Pre-Existing Conditions Explained

Dear Members,

We appreciate you all and your generosity in contributing to the health and wellbeing of thousands of like-minded individuals across the country. I am proud to be a member of Zion Health and to participate in your care.

One of the driving forces of our work is to keep medical costs down, which allows us to continue to keep our membership contributions low and offer a lower-cost alternative to traditional insurance. We do this by negotiating fair pricing for medical services and by having every member agree to our Member Guidelines, which outline the costs the community has agreed to share and not to share.

Our philosophy is that as a community of ethical, health-conscious people, we care for one another by directly sharing the costs associated with each other’s health needs. These needs typically are acute in nature, not health conditions present at the time of membership. Zion Health is able to offer monthly contributions among the lowest in the industry by having guidelines that govern how our contributions are used for these conditions. Our guidelines are one way our members can feel secure knowing their contributions are going toward needs the entire community has agreed to share. To keep sharing fair for the community, the Zion Health community shares in conditions that occur after membership, and we have limitations on sharing for conditions that existed prior to membership with Zion Health.

During the 24-month period prior to a new member’s activation date, any condition for which the member has been examined, taken medication, had symptoms, or received treatment for is considered a “condition existing prior to membership.” Members have a waiting period in the first year before pre-existing conditions are shareable. Even in these cases, we will negotiate with providers to help you receive any possible discounts on your medical costs.

Although pre-existing conditions are generally not shareable, we also want to be there for each other and ease one another’s medical burdens as much as possible. For that reason, we have put into place a framework for sharing pre-existing conditions in our Member Guidelines. One of the many ways we differ from traditional insurance is that we have a phase-in period for these pre-existing conditions. This means that beginning in your second year of membership, if the need meets guidelines for sharing, Zion Health can share up to the amounts listed below:

  • Year One: $0 (waiting period) maximum per pre-existing condition need
  • Year Two: $25,000 maximum per pre-existing condition need
  • Year Three: $50,000 maximum per pre-existing condition need
  • Year Four: $125,000 maximum per pre-existing condition need

After year four of your membership, expenses related to pre-existing conditions will remain shareable at a maximum of $125,000 in a 12-month rolling period. This period resets every membership year.

If you have questions about this, please contact our Member Care Specialists by email or call 888-920-9466.

Stay happy, stay healthy, and keep smiling!

Jeff Lee, MD

Medical Director

Picture of Jeff

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