Healthshare Frequently Asked Questions (FAQ)

WHAT IS ZION HEALTHSHARE?

Zion HealthShare is a Utah nonprofit corporation with administrative offices in St. George, Utah. Zion HealthShare is not an insurance company. Zion HealthShare provides the framework and administrative support for a medical cost sharing membership program.

When members have financial needs due to illness that are greater than they can bear individually, the goal of the Zion HealthShare community is to assist members in carrying one another’s burdens. The method by which Zion HealthShare seeks to facilitate the sharing of members’ medical costs is to teach and apply these principles of community and responsibility as an integral part of its sharing philosophy.

IS ZION HEALTHSHARE AN INSURANCE COMPANY?

No. Insurance arrangements are a contract whereby one party agrees to be legally responsible for and accept another party’s risk of loss in exchange for a payment—a premium. Medical cost sharing is an arrangement whereby members agree to share medical expenses through the act of voluntary giving. Zion HealthShare does not assess applicants’ health risks because neither Zion HealthShare nor its members are assuming financial liability for any other member’s risk. Unlike insurance, the focus of Zion HealthShare is to provide an avenue for members to help each other bear their immediate healthcare expenses.

When health care costs are paid by someone other than the person receiving care, as is typically the case when an insurance company or government entity agrees to cover such costs, the healthcare model can be undermined. Zion HealthShare believes many of the current problems with the healthcare system are the direct result of restricting personal freedom and responsibility through dependence on third-party payers. Zion HealthShare is designed to allow members to help one another while maintaining freedom of choice and personal responsibility.

IS ZION HEALTHSHARE LEGAL?

As a nonprofit corporation, Zion HealthShare is required to abide by certain state and federal regulations.

HOW DOES ZION HEALTHSHARE HANDLE MEDICAL CLAIMS?

Because there is no transfer of risk, as defined in applicable insurance rules and regulations, with respect to Zion HealthShare’s medical cost sharing program, no “claim” is ever owed by a Zion HealthShare on behalf of any member. When members incur medical expenses, they submit medical need requests that may or may not be eligible for reimbursement from the Benevolent Fund. Members are required to submit proof of their medical expenses to Zion HealthShare. Zion HealthShare then evaluates each submission for eligibility or ineligibility based on the Member Guidelines. Eligible medical need requests are designated for sharing using the funds accumulated through monthly member contributions.

WHAT IF I HAVE AN INSURANCE POLICY IN ADDITION TO MY ZION HEALTHSHARE MEMBERSHIP?

If you have a health insurance, workers compensation, or liability insurance policy, you must disclose them to Zion HealthShare. Since your Zion HealthShare membership is not insurance, when you have traditional insurance coverage your insurance company is primarily responsible for the payment of your medical expenses.

Zion HealthShare will only consider bills for sharing after your insurers have processed claims. The same applies for auto insurance after a car accident. Failure to disclose your relevant insurance coverage to Zion HealthShare may result in sharing ineligibility.

If you have a medical need arise, and you are eligible for benefits through either insurance or government assistance, please contact Zion HealthShare to speak with a member advisor before you submit a medical need request.

DO ALL THE MONTHLY CONTRIBUTIONS GO TOWARDS MEMBER’S MEDICAL EXPENSES?

Over 90% percent of all monthly contributions go toward sharing in medical need requests. Each month, less than 10% of contributions are retained by Zion HealthShare for administrative costs. An audit of Zion HealthShare’s finances is conducted each year by an independent firm and made available online.

WILL ZION HEALTHSHARE SHARE MEDICAL COSTS INCURRED OUTSIDE THE UNITED STATES?

Yes. For members who are traveling abroad, acute/emergent, eligible medical expenses can be shared no matter where in the world they were incurred and treated. Members interested in medical tourism need prior written approval from HealthShare before treatment.

WHO CAN JOIN ZION HEALTHSHARE?

Anyone who agrees to follow the Member Guidelines and abide by the Principles of Membership can join Zion HealthShare. Membership expires when an individual reaches the age of 65. Newborns who are not born under an eligible maternity need request have a seven-day waiting period before they can be added to the family’s membership.

WHAT HAPPENS IF ZION HEALTHSHARE NEED REQUEST EXPENSES EXCEED THE MONTHLY CONTRIBUTIONS RECEIVED?

Zion HealthShare keeps funds to share member expenses if medical need requests exceed the monthly contributions received. To date, all eligible medical expenses have been shared in full without need to draw from the saved funds.

However, if the rare event occurs that all medical need requests cannot be met for a given month, Zion HealthShare uses a prorating method to evenly distribute the available funds among members with medical need requests. For example, if the monthly contributions received for a given month amounts to 80% of the expenses for medical need requests submitted for that month, each member would have 80% of their eligible expenses shared that month. The Zion HealthShare community has not needed to prorate member expenses in the past and has prepared for the event that expenses exceed member contributions.

CAN I OFFER ZION HEALTHSHARE THROUGH MY COMPANY OR GROUP?

Yes. Although Zion HealthShare is an individual and family medical cost sharing program, we allow for a company contribution list. Employees who participate can be added or removed from the contribution list at any time and billed directly.

Participation in Zion HealthShare’s program is always voluntary, both from the company’s and the employee’s perspectives. Business owners choose to work with Zion HealthShare because they value community and personal responsibility and because they want to use a cost sharing approach to ensure provision of quality healthcare for their employees. There are numerous factors that contribute to Zion HealthShare’s greater efficiencies for both companies and employees.

DOES ZION HEALTHSHARE COMPLY WITH THE AFFORDABLE CARE ACT REQUIREMENTS?

Zion HealthShare is not a substitute for insurance as defined by the Affordable Care Act and therefore is not subject to the regulatory requirements or consumer protections of your particular state’s Insurance Code or Statutes.

EXCESSIVE ALCOHOL

Limitations- Medical conditions, hospitalizations, related treatments, due to alcohol consumption are not considered shareable. Accidents that are the result of illegal alcohol consumption are not shareable. Accidents and injuries incurred while committing an illegal act under the influence of alcohol are not considered shareable.

ILLICIT OR ILLEGAL DRUG USE

limitations- Marijuana is not considered an illicit drug for the purpose of needs being considered shareable with the Zion HealthShare community. Medical conditions, hospitalizations, related treatments due to illicit drug use are not considered shareable.