Member Guidelines

MEMBER GUIDELINES PDF

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Current Member Guidelines

MEMBER GUIDELINE HISTORY

MAY 1ST, 2021

Maternity Updated to a single IUA

“As with any other medical need, expectant mothers pay a single IUA for all expenses related to their maternity need. Shareable expenses may be related to miscarriage, prenatal care, postnatal care, and delivery. STD screenings prescribed by a licensed practitioner as part of routine prenatal care are shareable as part of the maternity need.”

Suicide and Attempted Suicide New Clarification

“Zion Health encourages members to take advantage of our LifeWorks program as a mental health resource. However, we understand that in the event of a dependent suicide, financial assistance can slightly ease the burden on our members. For this reason, Zion Health will share in expenses related to the suicide or attempted suicide of an adolescent up to age 18, up to $25,000 and after a one-year waiting period of continuous membership.”

End of Life Assistance Waiting Period Shortened

“If a member, or a member’s dependent, dies after one year of uninterrupted membership, financial assistance will be provided to the surviving family. The Zion Health member community will provide assistance upon receipt of a copy of the death certificate.”

Cataract Surgery New Clarification

“Cataract surgery is treated as a pre-existing condition and subject to the one-year waiting period before it is shareable. Each eye is considered a separate need and subject to an individual IUA.”

Chronic Pain Therapy New Clarification

“Services related to chronic pain therapy are treated as an alternative medical practice. They are shareable as part of a related eligible need, and members must get prior approval from Zion Health for the number and type of sessions.”

Preventive Services Additional Clarifications

“Preventive services are not subject to the IUA.

Zion Health shares preventive services in a limited capacity with the Direct Membership, or with the Connected add-on for the Essential Membership.

Annual office visits are shareable immediately upon membership activation, and may be used for preventive visits, specialist visits, or other services as outlined in the Preventive Guide. Zion Health will share the member’s first qualifying submission; all other subsequent provider visits are the member’s responsibility until 12 months have passed since the qualifying visit.

Colonoscopies, mammograms, and youth immunizations (up to 16 years old) are shareable after six months of continuous membership.

See the Preventive Guide for more details.”

*Other minor punctuation and grammatical changes were made for better readability.

OCTOBER 1ST, 2020


Prescriptions – Introducing Rx Share a new Generic medication prescription option.

RELATING TO NEEDS

  • Prescriptions for medication(s) that are billed by a provider and are related to a qualified Need are also considered sharable. With Zion Health’s approval, large prescription costs associated with a Need that are filled at the pharmacy can be shared.

Rx SHARE (available starting 10/1/2020)

  • Generic medications are sharable with Zion Health’s Rx Share program. Brand and specialty drugs are also available at a discount. This prescription sharing program is included with the Zion Health Direct Membership or as an add-on to our other membership types.

DISCOUNT PRESCRIPTIONS

  • Zion Health Rx program provides easy-to-use member-only discounts for generic, brand and specialty prescription(s).

Principles of Membership – Update

The following statement was added as part of principle one of the principles of membership.

I also acknowledge that Zion Health has declared an affiliation with, and faith in, a higher power and welcomes members of ALL faiths.

Physical Therapy & Occupational Therapy – Clarified inpatient maximum payout per need.

“Shareable for inpatient treatment and up to 35 outpatient sessions per need and up to $7,500.”

Speech Therapy – Clarified inpatient maximum payout per need.

“Shareable in relation to an illness, injury or accident. Up to 35 outpatient visits per condition and up to $3,000.  Sharing for Speech Therapy is excluded for speech delays or learning impairments not caused injury or accident.”

Therapeutic Massage Therapy – Clarified inpatient maximum payout per need.

“Shareable if prescribed by a licensed medical provider related to a shared need, up to 25 sessions and up to $3,000.”

Emergency Room – New Clarification

“Shareable for eligible medical needs from an illness, injury or accident.  Each additional visit to the emergency room after the first visit for a single medical need requires the member to pay an additional $500 of personal responsibility.  This amount is added to the members Initial Unsharable Amount (IUA).  Members with non-emergency needs should seek out other treatment options such as telemedicine, doctor visits, urgent care clinics or other appropriate care.”

Automobile Accident – Additional Clarification

“Only shareable when other third party and/or insurance entity is not liable.  If the member’s medical need is being considered or should be considered by a third party and/or insurance entity, Zion Health will not share until documentation is received to reflect the lack of liability or partial payment.”

Home Births – New Potential IUA savings

“Home births have less expenses typically. Zion Health may waive one Initial Unshareable Amount (IUA) for the mother if the costs are lower than what otherwise would be paid by the sharing community and approved by Zion Health.  The Initial Unsharable Amount (IUA) for the child(ren) would still need to be met.”

Injections – New Clarification

“Home births have less expenses typically. Zion Health may waive one Initial Unshareable Amount (IUA) for the mother if the costs are lower than what otherwise would be paid by the sharing community and approved by Zion Health.  The Initial Unsharable Amount (IUA) for the child(ren) would still need to be met.”

Mental Health – Additional Options for Coverage

“Medications and other care is not shareable for the treatment of any mental health related illnesses.  Mental health also includes anxiety, depression, mental illnesses, and psychology related conditions.  Zion Health provides a mental health membership add-on that allows for regular preventive mental health consultations.” 

Sleep Apnea – New Clarification

“Sleep apnea equipment and testing is not shared with the Zion Health community.”

Home Healthcare – New Clarification

“Home Healthcare expenses are sharable when related to an accident or injury and prescribed by a licensed physician.  Sharing is limited to 30 days and $5,000.”

Medical Equipment – Additional Clarification

“Medical equipment including durable medical equipment (DME) can be shared if prescribed by a licensed medical provider and part of a need and approved by Zion Health.”

Medical Supplies – Additional Clarification

“Medical supplies directly aid in the treatment or recovery of a sharable medical need and generally shareable within 120 days of the treatment start date as prescribed by a licensed medical provider.  Supplies costs need to be over $100 to be shared.  Zion Health will share in the retail or fair costs when applicable and encourage members to utilize alternative vendors such as local pharmacy or medical supply stores.”

Child Dependent Participation – Additional Clarification

“Limited to children age 18 and younger, and unmarried children ages 19 through 25. Once an unmarried child dependent turns 26, the child would need his or her own membership.”

Dental – New Clarification

“Zion Health only shares in dental related expenses that are deemed medical.”

Vision – New Clarification

“Zion Health only shares in vision related expenses that are deemed medical.”

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