Need Request -Partner Pages

MEDICAL NEED REQUEST

Please select from the dropdown the type of need request that best fits your medical situation. Specific fields will appear to collect your medical need request information. Once you submit your request, the Zion HealthShare Needs department will immediately begin to process it. Please be patient as this process may take some time. If you have concerns that your particular medical expenses might not be shareable, please see our Member Guidelines for clarification.

- Need Request Type*
- Member Name*
  First Last
- Member Phone*
- Member Email*
- Member Number*
- Visit Type*
- Is this a request for a reimbursement?*
  - Yes
  - No
- Cost associated with procedure or treatment*
- Need Request Description*
  Please provide the details of your medical need request. This may include what happened to initiate your need request, how you became aware you needed medical treatment, and/or what treatment you have received so far.
- What is the alternative treatment being requested alternative to?*
- When did you first start showing symptoms or require treatment?*
  MM slash DD slash YYYY
- Currently on any medication for the condition?*
- If yes, what is the condition(s)?
- If you are submitting this request for payment at the time of service or a future preventive service, please call 888-920-9466.
- Other Coverage*
  - Medicare
  - Medicaid
  - Insurance plan / other coverage
  - Auto insurance (if auto accident)
  - None
  Select all that might apply.
- Estimated Delivery Date*
  MM slash DD slash YYYY
- Name of OB/GYN and hospital (if known)*
- Date of service*
  MM slash DD slash YYYY
- Provider(s) information, name & contact information*
- Descriptions of service being recommended*
- Please use this feature to submit additional documents for existing medical need requests
- Supporting Files (if any)
  Please note that all file attachments cannot exceed 60 MB. If you have multiple files, you may need to submit them individually.
  Drop files here or
  
  Max. file size: 60 MB.
- Please include in your Regular Need Request:
  - Bills (itemized bills are best)
  - Any detailed receipts of IUA payments made directly to providers
  Download Needs PDF
- ***Please submit the associated itemized statement and payment receipt***
- What to include & what to expect:
  - Please include your completed HIPAA Release Form.
  - Any receipts or bills that you have received
  - Zion Health will be reaching out to you soon to help gather “Global Maternity” packages from your providers
  Download Maternity Needs PDF
- Please include in your Alternative Medicine Request:
  
  Request for cost sharing for alternative medicine/treatment may be eligible for sharing in the Zion Health community. When considering these important requests we take into account the following criteria:
  - Supporting documents of provider recommendation
- Additional Giving Need Request:
  
  Requests can be made for Zion Health to share in medical expenses that are not generally eligible for sharing with the community. When considering these important requests from our members we take into account the following criteria:
  - Amount of funds available in the “Additional Giving Fund”
  - Length of continuous membership
  - Supporting documents of provider recommendation
  - Descriptions of service being recommended
  - Future medical concerns if the member cannot receive the requested healthcare
  - Number of current requests for use of these community funds
  - Please submit any detailed information in your request that you feel will be helpful based on the above criteria
CAPTCHA
Medical need requests that arise from pre-membership medical conditions are only shareable if the condition was regarded as cured and did not require treatment, examination, medication, or present symptoms for 24 months prior to the effective date of membership.

To help identify if you have a pre-membership medical condition, you may ask yourself the following questions. Depending on your type of medical need request, one or more of the following may apply:
- Is your current medical need request related to an illness that presented symptoms prior to membership?
- Did your injury happen prior to membership?
- Are you currently on any medication related to this condition?
- Did you see your doctor or have testing done prior to membership for this condition?
Shareable amount for pre-membership medical conditions:
- Year One: $0 (waiting period) 
- Year Two: $25,000 maximum per need 
- Year Three: $50,000 maximum per need 
- Year Four: $125,000 maximum per need

Enjoy Medical Cost Sharing Membership

All of what you need in a medical cost strategy, great savings, and like-minded individuals.

Enroll Online

MEDICAL NEED REQUEST

Please use this feature to submit additional documents for existing medical need requests

Please include in your Regular Need Request:

***Please submit the associated itemized statement and payment receipt***

What to include & what to expect:

Please include in your Alternative Medicine Request:

Additional Giving Need Request:

Enjoy Medical Cost Sharing Membership

Please submit the associated itemized statement and payment receipt