Utilizing Preventive Sharing
Zion HealthShare promotes proactive health measures among our members through Preventive Sharing. These services are automatically included in every Direct Membership and can be added to any Essential Membership. Preventive Sharing provides access to Annual Provider Visits (APV), well-child exams, youth immunizations, and early detection procedures. Members are encouraged to prioritize their health by attending their annual provider visits and participating in applicable cancer screenings.
Request Preventive Sharing
Please review the How to Submit a Sharing Request article for more information on Preventive Sharing Requests.
For Upcoming Preventive Care Visits
To ensure a smooth process for your upcoming preventive care visit, you may need the following documents and information:
Good Faith Estimate (For Mammograms and Colonoscopies): If the service requires pre-payment or has a variable cost, a good faith estimate provides an anticipated cost breakdown.
Provider Information (For all Preventive Visits):
- Provider Name
- Provider Phone Number
- Provider Zip Code
- Date of Service
*After your visit has concluded please remember to request the following information to be submitted with your sharing request:
Itemized Statement: This document details the services provided by your healthcare provider and their associated costs.
Request Medical Advocacy:
As a valued member of Zion HealthShare, we provide a complimentary Medical Advocacy service to assist you in finding reasonably priced medical providers for your upcoming medical needs. Our team of specialists is available to assist you with advocating for self-pay discounts, pre-payments for upcoming services, and facilitating payment for therapy services after procedures. You may contact them at 888-399-0017 or email advocacy@zionhealthshare.org for assistance.
For Past Preventive Care Visits
If you recently had a preventive care visit and would like to request sharing, please submit a sharing request and all applicable documents through your Member Portal.
Additional Notes
As a reminder all documents and sharing requests must be submitted within six months of the date of service for your sharing request to be considered.
Related Member Guidelines
Preventive Sharing
*Official Member Guideline
Zion HealthShare shares specific preventive services with the Direct Membership or with the additional Preventive Sharing service added to the Essential Membership for six (6) months. Preventive sharing is not subject to the IUA. Members should take advantage of the Medical Advocacy service as it is a complimentary resource to help them locate low-cost facilities.
Zion HealthShare references the following resources regarding preventive sharing:
- US Preventive Services Task Force
- American Cancer Society
- Centers for Disease Control (CDC) and Prevention Guidelines
- American Academy of Pediatrics
- American Academy of Family Physicians
See the Preventive Medical Sharing Guide for more details.
Service |
Waiting Period |
Sharing Limit |
| Annual Provider Visit | None | $175 |
| Colorectal Cancer Screenings | Six Months | $500-$5,000 |
| Mammograms | Six Months | $600 |
| Youth Immunizations (0-18 years) | None to Six Months | See Below |
| Well Child Visits (0-3 years) | None to Six Months | See Below |
Annual Provider Visit
*Official Member Guideline
Sharing for an annual provider visit is available upon membership start date and every twelve (12) months from the eligible visit date. Sharing is limited to the services provided during the office visit only, up to $175.
Cervical cancer screenings are considered eligible for sharing only when performed during the annual provider visit. Prostate cancer screenings by blood tests for prostate specific antigen (PSA) are considered eligible for sharing only when ordered or drawn during the annual provider visit and after fifty (50) years of age. If a follow-up is requested for either, it will require a separate sharing request and subsequent IUA.
Please note: Emergency room or urgent care visits are not eligible for sharing as an Annual Provider Visit.
Sharing for an annual provider visit is available upon membership start date and every twelve (12) months from the eligible visit date. Sharing is limited to the services provided during the office visit only, up to $175.
The annual provider visit can be used for:
- Sick/Specialist/Preventive visit
- Dental
- Vision
- Mental Health
What is eligible for sharing?
- The office visit/exam/consultation charge.
- Additional services that occur on the same day as the office visit charge and are ordered at the APV.
- Routine cervical cancer screenings are considered eligible for sharing only when performed during the annual provider visit. *
- Prostate cancer screenings by blood tests for prostate specific antigen (PSA) are considered eligible for sharing only when ordered or drawn during the annual provider visit and after fifty (50) years of age. *
*If a follow-up is requested for either, it will require a separate sharing request and subsequent IUA.
What is not eligible for sharing?
- Any services (including labs) performed without an office visit/exam/consultation charge or on a separate date of service.
- Any additional services (including labs) or charges remaining once the $175 sharing limit has been met.
- Pelvic exams as a cervical cancer screening.
- Adult immunizations.
- Urgent care and emergency room visits.
- Membership fees.
Colorectal Cancer Screenings
*Official Member Guideline
Sharing for a colorectal cancer screening is available every ten (10) years beginning at the age of forty-five (45) and after six (6) months of a continuous membership that includes the Preventive Services additional service.
Sharing is limited to $5,000 for the screening colonoscopy, anesthesia, diagnostic testing, biopsies, and pathology performed as a part of the screening. Any additional costs, services, or follow-ups will be the member’s responsibility. For high-risk members under forty-five (45), this service may be eligible for sharing with prior written approval from Zion HealthShare.
Home colorectal cancer screening tests such as high sensitivity gFOBT (guaiac fecal occult blood test), FIT (fecal immunochemical test), and sDNA-FIT (stool DNA with fecal immunochemical test) are eligible for sharing beginning at the age of 45 and after six (6) months of continuous membership with preventive services. gFOBT and FIT are eligible for sharing once every twelve (12) months; sDNA-FIT is eligible for sharing once every three (3) years up to $500 for the test.
Any additional testing resulting from a home colorectal cancer screening test, including a colonoscopy, will require a separate sharing request and is subject to the IUA.
All other colorectal cancer screenings are ineligible for sharing as a preventive service but may be considered for sharing as a separate sharing request dependent upon the reason and only with prior written approval from Zion HealthShare. All non-preventive colorectal cancer screenings are subject to the IUA.
What is eligible for sharing?
- Colonoscopy*
- The screening colonoscopy procedure
- Related anesthesia
- Facility/physician costs on the date of the procedure
- Testing, including biopsies and pathology, if collected on the date of the procedure
- Costs for the at-home screening kit
What is not eligible for sharing?
- Services that did not take place on the date of the procedure.
- Diagnostic colonoscopies and testing.
- EKG’s on dates of service prior to the procedure.
- Screening upper endoscopies.
- Preparatory medications.
*If additional or follow up procedures are needed, it will require a separate sharing request and subsequent IUA.
Mammograms
*Official Member Guideline
Sharing for a mammogram is available after six (6) months of a continuous membership that includes the Preventive Sharing additional service and every year beginning at the age of forty (40). Sharing is limited to $600 for a 2D or 3D mammogram. The exam, appointment, and evaluation of imaging performed as a part of the screening will count toward the $600 limit. Any extra services provided will be the member’s responsibility. For high-risk members under the age of forty (40) this service may be considered for sharing with prior written approval from Zion HealthShare.
If the finding of the screening mammogram is inconclusive and warrants an ultrasound ordered by a licensed medical provider, Zion HealthShare will consider sharing in the cost which will be included in the $600 sharing limit.
All other mammograms are ineligible for sharing as a preventive service but may be considered for sharing as a separate sharing request dependent upon the reason and only with prior written approval from Zion HealthShare. All non-preventive and diagnostic mammograms are subject to the IUA.
What is eligible for sharing?
- 2D/3D screening mammogram*
- The exam
- Imaging appointment
- Evaluation of the imaging
- If the screening is inconclusive or if the radiologist recommends an ultrasound due to dense breast tissue, the community may share into costs up to the $600 sharing limit. Any additional expenses over the sharing limit are the member’s responsibility.
What is not eligible for sharing?
- Ultrasounds in place of a 2D/3D screening.
- Thermograms in place of a 2D/3D screening.
- MRIs in place of a 2D/3D screening.
- Diagnostic mammograms.
*If an abnormality is found during the screening and additional testing or treatment is required, it will require a separate sharing request and subsequent IUA.
Youth Immunizations
*Official Member Guideline
Sharing for youth immunizations is available upon membership start date for members born in connection with an eligible maternity sharing request, and after six (6) months of a continuous membership that includes the Preventive Services additional feature for all other members up to the age of eighteen (18).
Zion HealthShare may share up to the CDC price list in effect at the time of the eligible sharing request. Sharing is limited to the immunizations outlined below:
- HPV (Human Papilloma Virus)
- Men (Meningococcal)
- PCV (Pneumococcal)
- RV (Rotavirus Immunization)
- IPV (Inactivated Polio Immunization)
- HIB (Haemophilus Influenza Type B)
- Hep A (Hepatitis A)
- Hep B (Hepatitis B)
- VAR (Varicella)
- DTaP (Diphtheria, Tetanus, acellular pertussis)
- Tdap (Tetanus, Diphtheria, acellular pertussis)
- MMR (Measles, Mumps, Rubella)
Children born from an eligible Maternity sharing request, were added to the membership within 30 days from their date of birth and have had Preventive Sharing active on the household membership for at least six (6) months before their birth have no waiting period.
Children who are not born from an eligible Maternity sharing request, were added to the membership past 30 days from their birth date, or the household membership has not had six (6) months of continuous active Preventive Sharing on the household membership, will have a 6-month waiting period.
What is eligible for sharing?
- The immunization administration fees
- HPV (Human Papilloma Virus)
- Men (Meningococcal)
- PCV (Pneumococcal)
- RV (Rotavirus Immunization)
- IPV (Inactivated Polio Immunization)
- HIB (Haemophilus Influenza Type B)
- Hep A (Hepatitis A)
- Hep B (Hepatitis B)
- VAR (Varicella)
- DTaP (Diphtheria, Tetanus, acellular pertussis)
- Tdap (Tetanus, Diphtheria, acellular pertussis)
- MMR (Measles, Mumps, Rubella)
What is not eligible for sharing?
- Immunizations that are not listed above.
Well Child Visits
*Official Member Guideline
Sharing for well child visits is available upon membership start date for members born in connection with an eligible maternity sharing request and after six (6) months of a continuous membership that includes the Preventive Services additional feature for all other members. Sharing is limited to $175 for the office visit costs, and associated immunizations are limited as outlined in the Youth Immunizations section.
Qualifying visits are for children at the following ages:
- Birth
- 1 Month
- 2 Months
- 4 Months
- 6 Months
- 9 Months
- 12 Months
- 15 Months
- 18 Months
- 24 Months
- 30 Months
- 36 Months
Children born from an eligible Maternity sharing request, were added to the membership within 30 days from their date of birth and have had Preventive Sharing active on the household membership for at least six (6) months before their birth have no waiting period.
Children who are not born from an eligible Maternity sharing request, were added to the membership past 30 days from their birth date, or the household membership has not had six (6) months of continuous active Preventive Sharing on the household membership, will have a 6-month waiting period.
What is eligible for sharing?
- The well child office visit charge up to $175.
- Additional services if they occur on the same day as the office visit, up to the visit sharing limit.
- Immunizations that are included on the approved Youth Immunizations section.Children have access to a single well child visit at each of the following ages:
- Birth
- 1 month visit
- 2 month visit
- 4 month visit
- 6 month visit
- 9 month visit
- 12 month visit
- 15 month visit
- 18 month visit
- 24 month visit
- 30 month visit
- 36 month visit
What is not eligible for sharing?
- Any services performed without an office visit/exam/consultation charge.
- Any additional services or charges once the $175 sharing limit has been met.
- Non-developmental physical visits (dentist, dermatology, sick visits, etc.)
- Immunizations that are not included on the approved Youth Immunizations section.
Member Guideline Notice
Notice
Please note all article sections formatted like this are official member guidelines and will be marked “*Official Member Guideline” when applicable. Anything else is simply helpful information to assist you in understanding the member guidelines and how to use your Zion HealthShare Membership.
Members who call the Zion HealthShare office asking about eligibility of medical expenses will be given an opinion, not a decision. Sharing Requests and medical expenses cannot be authorized over phone. For more information on submitting bills to Zion HealthShare, review the Member Guidelines or login to your Member Portal.
These guidelines are effective as of January 1, 2025.
Note
The Member Guidelines that go into effect January 1, 2025 will only be applicable to sharing requests that are submitted on or after that date. If a sharing request was submitted prior to January 1, 2025 the sharing request will be reviewed for sharing eligibility according to the Member Guidelines in effect at that time.