Submit your Sharing Request
Sharing requests can be conveniently submitted in your Member Portal. Sharing requests must be submitted within six months of the date of service; however, the sooner you submit a sharing request, the easier it is for Zion HealthShare to process and have the community share in your medical costs. For non-emergency medical services, especially surgeries, we recommend you contact Zion HealthShare or submit your sharing request before the date(s) of service.
To determine sharing eligibility, Zion HealthShare needs you to provide specific information as part of your sharing request. Be sure to complete as much of the sharing request form as possible and attach all relevant documents—including itemized bills and any relevant medical documents.
Review The Member Guidelines
The Member Guidelines explain the types of medical expenses that are shareable with the Zion HealthShare Community and the types that are not. Reviewing the Member Guidelines is the easiest way to determine whether your medical need will be eligible for sharing or if it is your responsibility as a member.
We specifically recommend that you review Pre-Membership Medical Conditions, Medical Expenses Eligible for Sharing, and Medical Expenses Ineligible for Sharing.
Medical Advocacy
Present as Self-Pay Patient & Get Itemized Bills
If you have insurance…
you must disclose any insurance coverage to Zion HealthShare when you submit your Sharing Request.
If you do not have insurance…
tell your provider that you are a self-pay patient, and you need itemized bills with self-pay discounts.
Pay your IUA
The Zion HealthShare Community cannot share in a member’s medical expenses until their IUA has been met.
You can meet your IUA by paying your medical bills directly to your provider and submitting receipts to Zion HealthShare. When you do, ask for itemized bills for all costs. Submit these bills to your Member Portal so that we can confirm your IUA payment and begin the sharing process.
To make the process easier, you may pay your IUA directly to Zion HealthShare so that sharing for eligible medical expenses can begin right away. The IUA must be paid within six months of the date of service, or the medical expenses may become ineligible for sharing.
Sign a HIPAA Release Form and Work With Your Provider
To make an eligibility determination, Zion HeathShare may require medical records and other documents from your provider, as well as itemized bills for your shareable expenses. In order to receive medical records efficiently, there is a HIPAA Authorization Form you may need to sign so we can request your medical records for you. A HIPAA release also allows us to communicate with your providers to ensure a smoother sharing process. Please provide Zion HealthShare with your HIPAA release form as soon as possible and work with your provider so we can access the documents we need to share into your eligible medical expenses.
Related Member Guidelines
*Official Member Guideline
Sharing Requests
Sharing requests are submitted on a per member, per medical need basis. A medical need is the reason for which a member submits a sharing request. This includes, but is not limited to, preventive visits, maternity, an accident, or a serious medical incident. Each medical need may result in medical expenses incurred by receiving medically necessary treatment from licensed medical professionals and facilities, such as physicians, emergency rooms, and hospital facilities.
When a member has a medical expense to be shared, the member must submit a sharing request. Once their sharing request is open, the member must submit original, itemized bills for the medical expense within six months of treatment. Bills submitted more than six months after the date of service may be considered ineligible for sharing. There is no lifetime limit on the number of eligible expenses that may be shared.
Determination of a Sharing Request
Expenses related to the same medical need, whether expenses for a single incident or separate incidents, will be shared as one sharing request.
Maximum Shareable Amount
There is no annual or lifetime maximum for any member or membership household. However, some expenses may be subject to limitations according to these Member Guidelines.
Insurance, Third-Party Administrators, & Government Assistance Plans
In the event that a Zion HealthShare member is also covered by any relevant insurers, third-party administrators, or government assistance plans, and a medical need arises, the member’s insurance, third-party administrator, or government assistance plan shall be primarily responsible for the payment of the member’s medical expenses.
Members must submit a sharing request within six months of the medical need informing Zion HealthShare of their coverage by insurance, third-party administrator, or government assistance plan, upon which the insurance, third-party administrator, or government assistance plan will be primarily responsible for the payment of the member’s medical expenses. Upon final payment by the primary insurance, third-party administrator, or government assistance plan, Zion HealthShare will review remaining expenses for eligibility for sharing.
Failure to disclose coverage with an insurance, third-party administrator, or government assistance plan may result in ineligibility for sharing. This includes, but is not limited to, any form of coverage through a non-member spouse, family member, employer, or government entity. If you have primary insurance coverage, Zion HealthShare will be the secondary payor, and some expenses not covered by insurance may be shareable.
Exceptions may be made for maternity sharing requests. Contact Zion HealthShare prior to your provider visit.
Appeals
If a member believes that a sharing limitation was incorrectly placed or a determination of not shareable was provided on their sharing request, they may submit an appeal. Members may submit an appeal only if their membership remains active throughout the appeals process. All appeals are reviewed by a committee, which includes at least one Zion HealthShare board member, as well as trained medical professionals. All appeals results are final and may not be appealed again.
Appeal requests must be submitted within thirty (30) days of the sharing request determination and must be submitted by the member, not the member’s providers. Zion HealthShare may request additional information from providers if needed.
To file an appeal, send the medical evidence, a written explanation, and any other supporting documentation to determinations@zionhealthshare.org.
*Official Member Guideline
Submission of Sharing Requests
We strive to share medical expenses in a timely, accurate manner. To do this, it is crucial for members to submit sharing requests correctly and include all required documentation.
Submitting a Sharing Request
Sharing requests should be submitted through the Member Portal, as soon as possible. Most nonemergency sharing requests, such as surgical procedures, should be submitted prior to the date of service.
Members may contact Zion HealthShare directly during business hours for help with this process.
Contact the Member Care team:
888-920-9466
member@zionhealthshare.org
The Medical Advocacy service is complimentary to all Zion HealthShare members. Our team of experts is here to help members find providers and facilities. We can help members obtain self-pay discounts and pay ahead of time for eligible expenses.
Contact the Medical Advocacy team:
888-399-0017
advocacy@zionhealthshare.org
Required Documentation & Time Limit for Providing Documentation
In order to be eligible for sharing, sharing requests and each itemized bill and statement must be submitted within six months of the date of service. The IUA must also be paid within six months to be considered for sharing. When submitting a sharing request, members should submit any documentation received from their provider. Zion HealthShare may request additional documents that may be required throughout the sharing request process. Document types can include, but are not limited to, receipts, proofs of payment, itemized bills and statements.
Original, itemized bills and statements should be submitted promptly to Zion HealthShare along with the sharing request form for us to process the sharing request as soon as possible.
Please reference all applicable guidelines to determine if there are other document requirements or time limits.
Meeting the IUA
Medical expenses are only shareable after members have met their IUA. Members should provide documentation to Zion HealthShare of all payments that may contribute toward the member’s IUA.
The IUA must be paid within six months of the date of service or bills may become ineligible for sharing. Consideration will be given for situations where the cost of treatment has not exceeded the IUA after six months for certain sharing requests. Members must communicate with their Member Needs team representative about a timeline for IUA payment.
Aging Out at 65
Medical incidents that occur within thirty (30) days of the members scheduled age-out at sixty-five (65), will have up to thirty (30) days after their membership end date to submit a sharing request. All other time limits will remain in effect including:
- itemized bills and statements must be submitted within six (6) months of the date of service, and
- the IUA must be paid within six (6) months of the date of service, or they become ineligible for sharing.
Medical Records Addendums
Medical Records may be requested to assist with the determination of a sharing request. After the requested medical records have been reviewed and a determination is made, medical record addendums will not be considered unless they are combined with an official addendum from the applicable provider. The addendum must be separate and include the following:
- signature from the applicable provider,
- date,
- description of what was changed, and
- reason for change.
Paying at the Time of Service
Zion HealthShare is not insurance, so members should tell their provider they are an uninsured, self-pay patient. That way, members can obtain self-pay discounts on services, which allows us to keep membership contributions low. Members should obtain itemized bills and receipts to request payment or reimbursement from Zion HealthShare. In some cases, prepayment may be an option.
Contact our Medical Advocacy team before receiving medical treatment for prompt payment at the time of service.
Requesting Discounts
Members have options for sharing prior to, at the time of, or after medical services are rendered. For all purposes, members should present as self-pay patients and communicate costs and discounts as soon as possible to Zion HealthShare.
Sharing Request FAQ
What costs are eligible for sharing as part of a single sharing request?
At Zion HealthShare, medical expenses resulting from an injury or illness may be eligible for sharing. To be eligible for sharing, treatment must be provided by a licensed medical professional and medically necessary. The Member Guidelines explain which costs are eligible for sharing with the Zion HealthShare community.
Expenses related to the same medical condition may be shared under a single sharing request. Eligible expenses paid toward treatment of this condition will accumulate toward the member’s initial unshareable amount (IUA).
What should I expect after submitting my sharing request?
Once your request is submitted, you should expect the following:
- A confirmation email with any additional instructions from Zion HealthShare.
- In order to receive medical records efficiently, you may need to sign a HIPAA Authorization Form so we can request your medical records.
- The determination of sharing eligibility for your sharing request within the Zion HealthShare community.
- If determined eligible for sharing, you will receive email updates about status changes, provider payments, reimbursements, and/or any missing information.
How do I get the lowest possible price if my medical expenses do not exceed my IUA?
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 schedule payment arrangements in advance. You may contact them at 888-399-0017 or email advocacy@zionhealthshare.org for assistance.
Learn more about how insurance may affect your sharing request.
What documentation do I need before submitting my sharing request?
You may open a Sharing Request without any documentation. However, please submit related documentation as soon as possible through your member portal. Zion HealthShare may request other documentation that may be required throughout the sharing request process. Document types can include payment receipts, bills, medical records, treatment plans, and itemized statements.
How long does it take Zion HealthShare to share in my medical expenses?
Our highest priority is to process your sharing requests quickly. To expedite the process, please check the status of your sharing request frequently through your Member Portal for updates and additional documentation requests.
How do I submit a sharing request if I signed up for Zion HealthShare through an affiliate or my company?
Regardless of how you join Zion HealthShare, whether you joined through our website, through an affiliate, or through a company, all sharing requests must be submitted through your Member Portal. For assistance in accessing your Member Portal, please call Member Care at (888) 920-9466.
How do I submit a sharing request if I have traditional insurance as well?
Members must submit a sharing request within six months of any medical need. At the time of submitting your sharing request, please inform Zion HealthShare of any additional coverage (which may include health insurance, third-party administrator, or government assistance plans). Your insurance provider, or the responsible parties' insurance provider, will be primarily responsible for the payment of your medical expenses. Upon final payment by the primary insurance, Zion HealthShare will review the remaining expenses for eligibility for sharing. Please make sure that you submit a sharing request and all subsequent medical bills/statements through your Member Portal within six months of any medical need.
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 May 1, 2024.
Note
The Member Guidelines that go into effect May 1, 2024 will only be applicable to sharing requests that are submitted on or after that date. If a sharing request was submitted prior to May 1, 2024 the sharing request will be reviewed for sharing eligibility according to the Member Guidelines in effect at that time.