Summary of Sharing

What Costs Do We Share?

Medical costs are shared on a per-person, per-incident basis, for illnesses or injuries incurring medical expenses when treated by physicians, urgent care facilities, clinics, emergency rooms or hospitals (inpatient and outpatient).

Members share these kinds of costs:

  • Total bills incurred per incident over the Single, Couple or Family Annual Unshared Amount*
  • Inpatient or outpatient hospital treatment or surgery for a medically-diagnosed condition
  • Doctor’s visits related to each medical incident
  • Prescriptions 45 days before and after each related medical incident
  • Physical therapy and home health care for each related medical incident

A medical incident is any medically diagnosed condition receiving medical treatment and incurring medical expenses. See Sharing Guidelines.

These are the kinds of expenses we do not share together:

  • Pre-existing conditions for the first 12 months of participation
  • Dental/Vision services or procedures
  • Medical costs less than the Single, Couple or Family Annual Unshared Amount*

*A medical expense eligible for sharing must exceed an Annual accumulative Unshared Amount which is $500 for a single, $1,000 for a couple, $1,500 for a family and is calculated upon each member’s enrollment date until their next annual renewal date.