamin B 12 Deficiency
- Vitamin D Deficiency
Five-year Limitations:
- Barrett’s Esophagus
- Bell’s Palsy
- Cancer
- Cerebral Ataxia
- Celiac Disease
- Crohn’s Disease
- Cirrhosis
- Congestive Heart Failure (CHF)
- Deep Vein Thrombosis (DVT)
- Degenerative Disc Disease
- Diverticulitis and Diverticulosis
- Dysphagia
- Embolism
- GERD (Gastroesophageal Reflux Disease)
- Heart Murmur
- Heart Palpitations
- Heart Valve Disease
- IBS (Inflammatory Bowel Disease)
- Marfan’s Syndrome
- Meningitis
- Mitral Valve Prolapse
- Pancreatitis
- Peripheral Vascular Disease (PVD)
- Psoriasis
- Sjogren Syndrome
- Surgery
- Systemic Lupus Erythematosus
- Ulcerative Colitis
- Vitiligo
Lifetime Limitations:
- ALS
- Alzheimer’s Disease
- Aneurysm
- Autism Spectrum Disorders
- Cerebral Palsy
- Chronic Obstructive
- Pulmonary Disease (COPD)
- Cystic Fibrosis
- Dementia
- Diabetes Type I
- Down’s Syndrome
- Ectasia
- Emphysema
- Fragile X Syndrome
- Fibromyalgia
- Hepatitis (Chronic Viral B & C)
- HIV/AIDS
- Lupus
- Lyme’s Disease
- Macular Degeneration (wet or dry)
- Morbid Obesity (pending weight loss)
- Multiple Sclerosis
- Muscular Dystrophy
- Parkinson’s Disease
- Sickle-Cell Disease
- Spina Bifida
- Typhoid
Source: Altrua HealthShare Member Guidelines
Christian Care Ministry (Medi-Share)
Although Medi-Share was designed primarily for new and unexpected illnesses or injuries, some pre-existing conditions may be eligible for sharing.
Medical bills for diagnosis or treatment of a non-congenital pre-existing medical condition, defined as signs/symptoms, testing, diagnosis, treatment, OR medication for a condition within 36 months prior to membership (based on medical records), will ONLY be eligible for sharing as follows:
• Up to $100,000 per Member per year (based on effective date) once the member has been faithfully sharing for 36 consecutive months.
• Up to $500,000 per Member per year (based on effective date) once the Member has been sharing faithfully for 60 consecutive months.
High blood pressure or cholesterol that is controlled through medication or lifestyle will not be considered a pre-existing medical condition for purposes of determining eligibility for future vascular events.
Where there has been a lapse in Membership, a condition will not be considered pre-existing if the first instance of the condition appeared during the previous Membership. An exception would be maternity that occurred outside the current Membership period, which will not be eligible for sharing.
The bottom line: If you haven’t been treated or had symptoms for 3 years or more when you join, your condition may be eligible for sharing if it reoccurs, with some limitations on the amount shareable.
Source: Medi-Share Pre-Existing Conditions
Christian Healthcare Ministries (CHM)
Christian Healthcare Ministries defines a pre-existing condition as any medical condition for which you experience signs, symptoms, testing or treatment before joining Christian Healthcare Ministries. (Routine or maintenance medications are considered treatment.)
For example, if you have a stent that was inserted for a heart condition, the stent is considered treatment and your heart condition is pre-existing.
A condition is no longer considered pre-existing if you have experienced one year without signs, symptoms, or treatment (including no maintenance medication) for that condition and it is documented by your official medical records. In contrast, cancer is no longer pre-existing if, after your doctor has pronounced you cancer-free or cured, you have gone five years without any signs, symptoms, testing or treatment.
CHM has two programs for pre-existing conditions and one of them, the Gold schedule, is only for Gold members. Bills incurred for a [non-active] pre-existing condition are eligible as follows:
- In the first year of CHM membership, up to $15,000 can be shared.
- In the second year an additional $10,000 can be shared.
- In the third year, another $25,000 can be shared, bringing the three-year total to $50,000.
- After the third year, the condition is no longer considered pre-existing.
Source: CHM Guidelines
Liberty HealthShare
Liberty HealthShare defines a pre-existing condition as a condition for which signs, symptoms or treatment were present prior to application, or can be reasonably expected to require medical intervention in the future, needs to be declared upon application for Liberty HealthShare membership, and updated with any new symptoms/signs or diagnoses that become apparent after the application submission.
Failure to declare a medical condition upon application, or failure to update Liberty HealthShare after application, may preclude sharing in that condition any time in the future. Failure to fully disclose known or suspected pre-existing condition information at the time of application and before Enrollment Date is a violation of our shared trust between members and may subject the member to termination of membership.
Chronic or recurrent conditions that have evidenced signs/symptoms and/or received treatment and/or medication within the past 36 months are not eligible for sharing during the first year of membership.
After the first full year of continuous membership, up to $50,000 of total medical expenses incurred for a pre-existing condition may be shared in total during the second and third years of membership. Upon the inception of the 37th month of continuous membership and thereafter, the condition may no longer be subject to the pre-existing condition sharing limitations. Appeals may be considered for earlier sharing in surgical interventions when it is in the mutual best interest of both the members and the membership to do so.
Source: Liberty HealthShare Sharing Guidelines
OneShare Health
At OneShare Health, a Pre-Existing Condition is defined as any sickness or Injury for which you have received medical treatment, advice, care, or services, including diagnostic measures, took prescribed drugs, or showed signs and symptoms, whether treated or not, within 24 months before the Effective Date of your Program. Eligibility for Pre-Existing Conditions has a 24-Month Waiting Period.
Although OneShare Health requires a 24-Month Waiting Period for Pre-Existing Conditions, Routine Maintenance is available through PCP, Specialists Visits, and Physician-ordered Labs on the Classic and Complete Program for the following conditions: Diabetes 1&2, High Blood Pressure, High Cholesterol, and Hyper- or Hypothyroid.
OneShare Health “reserves the right to exclude sharing eligibility for any Pre-Existing Conditions, whether disclosed at the time of your enrollment or discovered after the Effective Date of the Membership.”
Source: OneShare Health Pre-Existing Conditions
Samaritan Ministries
A. Previous Diagnosis, Treatment, and Reasonable Person Standard
Samaritan Ministries will consider bills to be related to a pre-existing condition, and therefore ineligible for sharing, when certain criteria apply.
If you had a diagnosis, treatment, or had symptoms which would have prompted a reasonable person to seek treatment or evaluation during the 12 months prior to membership, the condition will be considered pre-existing.
Exceptions: For back problems, blood diseases, cases of related cancers, diabetes, genetic disorders, heart conditions, hereditary diseases, or the replacement and maintenance of implanted prosthetics and orthotics, the condition will be considered pre-existing if you had a diagnosis, treatment, or had symptoms which would have prompted a reasonable person to seek treatment or evaluation during the 36 months prior to membership. Tests or a doctor’s statement may be required to verify the lapse of symptoms, treatment, and medication.
For the purposes of determining the eligibility of a bill for sharing, a reasonable person is someone who seeks medical attention (treatment or evaluation) when the symptoms he is experiencing:
- Prohibit him from performing typical life-tasks (i.e. changes your behavior on a regular basis),
- Exceed manageable pain levels (i.e. the symptoms require ongoing pain management), or
- Would prompt most people with similar symptoms to seek medical attention.
New bills are not considered as resulting from a pre-existing condition unless the new medical bills directly resulted from the prior condition. Be aware that even though a condition may appear at one time to have been cured, there could be a subsequent relapse or complication which is a result of the original condition. Samaritan Ministries may require that the member provide a written opinion from a physician that the current medical bill(s) was not due to the prior condition.
How do I determine if I have a pre-existing medical condition?
- Did I have a diagnosis, treatment, or symptoms which would have prompted a reasonable person to seek treatment or evaluation for this condition in the 12 months prior to my membership? If yes, condition is pre-existing. If no, proceed to the next question.
- Is my condition a back problem, blood disease, cancer, diabetes, genetic disorder, heart condition, hereditary disease, or related to an implanted prosthetic or orthotic? If yes, proceed to the next question. If no, condition is not pre-existing.
- Did I have a diagnosis, treatment, or symptoms which would have prompted a reasonable person to seek treatment or evaluation for this condition in the 36 months prior to my membership? If yes, condition is pre-existing. If no, condition is not pre-existing.
B. Conditions 24 Months Treatment-Free
If a member with a pre-existing condition does not receive treatment for that condition for at least 24 consecutive months while an active member participating in Samaritan Given, the pre-existing condition will no longer be considered pre-existing and will be eligible for sharing.
“Treatment” refers here to services the member receives from a licensed medical provider for the purpose of managing or curing a medical condition. Follow up visits or evaluations are not considered “treatment” for the purpose of this guideline unless they reveal that the condition is not resolved.
This guideline applies also to members who previously participated in Samaritan Classic or Samaritan Basic but are now participating in Samaritan Given, as long as they were active members with no interruption over the 24 consecutive months.
Is my pre-existing condition still considered to be pre-existing, or is it now eligible for sharing?
Have you been a member of Samaritan Ministries for at least 24 consecutive months without receiving any treatment for this condition? If yes, condition is not considered pre-existing. If no, conditions is still considered pre-existing.
C. Exceptions for Diabetes and Cholesterol Level
Diabetes: Medical bills resulting from Type 1 diabetes that existed prior to a membership will not be eligible for sharing.
Diabetes Explained—By Type 1 diabetes (also called juvenile onset diabetes), meaning that condition where the body produces insufficient insulin. Type 2 diabetes (also called “non- insulin dependent diabetes”), the condition where your body is insulin resistant, and gestational diabetes, are subject to a 12-month symptom and treatment-free limitation. The condition commonly referred to as “pre-diabetes” will not be considered a pre-existing condition.
For Type 2 diabetes, you will have met the 12-month limitation if:
- at least 12 months have passed without any symptoms which would have prompted a reasonable person to seek diagnosis, care, treatment, or medication; and
- in the month before and the month after the 12-month period (and anytime you are tested in-between) your Hemoglobin A1C test level is 7% or below. Documentation of these test results must be provided to Samaritan Ministries.
Elevated Cholesterol: Elevated Cholesterol is not by itself considered a pre-existing condition, nor the mere fact that a person is taking a prescribed statin drug. However, if the drug is prescribed for or due to diagnosed arteriosclerosis for a particular location (e.g. heart, carotid artery), that condition would be pre-existing as to that location.
High Blood Pressure: Hight Blood Pressure will not be considered a pre-existing condition, regardless of symptoms, treatment, or medication prior to membership.
Source: Samaritan Ministries Member Guidelines
Sedera
Sedera considers any medical condition that existed prior to membership (diagnosed, suspected or producing observable signs or symptoms) is considered a Pre-existing Medical Condition. Needs that result from Pre-existing Medical Conditions are subject to sharing limitations (as presented in these Guidelines) unless 36 months immediately prior to membership effective date has passed without any signs or symptoms of the condition, without any treatment needed, without any medication prescribed or taken, and without any suspicion by the patient or doctors that the condition is resurfacing. This applies whether or not the cause of the symptoms is unknown or misdiagnosed.
Sharing Limitations for Pre-existing Medical Conditions are gradually removed according to the following schedule:
First 12 months – Not shareable
Months 13 – 24 Shareable up to $25,000
Months 25 – 36 Shareable up to $50,000
Month 37 and after – Fully shareable
Source: Sedera Member Guidelines
Share HealthCare
Any condition for which signs, symptoms, or treatment were present within the past 24 months or 60 months for any malignant form of cancer (tissue or blood) prior to applying for Membership, or can be reasonable expected to require medical intervention in the future, must be disclosed on the Member Information Sheet to Share HealthCare and are not eligible for sharing.
Medical expenses incurred within the first 90 days of Membership may be subject to a pre-existing condition review, including but not limited to, request for medical notes/records, hospital charts, surgical records, or other relevant medical history information. Failure to fully disclose pre-existing condition information at the time of enrollment is a violation of the shared trust among Members and may subject the Member to termination of Membership.
Source: Share Healthcare Handbook
Solidarity Healthshare
For pre-existing health conditions that can be improved through lifestyle changes, members may qualify for Solidarity Well.
For pre-existing conditions that cannot be improved through lifestyle changes, have evidenced symptoms at the time of enrollment, or received treatment or medication in the past 24 months, Solidarity will share according to the following schedule:
- First year of membership: Not eligible for sharing
- Second year of membership: Up to $25,000 is eligible
- Third year of membership: Up to $25,000 is eligible
- Fourth year and following of continuous membership: The condition is no longer considered pre-existing.
Source: Solidarity Healthshare Pre-Existing Conditions
Zion HealthShare
Pre-existing conditions have a phase-in period wherein sharing is limited. Starting from the initial enrollment date, members have a one-year waiting period before pre-existing conditions are shareable. After the first year, pre-existing needs are eligible for sharing on a limited basis, with the amount increasing each membership year. Members are never required to pay a second IUA for the same need, including pre-existing conditions.
Zion HealthShare attempts to negotiate all medical bills received, and many membership types include the PHCS network for pre-negotiated medical expenses. Even if a pre-existing condition is not shareable, members may still receive discounts for their services through negotiation.
Shareable amount for pre-existing conditions:
• Year One: $0 (waiting period)
• Year Two: $25,000 maximum per need
• Year Three: $50,000 maximum per need
• Year Four: $125,000 maximum per need
After year four of membership, expenses related to pre-existing conditions will remain shareable at a maximum of $125,000 in a 12-month rolling period and resetting each membership year.
Members who enroll in the Zion HealthShare Bridge Program through their employer are subject to the limitations in the program outline.
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