MEMBERSHIP GUIDELINES!

Zion Health was created with the same principles of other proven medical cost sharing communities. Zion Health has re-imagined the HealthShare concept to make medical cost sharing more accessible, simplifying the process, and encouraging healthy living. If you have experienced or heard of medical cost sharing communities, we invite you to take a closer look at Zion Health. Our re-imagined approach is sure to captivate you!

HEALTHSHARE BEGINNINGS

Modern day medical cost sharing, also known as a HealthShare, began in the 1980’s when a beloved pastor in Ohio was involved in a terrible automobile accident. The Christian community came together and paid all of his medical bills, in full, in just 45 days. These Christians decided to follow the Biblical mandate of ‘bearing one another’s burdens’ by sharing healthcare costs in a simple and effective way.

Today, members of HealthShare communities across the country share on another’s medical bills in the same fashion. This system has been proven to be an effective alternative to traditional and increasingly complex and costly health insurance. Members enjoy freedom, flexibility and stability of community medical costsharing while keeping more money in their own pockets.

MEMBERSHIP ELIGIBILITY

Membership eligibility in Zion Health is primary based upon two factors.

  1. Commitment to adhere to Zion Health’s Principles of Membership.
  2. Participation in the community by submitting monthly contributions.

To be considered for membership, prospective Members must enroll and accepted into the membership by meeting the criteria of the Membership Eligibility. The membership begins on a date specified by Zion Health. The first month’s contribution must be received within 15 days of a new Member’s effective date in order for the membership to become effective.

Commitment

Members of Zion Health share a common commitment to abide by a set of personal standards outlined in its Principles of Membership. If at any time during participation in the membership, a violation of the Principles of Membership is discovered or revealed through the review of the Member’s submitted medical records, all needs of the Member in violation, submitted after the Date of Service in which the violation was discovered, will be put on hold. The Member will be issued an explanation of the violation and granted thirty (30) days to submit documentation supporting its compliance with the Principles of Membership, notwithstanding any contradicting information obtained by Zion Health before being withdrawn from the membership, rendering all needs ineligible. If the documentation and explanation submitted by such Member is not satisfactory to show compliance with the Principles of Membership, the Member will be automatically withdrawn from the sharing program and its membership will be revoked. In the event that a Member is withdrawn due to a violation of the Principles of Membership, Zion Health will not return Member contributions prior to the date of withdrawal, because contributions are submitted for Member to Member sharing.

Participation

To maintain an active membership with Zion Health, a Member must submit a Membership Commitment Form each year to demonstrate its continual commitment to be a part of the Zion Health community and abide by the Principals of Membership. It is the Member’s responsibility to submit the Membership Commitment Form to Zion Health within 30 days of the Member’s annual renewal date. Any Membership Commitment Form not received within the 30 days will cause the membership to become inactive until this document has been received.

A Member must submit a Monthly Contribution associated with their membership level to Zion Health to be used for member-to-Member sharing. Monthly contributions are to be received each month and required to be received no later than thirty days of the billing date. If a Monthly Contribution is not received by the last day of a participating month, membership will become inactive. Any Member that has been withdrawn from the membership will be able to re-apply under the terms outlined to them in writing by Zion Health. Any Member who allows its membership to become inactive three consecutive times will not be able to re-apply for membership. Any Member’s needs occurring after they become inactive or before they re-apply for membership are ineligible for sharing.

Qualification

Applicant(s) must meet all criteria set forth in a Membership Enrollment and the Membership Guidelines on the date of his/her application to be qualified for membership. If, at any time, it is discovered that a Member did not submit a complete membership, the incomplete membership could result in either a retroactive Membership Limitation or a retroactive denial of his/her membership.

While Member health status has no effect on eligibility for membership, there are limitations on the sharing of needs for some conditions that existed prior to a Member’s Effective Date. Needs that do not qualify for medical sharing may still be met in part or in whole through Special Needs Sharing Program.

Dependents

A dependent may participate under a combined membership with the Head of Household through the age of 26. On the 27th birthday, the child would need his or her own plan. A dependent who wishes to continue participating with Zion Health can by completing an enrollment. Children born into the membership, due to an eligible maternity need, can become a Member.  Under a combined membership, the Head of Household is responsible to ensure that each individual participating under the combined membership meets and complies with the Principles of Membership and the Membership Guidelines.

Children between 3 months and 18 years of age may qualify for membership without their parent’s mutual participation on a case-by-case basis as determined by Zion Health. In these cases, the child’s parent or guardian must complete and sign the membership application and any associated materials for the child, and is responsible to ensure that all application requirements, Membership Guidelines, and Principles of Membership are met. A legally adopted child may qualify as a dependent or contributor.

Contributions

Member contributions can be made directly with Zion Health, with a direct primary care practice or with a participating employer on a Member Contribution List. All Member contributions are voluntary, but the Monthly Contribution is required to be active and eligible for sharing.

Appeals

In a case when a Member believes a limitation was incorrectly placed on Member sharing an appeal can be submitted. Members may submit an appeal for a Membership Limitation removed by providing medical evidence that they qualify for such removal.

*Defined Terms

ZION HEALTH PRINCIPLES OF MEMBERSHIP

Each Member of Zion Health must comply with the following requirements in order to preserve its membership in Zion Health and be eligible to participate in the sharing program. The requirements below benefit all Members by assuring honor and integrity on the part of Members and by minimizing medical risks and ensuring proper accountability while encouraging good health practices. All Zion Health Members must agree with and attest to the following statements:

  1. I believe that a community of moral, ethical and health-conscious people can most efficiently and effectively encourage and care for one another by directly sharing the costs and expenses associated with each other’s health care needs.
  2. I understand that Zion Health is a Benevolence Organization, not an insurance entity, and that while Zion Health assures that every effort will be made to have Members fulfill their monthly sharing commitment, Zion Health, in and of itself, cannot guarantee payment of any medical expenses. I agree to practice good health measures and strive for a balanced lifestyle.
  3. I agree to refrain from the usage of any form of illicit/illegal drugs and excessive alcohol consumption, all of which are harmful to the body. Tobacco consumers have an increased share of $50 monthly per household.
  4. I believe I am obligated to care for my family and that physical, mental or emotional abuse of any kind to a family Member or anyone else is morally wrong.
  5. I agree to submit to mediation followed by subsequent binding arbitration, if needed, for any instance of a dispute with Zion Health or its affiliates.

ENROLLMENT REQUIREMENTS

Members can choose from different levels of participation for Zion Health membership. Monthly share amounts are derived from household membership status and age.

Determination of Household Membership

Four tiers (Household Members):

Member Only
Member & Spouse
Member & Child or Children
Member Family

Child Dependent Participation

Limited to children age 18 and younger, and unmarried children ages 19 through 26 who are bona fide dependents of a Member parent.

Marriage

When the dependent of a Member is married, he or she will not be a Member with Zion Health unless he or she re-enrolls in a Membership separate from the parents.

Transition Allowance

Married dependents and those over the age of twenty-seven (27) will no longer be considered part of their parents’ membership.

Any medical needs which occur from the time a child leaves his parents membership to the date he or she begins their own will not be shared.

Newborn

Newborns whose addition to the household membership will increase the Monthly Contribution amount will be included within the household membership retroactive to the date of birth as long as the Member notifies Zion Health to add the child to the membership no later than 30 days after birth. Otherwise the effective membership date will be no earlier than the date of notification to Zion Health.

Adoption

Adopted, unmarried children are considered members of the household the same as biological children. Any physical conditions of which the adopting parents are aware of for the adopted child prior to the legal adoption are considered Pre-Existing Conditions and not shareable.

Grandchildren

Grandchildren may be included as part of their grandparent’s membership if they meet all the following criteria.

1. They live with their grandparents at least 9 out of 12 months of each year;
2. The grandparents have legal custody of the grandchild; and
3. They have no other agency, person or group responsible for their medical needs.

*Defined Terms

MEMBER RESPONSIBILITIES

Members should be aware of the responsibilities expected as part of the sharing program. Each Member’s actions can affect the whole community which is why it is very important to follow these standards.

Member Shares

Membership Shares or contributions should be made timely (within 30 days of due date).

Proper Submission Of Medical Needs To Zion Health.

Submission of medical needs to Zion Health allows for timely and accurate sharing of a medical need.  You can submit medical needs online, by phone or by your provider.  Providers can submit a “claim” form for your need electronically or by using our mailing address.

We like paying providers quickly and to negotiate the best rates for your healthcare services.  This keeps providers happy and helps us keep rates low for our members.  Keeping Zion Health in the loop with any potential “cash pay” discounts and consulting with us prior to signing payment arrangements can help us with the medical cost negotiations on your behalf.

Trust & Accountability

Zion Health community Members are expected to act with honor and integrity.  Members should not falsify medical needs or use deceptive practices. If a Member abuses the trust given, they will have their membership discontinued.

*Defined Terms

ADDITIONAL GIVING

Zion Health practices good stewardship of the Benevolent Fund by adhering to these guidelines and limiting disbursements from the Benevolent Fund to the needs of those Members who comply with the Membership Requirements. Zion Health encourages Members to contribute as often and as much as possible in excess of their respective Monthly Contributions to enable Zion Health to assist those Members who have a Special Need. The receipt and administration of such additional contributions from the Members is part of the “Additional Giving Program”.

Additional attributes of the Additional Giving Sharing Program are set forth:

  1. Needs that do not meet the guidelines may be eligible for Additional Giving sharing requests. Members and other contributors may give additional funds for a general or specific need. Members looking to request sharing must meet a $500 threshold or above to be considered.
  2. Members who have needs during a given month may have only a part of the need shared. Members or other contributors can provide additional funds to share within the community. Members are encouraged to share out of their surplus.
  3. 100% of all contributions made to the Additional Giving program are shared for medical costs exclusively and not subject to administration costs.

NEEDS THAT MEMBERS SHARE

This section explains how the Shareable Amount of Member’s medical expenses will be determined. There is no Lifetime Limit on the number of conditions or the total dollar amount of different needs that may be shared. Original itemized bills for the medical expense Members want shared must be submitted within six months of treatment. Bills submitted more than six months after the service date of treatment will not ordinarily be shareable.

Medical needs are submitted on a per member, per incident basis. These are injuries and illnesses resulting in medical expenses incurred by receiving Medically Necessary treatment from Licensed Medical Professionals; including physicians, emergency rooms and hospital facilities.

Determination Of A “Need”

Expenses related to the same medical condition, including those for separate incidents, will be shared as one need and accumulate towards the total need amount. If at least 12 months pass without any symptoms, medication or other treatment for the original condition originally created the need, or related subsequent conditions recurs, it will be treated as a new need.

Initial Unshareable Amount (IUA)

Amount paid by the Member before the Zion Health community shares in Medical Expenses.  This amount is also known as your personal responsibility.  Zion Health has three primary levels of personal responsibility.  $1,000, $2,500 and $5,000.  The lower the Initial Unsharable Amount, the higher the monthly sharing contributions.

Maximum Shareable Amount

There is no lifetime maximum amount eligible for sharing for any Member or household. Zion Health has a systematic way to handle large needs and has budgeted to address large needs as they come in on a monthly basis.

Multiple Needs Within A 12-Month Period

Member households that experience multiple needs within a 12-month rolling membership year are asked to pay up to three Initial Unshareable Amount per year. Additional needs that meet a $500 threshold would be considered fully shareable with the Zion Health community.

Insurance Entities And/Or Government Programs

Insurance and/or government entities are always considered primary prayer for any Members medical expenses. Members who are eligible for benefits through either insurance arrangements or government programs are required to contact Zion Health’s Member advisor before submitting their medical need to work through the claim or needs processing.

Time Limit For Sharing Documentation

Receiving the bills and needs request promptly will help Zion Health to provide the speedy processing of your need. When there is a number of bills related together in one need, it is helpful for these bills to be submitted at one time if obtained within a 30-day period.

Original and itemized bills should be submitted to Zion Health with a need handling form as soon as possible. Bills and needs requests should be submitted within 6 months from the Date of Service to be shared.

*Defined Terms

MEDICAL CONDITIONS EXISTING PRIOR TO MEMBERSHIP

Medical expenses for any service or treatment provided during membership which meets these guidelines are shareable while being a Member in good standing except as explained below.

Conditions cured and 12-month symptom and treatment free

A need that comes from a condition that existed prior to membership are only shareable if the condition is fully cured and does not have treatment or symptoms in a 12-month period.

Please note: Needs that existed prior to membership may still qualify for Additional Giving.

Exclusion of Insulin Dependent Diabetes

Medication to treat insulin dependent diabetes, when the condition existed prior to membership, are not shareable.

Exceptions for High Blood Pressure, High Cholesterol Hemorrhoids and Sleep Apnea

High blood pressure, high cholesterol, hemorrhoids and sleep apnea will not be considered a pre-existing condition as long as they have not been hospitalized for the condition in the past 12 months and able to control through medication or diet.

Exceptions for certain other medical conditions

Zion Health recognizes that every situation is different. Zion Health reserves the right to make exceptions for certain medical conditions on a case by case basis provided it serves to benefit the membership as a whole.

*Defined Terms

SHAREABLE CONDITIONS

Member needs that result from expenses not associated with a prior medical condition are generally shareable. The following chart reflects limitations of the plan. All shareable conditions are subject to the Member Initial Unshareable Amount.

Abortion

Needs resulting in expenses for abortion of a living unborn baby will not be shared.

ADD, ADHS and SPD Treatment

No sharing of prescriptions related to condition.

Alternative Medical Practices

Shareable pending prior written approval by Zion Health. Member is required to demonstrate the proposed value of the alternative treatment.

Alcohol or drug abuse treatment

Treatment for alcohol, substance abuse or chemical dependency is shareable up to the $3,000 Maximum Shareable Amount per Member.

Ambulance Transports

Shareable as part of a need whenever medically needed or due to severity, proximity and circumstances associated with a specific illness or injury.

Audiological

Shareable to correct hearing loss but not for hearing aids.

Automobile Accident

Only shareable when other third party and/or insurance entity is not liable.

Chiropractic

Services related to treatment of a specific musculoskeletal injury or disease are shareable for up to 25 Office Visits and includes related items for treatment for up to 120 days. All other chiropractic services will be treated as “Alternative Medical Practices”.

Cosmetic Surgery

Shareable only for disfiguration due to shareable injury or illness.

Dental & Vision

Not shareable except with illness or injury.

Fertility

Not shareable.

Hospice Care

Shareable for 90-day periods with physician approval or certification of terminal illness.

Hospitalization

Shareable at semi-private room rate or if a licensed medical provider prescribes ICU or quarantine.

Hyperbaric Therapy

Shareable for treatment of specific illness or injury. Outpatient included with up to 35 as a maximum number of therapy sessions.

Injuries obtain from certain acts

Injuries or illnesses caused by a result of participating in a riot, criminal act, assisted suicide or euthanasia will not be shareable.

Therapeutic Massage Therapy

Shareable if prescribed by a licensed medical provider up to 25 sessions.

Laboratory Tests and Checkups

Shareable only when prescribed by a licensed medical provider due to symptoms of a condition not in existence prior to membership.

Long-term Care and Skilled Nursing

Shareable as a result of recovering from an injury or illness as prescribed by a licensed medical provider. Sharing limited to 90 days per medical need.

Medical Equipment

Shareable if prescribed by a licensed medical provider. First month and 6-month subsequent rental amount not to exceed amount of the purchase of item. Equipment must directly aid in treating the condition.

Medical Supplies

Generally shareable within 120 days of treatment start as prescribed by a licensed medical provider.

Naturopathic

Shareable pending written approval from Zion Health.

Newborn Care

See maternity guidelines.

Nutritionists

Generally, not shareable unless prescribed by a licensed medical provider.  Approval needs to be provided prior to sharing.

Organ Transplants

Shareable subject to limitations for conditions prior to membership.

Physical Therapy

Shareable for inpatient treatment and up to 35 outpatient sessions per need.

Prescriptions

Prescriptions for medication related to qualified shareable medical condition.

Preventative Servcies

Colonoscopies and other preventive services are not included unless enrolled in a Direct Membership and after one year of continuous membership or Connected Health program with your direct primary care practice.  Preventive services require authorization from Zion Health with a select locations to control sharing costs and are not subject to the initial unsharable amount (IUA).

Speech Therapy

Shareable in relation to an illness, injury or accident. Up to 35 outpatient visits per condition.

Sports

Injuries or illnesses resulting from participation as combatant sport is not shareable.

Sterilization

Elective sterilization such as tubal ligation and vasectomy is not shareable.

Surrogacy

Expenses related to a surrogate pregnancy, whether or not the surrogate is a Member are not shareable.

Weight Reduction

Shareable only if prescribed by a licensed medical provider and approved by Zion Health. $3,000 Maximum Shareable Amount per Member.

*Defined Terms

MATERNITY NEEDS

As a general rule, maternity needs are treated like any other medical expenses and are shareable. These expenses include prenatal care, delivery, postnatal care and miscarriage.

General

Maternity needs are treated like any other medical expenses and are shareable. These expenses include prenatal care, delivery, postnatal care and miscarriage.

Separate Needs

Bills for all pregnancy and birth related complications of the mother will be shared as part of the maternity need.  Two initial unsharable amounts (IUA’s) are applied to a single maternity need.

Any pre-birth or post birth need of the child will be considered a separate need from the mother’s maternity care.

Early Sharing Request

If a maternity care provider will reduce the normal charges if a Member prepays some or all the bill, Zion Health will consider sharing the maternity need prior to the birth. The Member must request an estimate and submit it with the need request.

Home births

Home births have less expenses typically. Zion Health may waive the Initial Unshareable Amount if the costs are lower than what otherwise would be paid by the sharing community and approved by Zion Health.

Pregnancy Prior to Membership

Eligible amount to share for maternity needs from pregnancy prior to membership will be equal to the total amount contributed from membership start. If Member terminates and restarts membership the amount will be based on the restart date.

Premature Birth

The baby’s needs are fully shareable for the baby born prematurely.

*Defined Terms

END OF LIFE ASSISTANCE

For a Member, and/or his or her dependents, who die(s) after two years of uninterrupted Membership as a Sharing Member, financial assistance to the surviving family will be provided by the Members according to the following schedule, upon receipt of a copy of death certificate, and as listed on the Member enrollment.

SUBMISSION OF MEDICAL NEEDS

Eligible medical expenses will be shared for all household members who meet all qualifications. Member should carefully follow instructions for submitting their needs requests.

  • Qualification based upon lifestyle choices & medical history.
  • Member has a need.
  • Member contacts Zion Health.
  • Needs Request Completed & Submitted to Zion Health
  • Zion Health Reviews Medical Needs
  • Zion Health Advocates Need, Including Negotiation of Need Amount
  • Zion Health Funds Qualified Need
  • Need Completed

DISCLAIMER

Zion Health is not an insurance company. Neither this publication NOR membership in Zion Health are issued or offered by an insurance company. The purpose of these membership guidelines is to help Members understand and identify medical needs that qualify for potential reimbursement and the process by which reimbursements are made. The membership guidelines are not for the purpose of describing to prospective Members what amounts will be reimbursed by Zion Health. While Zion Health has shared all Eligible Needs of its Members to date, membership does NOT guarantee or promise that your Eligible Needs will be shared. Rather, membership in the Zion Health community merely guarantees the opportunity for Members to care for one another in a time of need and present their medical needs to other Members as outlined in these membership guidelines. The financial assistance Members receive will come from other members’ Monthly Contributions that are placed in a Benevolent Fund, and not from Zion Health.

THIS PUBLICATION AND MEMBERSHIP IN ZION HEALTH SHOULD NEVER BE CONSIDERED A SUBSTITUTE FOR A HEALTH INSURANCE POLICY. IF THE MEMBERSHIP IS UNABLE TO SHARE IN ALL OR PART OF A MEMBERS ELIGIBLE MEDICAL NEEDS, EACH MEMBER WILL REMAIN SOLELY FINANCIALLY LIABLE FOR ANY AND ALL UNPAID MEDICAL NEEDS. THESE GUIDELINES DO NOT CREATE A LEGALLY ENFORCEABLE CONTRACT BETWEEN ZION HEALTH AND ANY OF ITS MEMBERS. NEITHER THESE GUIDELINES, NOR ANY OTHER ARRANGEMENT BETWEEN MEMBERS AND ZION HEALTH, CREATE ANY RIGHTS FOR ANY MEMBER AS A RECIPROCAL BENEFICIARY, A THIRD-PARTY BENEFICIARY, OR OTHERWISE. AN EXCEPTION TO A SPECIFIC PROVISION OF THESE GUIDELINES ONLY MODIFIES THAT PARTICULAR PROVISION AND DOES NOT SUPERSEDE OR VOID ANY OTHER PROVISIONS. THE DECISION BY ZION HEALTH TO REIMBURSE A MEMBER’S ELIGIBLE NEEDS DOES NOT AND SHALL NOT CONSTITUTE A WAIVER OF THIS PROVISION OR ESTABLISH BY ESTOPPEL OR ANY OTHER MEANS ANY OBLIGATION ON THE PART OF ZION HEALTH TO REIMBURSE A MEMBER’S ELIGIBLE NEEDS.

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Guideline Terms