FREQUENTLY ASKED QUESTIONS (FAQ)

WHAT 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.When members have financial needs due to illness that are greater than they can bear individually, the goal of the Zion Health community 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.

IS ZION HEALTH 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 costsharing is an arrangement whereby members agree to share medical expenses through the act of voluntary giving. 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.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 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. Providers can send bills directly to Zion Health using standard electronic correspondence tools in the medical industry (EDI). If not sent directly from then provider, Zion Health members are required to submit proof of their medical expenses to Zion Health. Zion Health then evaluates each submission for eligibility or ineligibility based on the Member Guidelines. Eligible needs are designated for sharing using the funds accumulated through monthly member contributions.

DO ALL THE MONTHLY CONTRIBUTIONS GO TOWARD MEMBERS’ MEDICAL EXPENSES?

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

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

Yes. For members who are travelling abroad, eligible needs can be shared no matter where in the world they were incurred and treated. Members interested in medical tourism need prior written approval from Zion Health before treatment.

WHO CAN JOIN ZION HEALTH?

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

WHAT HAPPENS IF ZION HEALTH NEEDS EXCEED THE MONTHLY CONTRIBUTIONS RECEIVED?

Zion Health keeps funds to share member needs in the event that medical needs exceed the monthly contributions received. To date, all eligible needs have been shared in full without need to draw from the saved 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 prepared for the event that needs exceed member contributions.

CAN I OFFER ZION HEALTH THROUGH MY COMPANY OR GROUP?

Yes. Although 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.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 COMPLY WITH THE AFFORDABLE CARE ACT REQUIREMENTS?

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