FREQUENTLY ASKED QUESTIONS (FAQ)

Zion Health believes that its members, in concert with the medical providers of their choosing,
have a natural incentive to do what is best for themselves and their families.We also believe
individuals have the primary responsibility for making their own healthcare decisions. When
members have financial needs due to illness that are greater than they can bear individually,
the goal of the Zion Health community, in a corporate sense, is to assist members in carrying
one another’s burdens. The method by which Zion Health 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.

What kind of company is Zion Health?

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

Isn’t Zion Health really just another health 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 Health is not licensed or registered by any insurance board or
department. Zion Health does not assess applicants’ health risks because neither Zion Health
nor its members are assuming financial liability for any other member’s risk. Unlike insurance,
the focus of Zion Health is to provide an avenue for members to help each other bear their
immediate healthcare expenses.

What’s the advantage of Zion Health not being a health insurance company?

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 Health 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 Health is designed to allow
members to help one another while maintaining freedom of choice and personal responsibility.

Is Zion Health legal?

As a nonprofit corporation, Zion Health is required to abide by certain state and federal
regulations. The health sharing program administered by Zion Health may be legally operated
in all fifty (50) states.

How are members of Zion Health affected by the federal healthcare law
(including the Affordable Care Act)?

Beginning in 2019, individuals are no longer required to obtain minimum health insurance
coverage pursuant to the “individual mandate” under the Affordable Care Act and will not be
penalized for failing to purchase traditional health insurance.

How does Zion Health handle medical claims?

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

What procedure should I follow to request reimbursement for my medical
bills when I have a need?

At or before the time a member receives medical service, the member should inform their
medical providers (doctors, laboratories, clinics, hospitals, etc.) that he or she is a self-pay
patient. Healthcare providers can send bills directly to Zion Health. Any proof of payment made
towards their IUA (initial unshareable amount) should be submitted to Zion Health. Zion Health
will review the submitted documentation for sharing with the community. Zion Health’s team
of medical bill negotiators may contact the providers to discuss the appropriate payment for
the services that were performed and determine if negotiations are applicable for the billed
amounts.

How long does it take Zion Health to process a medical need?

Typically, eligible reimbursement is made to members, or payment is made to the providers
within 5-7 days once all documentation has been received.

Can I choose my own doctors and hospitals without being penalized?

Yes. Each member’s personal freedom to select the medical providers of their choice is
fundamental to Zion Health’s philosophy. Zion Health endeavors to provide members with
detailed and current information and recommendations to help them identify and receive
treatment from the highest quality health provider(s). Accordingly, there are no out-of-network
penalties or other restrictions.

Does Zion Health charge monthly premiums?

Because Zion Health is not insurance, it does not charge premiums. Rather, Zion Health’s
members freely choose to assist other members with their medical expenses by contributing
a predetermined amount each month; called a “share.” Ninety percent (90%) of each member’s
monthly contributions are designated solely for assisting other members’ needs.

Does Zion Health use deductibles And co-insurance?

No. Zion Health’s process differs significantly from insurance practices in this regard; to our
member’s advantage. Traditional insurance deductibles are cumulative over the course of a
predetermined plan period. Co-insurance is the portion of the medical expense owed by the
patient. These insurance cost-sharing measures can amount to thousands of dollars in out-ofpocket costs to insurance policy holders annually. Conversely, when members incur an eligible
medical expense that exceeds the initial unshareable amount, any amount above the initial
unshareable amount may be eligible for sharing. On the fourth medical need in a household,
the member no longer needs to pay the initial unshareable amount. If the additional medical
expenses are more than $500, the remaining costs are fully sharable with the community.

Why would members want to send more than their monthly contribution
amounts?

Zion Health is a mutual sharing and benevolent organization. Members sometimes give more
than their monthly amount required to maintain membership in Zion Health. Such funds are
collected and administrated as part of the Additional Giving fund. Zion Health facilitates the
administration and sharing of money received from Additional Giving to provide medical cost
sharing to members who have needs that would not normally be shareable.

What if I have a medical need that is not shareable?

For needs that do not qualify for sharing but that create a financial burden to the member or
family, the Additional Giving program may be of assistance. The Additional Giving program is
outlined in greater detail in these guidelines.

Do all the monthly contributions go to meet members’ needs?

Each month, ten percent (10%) of the monthly contributions received are retained by Zion
Health to cover administrative costs. An audit of Zion Health’s finances is conducted each year
by an independent auditing firm and made available online.

Will Zion Health share medical costs that were incurred outside of the United
States?

Yes, members’ eligible needs, wherever incurred, will be handled through the Zion Health
sharing program.

What are Zion Health’s membership requirements?

Zion Health members must agree to the Principles of Membership and be under 65 years of
age.

Can my membership be dropped if I have very high medical needs?

Members cannot be dropped from the sharing program due to their medical needs. Neither
membership nor monthly contribution is adversely impacted by the amount of medical
expenses a member or their family members may have.

Can my family members participate in the sharing program?

Spouses and dependent children are welcome to participate in the sharing program.

What if my dependents do not agree to abide by the Zion Health Member
Guidelines?

All Members of Zion Health must agree to abide by the Zion Health membership requirements
as directed by Zion Health. For children under the age of 26 who are living with their member
parent or guardian, Zion Health requires that the member hold their children responsible for
compliance with all requirements stated in the Member Guidelines. For example, Zion Health
does not approve the sharing of medical expenses for injuries resulting from the use of illegal
substances. Hence, medical expenses incurred by a member’s child who is injured while he/she
is under the influence of an illegal substance are generally not eligible for sharing.

Is there a lifetime or yearly maximum amount that is eligible for sharing for
any one person or family?

There are no lifetime or annual maximum amounts eligible for sharing for most medical
needs. Some conditions have limits, generally calculated per need, as described in the section
“Limitations on Sharing.” There is no limit on the number of needs that an individual member
or household may have.

What kinds of needs do Zion Health members share?

In general, needs for illnesses or injuries resulting in visits to licensed medical providers,
emergency rooms, testing facilities, or hospitals are shared on a per person, per incident basis
once the member has met their personal responsibility by paying their initial unshareable
amount.

What kinds of needs do Zion Health members not share?

Needs resulting from medical conditions that existed prior to the effective date are typically
not shared or are shared in a limited capacity. For any needs that do not qualify for sharing
but that create a financial burden to your family, the Additional Giving program may be
of assistance. Finally, each member has an IUA (initial unshareable amount) for which
reimbursement from the Benevolent Fund will not be made.

Does Zion Health share routine medical care?

Zion Health shares in some preventive medical services, such as annual office visits, youth
immunizations, preventive mammograms, and colonoscopies. See the Preventive Medical
Sharing guide for more details.

How does Zion Health handle very large medical expenses?

Zion Health takes steps to ensure that money is set aside for very large medical needs. A
minimum of 15% of all monthly member contributions are set aside in preparation of the
occurence of very large medical expenses, i.e. those over $100,000.

What amounts do members share for maternity needs?

For a pregnancy that begins after the start of a member’s effective date, maternity needs are
shared like any other need. For a pregnancy that began prior to a member’s effective date,
pregnancy is treated as a pre-existing condition and not shared.

Am I excluded from membership/reimbursement eligibility if I’m a cancer
survivor?

No. In fact, there are several ways in which costs related to treatment for cancer survivors
could be shared:
1) The expenses for a second occurrence of cancer would only be ineligible for sharing if it
“resulted from” the first episode of cancer.
2) Except for insulin-dependent diabetes, all conditions a member had prior to their effective
date may be shareable according to the limitations set forth in the section “Medical Conditions
Existing Prior to Membership.”
3) Even expenses that are not eligible under the basic sharing program may be shared among
our members through the Additional Giving fund.

How does Zion Health handle expenses for medical treatments that occurred
overseas?

Bills from medical treatments that occurred overseas must be written in or translated into
English and the price converted to U.S. dollars before the need is submitted. They are then
processed in the same manner as bills from medical treatment in the U.S.

What if I lose my job or change employers? Can I take my Zion Health plan
with me?

Yes, continuation of membership in Zion Health’s sharing program after termination of
employment is a simple process. Because membership is individually based, members can
change the billing method at any time.

This program sounds kind of unusual; does it really work?

The concept of medical cost sharing has been highly successful within the confines of faithbased groups for more than forty (40) years. During this time period, hundreds of thousands
of individuals, families, and businesses have shared hundreds of millions of dollars in medical
expenses. As a result, there is a strong foundational precedent in the concept of medical cost
sharing.

A community of health-conscious individuals who care for their fellow men can successfully
participate in the sharing of medical expenses in a manner that will reduce the financial
burden of receiving medical care for all members. Members should note, however, that past
successes by faith-based sharing groups assisting one another is no guarantee of the future
success of similar programs. There is no promise or contract by Zion Health or the members to
contribute toward any need any other member might have in the future.

What happens if Zion Health’s members’ needs are greater than the monthly
contributions received?

Zion Health keeps excess funds to share member needs in the event that needs for a month
exceed the monthly contributions received. To date, all eligible needs have been shared in full
without need to draw from the excess funds.
However, if the rare event occurs that all needs cannot be met for a given month, Zion Health
uses a prorating method to evenly distribute the available funds among members with needs.
For example, if the monthly contributions received for a given month amounts to 80% of the
needs submitted for that month, each member would have 80% of their eligible expenses
shared that month. The Zion Health community has not needed to prorate member needs in
the past and has ample excess sharing contributions to draw from, but has these procedures in
place to account for every possibility.

How much does it cost to belong to Zion Health?

Every member provides a specific monthly contribution depending on their plan type, age,
and chosen initial unshareable amount. Employer contributions, if applicable, can also affect
the monthly cost to the member. See the Zion Health website for current monthly contribution
rates. Monthly contributions are subject to change by vote of Zion Health’s board of directors.

Can my employer pay some, or all, of my monthly contribution amount?

Yes, there is no limit (other than business financial restraints) as to how much your employer
can contribute towards your required monthly contribution.

How is my portion of the monthly contribution collected?

Zion Health offers multiple payment options for members to pay their monthly contributions,
including direct payment and payment through payroll deductions.

Are my monthly contributions higher if I, or a participating member in my
family, uses tobacco products?

Yes. Tobacco use of any kind is clinically proven to cause serious health conditions. Due to
the increased likelihood of higher medical costs associated with tobacco use, Zion Health
households with one or more tobacco users are required to contribute a higher monthly
contribution amount to maintain membership. Additionally, medical needs for tobacco users
age 50 and older are limited to $50,000 for each of the following four disease categories:
cancer, heart conditions, COPD, and stroke.

Are my monthly contributions a pre-tax deduction like health insurance
premiums?

No. The monthly contribution is a voluntary contribution towards a membership program that
facilitates the sharing of member’s medical bills. As such, the money members contribute to
the Zion Health program is a post-tax contribution.

How often can the monthly contribution amounts be changed?

Monthly contribution amounts can be changed twice a year, in accordance with the policies
and procedures set forth in these guidelines. The monthly contribution can only change when
approved by Zion Health’s board of directors. To date, Zion Health has never had to increase
the monthly contribution rate and does not plan to do so in the near future.

Are my pre-existing conditions always unsharable?

In the first year of membership, pre-existing conditions are not sharable with the Zion Health
community. Pre-existing conditions become sharable on a limited basis after one year of
continuous membership, with the limit increasing to a maximum of $125,000 per need in
the fourth year of membership and onward. For more information, see the section “Medical
Conditions Existing Prior to Membership.”

COMPANY FREQUENTLY ASKED QUESTIONS

Is Zion Health a group benefit?

No, Zion Health 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
contributions list at any time and billed directly.

Why should my company participate in Zion Health’s medical cost sharing
program?

Participation in Zion Health’s program is always voluntary, both from the company’s and the
employee’s perspectives. Business owners choose to work with Zion Health 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 Health’s greater efficiencies for both companies and employees.

Does Zion Health’s medical cost sharing program comply with the Affordable
Care Act requirements?

Zion Health’s sharing program is not a substitute for insurance as defined by the Affordable
Care Act and therefore does not meet the requirements by itself.

What are the risks and liabilities my company may be exposed to through
participation in Zion Health?

Zion Health is a voluntary and benevolent program. It is not insurance. Member companies are
not purchasing insurance coverage by participating in the sharing program. By participating
in the sharing program, companies are neither promising their employees that their larger
medical bills will be paid, nor are they taking on liability to pay those bills as a company.
Companies can choose to contribute on behalf of their employee members.

Can my employee’s monthly contributions be collected via payroll
deductions?

Yes. Zion Health allows members to join a contribution list of members who are part of a
company. Employers can deduct member contributions by payroll deduction on a post-tax
basis.

Can my company pay some or all of its employee’s monthly contributions?

Yes. Participating companies can contribute as much of the employee’s monthly contributions
as they wish. It should be recognized that this is viewed as a component of the employee’s
total compensation. Companies can tier their employees based on legal requirements and
offer different product bundles to each tier. Talk to your legal representative about legal
requirements on tiering qualifications.

How do I set up my employees’ withholding amounts?

Companies should consult with their own legal and tax advisors for more information
regarding payroll and income tax implications for their specific situations.

Is there any additional administration or work for my company as a result of
participation?

The Zion Health team is glad to assist with any questions you or your staff might have
regarding monthly contributions and the entire Zion Health process.

The cost savings sound great, but how will my employees be affected by Zion
Health’s program?

The employees of participating businesses are granted the opportunity to voluntarily join Zion
Health’s medical cost sharing program. As such, participating employees voluntarily choose to
pay the portion of the monthly contribution that is not carried by their company. Any employee
can withdraw from the program at any time, but if they do, they will no longer be able eligible
to receive contributions towards their medical expenses in the event that they incur a medical
need.