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What is Considered a Pre-Existing Condition?
Zion HealthShare defines 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.
Zion HealthShare’s Limitations for Pre-Existing Conditions
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. 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.
Source: Zion HealthShare Member Guidelines
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