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.