Appendix A: Defined Terms

Healthsharing plans are becoming more common in the United States. They allow individuals to pool their resources together to pay for medical expenses. The idea behind them is to create a community where members share costs and benefits. Here is a list of commonly use words associated with Zion HealthShare’s medical sharing benefits.

Additional giving

Voluntary contributions by members for the purpose of offsetting expenses for other members’ unshareable medical expenses.

Annual limit

The maximum amount shared for eligible need requests per participating member per year. Zion HealthShare does not have annual or lifetime sharing limits for our members unless specifically stated in the Member Guidelines.

Application date

The date Zion HealthShare receives a complete membership application.

Benevolent organization

An organization whose primary purpose is to care for the needs of the persons/members who make up the membership. A benevolent organization is not an insurance company.

Benevolent fund

A fund maintained by Zion HealthShare created from the contributions of members for the exclusive purpose of reimbursing eligible medical expenses of members.

Congenital Condition

Any disease or physical abnormality present at birth or that is identified or diagnosed within the first year of life.

Contribution list

A list of members who are being billed by payroll deduction through a company opposed in lieu of direct billing from Zion HealthShare.

Date of service

The day medical services were rendered on behalf of a participating member.

Dependent

The head of household’s spouse or unmarried child(ren) under the age of 26, who are the head of household’s dependent by birth, legal adoption, or marriage, and who are participating under the same combined membership. Unmarried children under 26 years of age may participate in the membership as a dependent.

Effective date

The date a person’s membership begins. Zion HealthShare Direct members also have the effective date as the billing due date.

Eligible medical need request

A medical need request that qualifies for sharing via the contributions of Zion HealthShare members.

Head of household

The oldest participating member in the household.

Household membership

One or more family members participating under the same membership.

Inactive member

A contributor, and contributor’s dependents if applicable, who has not submitted monthly contributions in the manner established by the Member Guidelines. An inactive member is not eligible for sharing.

Ineligible medical need request

A medical need request disqualified from voluntary sharing of contributions from member contributions due to a policy set forth in the Member Guidelines.

Initial Unshareable Amount

The specified financial amount that members are required to bear on their own prior to any amount that may be eligible for sharing. The Initial Unshareable Amount is also known as the IUA.

Licensed medical professional

An individual who has successfully completed a prescribed program of study in a variety of health fields and who has obtained a license or certificate indicating their competence to practice in that field (MD, DO, ND, NP, PT, PA, Chiropractor, etc.).

Lifetime limit

The maximum amount shared for eligible need requests over the course of an individual member’s lifetime of membership.

Maternity need request

A need request that must be submitted within six months of confirmation of pregnancy from a licensed medical professional.

Maximum shareable amount

The maximum dollar amount (limit) that can be shared for any one medical need request. Certain medical need requests have a maximum shareable amount as described in the Member Guidelines.

Medical Cost Sharing

A membership-based, non-insurance arrangement established for the purpose of sharing legitimate healthcare expenses between members.

Medically necessary

A service, procedure, or medication necessary to restore or maintain physical function and that is provided in the most cost-effective setting consistent with the member’s condition. The fact that a provider may prescribe, administer, or recommend services or care does not make it medically necessary. This applies even if it is not listed as a membership limitation, or in the Member Guidelines. To help determine medical necessity, Zion HealthShare may request medical records and information from licensed medical professionals.

Medical needs request

A request that is required to process medical expenses for accidents, injuries, or medical conditions that result in medical costs. Medical need requests can be submitted online at zionhealth.org or by calling Zion HealthShare at (888) 920-9466. The medical need request must be submitted to Zion HealthShare within six months of first treatment to be eligible for sharing.

Member(s)

A person or people (or dependent thereof) who has agreed in writing to abide by the requirements of Zion HealthShare and is thereby eligible to participate in the sharing of medical expenses with other members in accordance with the Member Guidelines and their membership type.

Member plan

A variety of sharing options are available with different initial unshareable amounts and sharing limits, as selected in writing on the membership application or enrollment portal and approved by Zion HealthShare.

Member responsibility amounts

Amounts needed to be paid by the member for medical costs that are not shareable with the Zion HealthShare community.

Membership

This term applies to the collective body of all active, participating members of Zion HealthShare.

Membership cancellation request

A request by a member to Zion HealthShare that their membership be canceled. The request must include the reason for cancellation and the requested month in which the cancellation of the membership is to be effective. Zion HealthShare requires 15 day notice prior to your payment draft date. Zion HealthShare does not prorate cancellations or gift refunds. Cancellations become effective on the last day of your monthly billing anniversary following the timely receipt by Zion HealthShare of your membership cancellation request.

Members have 30 days from the membership cancellation date to reactivate membership in order to qualify for continuous membership. For example, employers who terminate employee memberships.

Membership commitment

The required principles and ongoing behavioral code attested to by members as required for membership.

Membership limitation

A specified medical condition for which medical needs arising from or associated with the condition are ineligible for reimbursement from the Benevolent Fund. An associated condition is one that is caused directly and primarily by the medical condition that is specifically ineligible. The membership limitation will be issued during the application process and may be subject to medical record review. Membership limitations (excluding cancer) do not apply to office visits/urgent care.

Membership update

A communication from the member to Zion HealthShare providing any changes to the details of their membership information (e.g., change of address, phone number, etc.) or requesting that their membership be changed. The change request or update may take up to three business days to complete. Once a representative of Zion HealthShare approves the requested changes, the approved changes may go into effect on the monthly membership anniversary.

Membership withdrawal

When a membership has been or will be canceled due to the submission of a Membership Cancellation Request Form, a violation of the Zion HealthShare’s Principles of Membership, or non-receipt of a voluntary monthly contribution or annual membership fee for more than 10 days past the date such payment was due. Such cancellation of membership is referred to as membership withdrawal.

Monthly contributions

Monetary contributions given voluntarily and placed in the care of Zion HealthShare by a member to maintain active membership and to be disbursed for to the eligible medical expenses of its members in accordance with the Member Guidelines.

Provider Visit

Sick visits, wellness visits, specialist visits, and urgent care visits are generally considered to be provider visits. The medical bill must include an office visit CPT code for the medical expenses to qualify as a provider visit. Provider visits may be subject to other eligibility qualifications as outlined in the Member Guidelines.

Proration

If shareable medical expenses are ever significantly greater than shares available in any given month, Zion HealthShare may prorate the shareable amount requested for medical expenses. This involves an across-the-board percentage reduction of medical need request payments but does not necessarily mean that all member medical need requests will not be met in that month.

Shareable amount

The amount of the medical need request that remains after the member’s initial unshareable amount has been satisfied and falls within the sharing guidelines.

Explanation of sharing (EOS)

Correspondence that is delivered to the participating members and their providers once medical need requests have been processed, are pending, or have been rejected. The Sharing Summary will state their member responsibility amount as well as any amounts shared by the Benevolent Fund on the member’s behalf.

Additional Giving Needs Request

Correspondence that is delivered to the participating members and their providers once medical need requests have been processed, are pending, or have been rejected. The Sharing Summary will state their member responsibility amount as well as any amounts shared by the Benevolent Fund on the member’s behalf.

Unusual, customary, and reasonable costs (UCR)

The general cost of medical services in a geographic area, as determined by Zion HealthShare, based on what providers in the area usually charge for the same or a similar medical service.

Unshareable amount(s)

A medical expense incurred by a member that is not shareable for one or more of the following reasons: a member’s violation of the Zion HealthShare’s Principles of Membership, non-current membership status, or any other condition or requirement that is excluded by the Member Guidelines.

Enjoy Medical Cost Sharing Membership
All of what you need in a medical cost strategy, great savings, and like-minded individuals.