Congratulations!
We are so excited to share in this exciting and special time with you! The Member Guidelines explain what maternity services are eligible for sharing with the Zion HealthShare community. This Maternity Guide will help you understand how the community shares in your maternity services as well as your responsibilities as a member.
*Official Member Guideline
General
As with any other sharing request, expectant mothers pay a single IUA for all expenses related to their maternity sharing request. Shareable expenses may be related to miscarriage, prenatal care, postnatal care, and delivery.
The maternity sharing request must be submitted no later than six (6) months from the date of pregnancy confirmation. Sharing requests submitted after that date will be considered ineligible for sharing.
Once the maternity sharing request is open, submittal of original, itemized bills for the medical expense(s) must be within six months of service. Bills submitted more than six months after the date of service may be considered ineligible for sharing.
Waiting Period
Conception occurring prior to membership start date is ineligible for sharing. Pregnancy existing prior to membership is not shareable. The conception date will be confirmed by medical records. Members who purposely misrepresent their conception dates may be subject to membership revocation.
Newborns who are not born in connection with an eligible maternity sharing request may be added to a household membership by calling or emailing Zion HealthShare. The newborn’s membership start date can be no sooner than seven (7) days after delivery, if not born in connection with an eligible maternity sharing request. Any complications that the newborn may have, or any medical conditions present at birth, will be considered pre-membership medical conditions.
See the Pre-membership Medical Condition section for details.
What is Shareable
Prenatal
- Routine office visits
- Routine lab work
- Fetal non-stress test (after 36 weeks)
- Up to three standard ultrasounds (unless an unexpected complication requires additional scans)
- STD/STI screenings prescribed by a licensed practitioner as part of routine prenatal care
- Pelvic manipulation – only shareable if new onset of back and/or pelvic pain, after the 30th week, and with a total of 20 visits but no more than $2000, whichever occurs first. Exceptions will be considered for multiple births. Pelvic manipulation will no longer be shareable with the eligible maternity request after the date of delivery.
Delivery
- Ob-gyn labor and delivery
- Cesarean
- Multiple births
- Hospital labor and delivery
- Hospital room and board
- Anesthesiologist
- Legally practicing midwives - In order for midwifery costs to be shareable, an itemized breakdown of the services provided in their global package must be provided to Zion HealthShare before services are rendered. Not all midwifery services may be eligible for sharing.
- Home births
- Maternal fetal medical specialist consultations, when ordered by the medical provider managing the pregnancy.
- Birthing centers
- Charges related to unexpected complications for the mother
- One in-hospital pediatrician visit, including routine immunizations, routine lab work, and routine hearing tests (all shareable when the baby is added to the membership within 30 days of delivery and when these services occur prior to discharge from hospital)
Postnatal
- Mother’s six-week postpartum checkup with pap test
- Two-week cesarean post-op appointment
What is Unshareable
Prenatal
- 3D and 4D ultrasounds
- Most immunizations (such as flu shots)
- Non-prescription supplements
- Genetic testing/counseling, including but not limited to:
- Amniocentesis
- Inhibin A
- Alpha-Fetoprotein Serum (AFP)
- Any type of Nuchal Translucency (NT) ultrasound
- NIPT testing
- Services by companies providing genetic testing
- Chiropractic services for babies in breech positions
Delivery
- Doula services
- Birthing tubs (or other items related to midwife delivery)
- Placenta encapsulations
- Circumcision
- Diagnostic hearing screening (including evoked auditory tests, BAEP, ABR, or BAER)
Postnatal
- Breast pumps
- Lactation consultant
- Mother’s immunizations
- Postpartum counseling
- Additional postpartum services
Other services may be ineligible or eligible as determined by Zion HealthShare. If you have questions about a specific service, please contact Zion HealthShare prior to receiving care. All genetic testing will be the responsibility of the member.
Checkups for the baby after delivery are not part of the maternity sharing request. If the newborn has any complications, they would require a separate sharing request. All of the baby’s checkups and any complications are subject to eligibility determination based on the Member Guidelines.
Maternity IUA Payment
Please reference the Submission of Sharing Request guidelines.
Home Births
Home births typically incur fewer expenses. If the costs are significantly lower for a home birth than for a hospital birth and the member is under the care of a licensed care provider, Zion HealthShare may partially waive the IUA for a maternity sharing request.
Separate Sharing Requests
Any complication for the newborn occurring after birth, whether the complication existed before or after birth (including congenital conditions), is separate from the mother’s maternity sharing request and will require its own sharing request and IUA (in the event of a multiple birth, complications, each individual newborn will require their own sharing request and IUA).
Expenses for any pregnancy or birth-related complications of the mother are eligible for sharing as part of the maternity sharing request.
Premature Birth
A newborn’s eligible medical needs are considered shareable as part of an eligible maternity sharing request, even if the baby is born prematurely. Any services outside standard maternity and newborn care would be considered a separate medical need for the baby and will require a new sharing request submission and new IUA.
In Vitro Fertilization (IVF)
Expenses related to fertility treatments are ineligible for sharing. For pregnancies occurring by IVF or other non-traditional fertilization methods, Zion HealthShare defines date of conception as the date the fertilized embryo is implanted in the uterus.
Miscarriage
Any expenses related to a miscarriage that is associated with an eligible maternity sharing request are shareable if the costs exceed your IUA.
Expenses related to a miscarriage that is not associated with an eligible maternity sharing request are eligible under a regular sharing request.
Gestational Diabetes
Gestational diabetes is considered a complication of pregnancy, and members who develop this condition are encouraged to follow the recommendations of their treating providers.
Gestational diabetes is not considered insulin dependent. Therefore, costs of medications prescribed to treat gestational diabetes, including insulin, can be shared according to our prescription sharing guidelines.
Members are encouraged to seek counsel from their ob-gyn on dietary changes and exercise. Glucometers and test strips can be purchased at local pharmacies or online at reasonable costs. For these reasons, nutritionists, other therapists, and testing supplies are not shareable.
Maternity Checklist:
- Submit maternity sharing requests online through your Member Portal
- Schedule your first provider appointment
- Submit provider notes from your appointment to your Member Portal
- Submit bills/financial agreements/payment packages to your Member Portal
- Pay your IUA
- Submit your facility payment agreement to your Member Portal
- Deliver your baby at home, in a birth center, or at the hospital
- Add your newborn to your Zion HealthShare membership within 30 days of birth
- Submit any final medical bills to your Member Portal
What to do…
…when submitting your sharing request
You are encouraged to open a maternity sharing request as soon as you receive confirmation of your pregnancy. This allows for proper and timely processing of the bills associated with the shareable maternity services and avoids circumstances where medical services may become ineligible for sharing with the Zion HealthShare community. Maternity requests must be submitted through your Member Portal.
Please note that your maternity Sharing Request must be opened within six months of pregnancy confirmation to be considered for sharing.
...at your first provider appointment
- Request a record of the first OB visit and submit to maternity@zionhealthshare.org.
- If you do not have insurance, tell your provider you are not utilizing insurance and ask how the provider will work with you as a self-pay patient. If you have primary insurance, you must declare this when you submit your sharing request.
- Request a copy of the financial package or prepayment agreement with the provider that includes self-pay discounts. These packages include prenatal, delivery, and postpartum care. They may or may not include sonograms and bloodwork.
- Submit itemized bills and package/agreement documents to maternity@zionhealthshare.org.
…when you schedule the birth
If you do not have insurance, please contact the pre-registration department, let them know you are not utilizing insurance, and ask them how they will work with you as a self-pay patient. Request a written prepayment agreement and submit it to your Member Portal as soon as possible.
…when your baby is born
- Snuggle your new baby!
- Add your newborn to your Zion HealthShare membership within 30 days of delivery
- Gather all final medical bills and submit them to Zion HealthShare.
Prepayment Agreements
Prepayment agreements can be obtained from most OB/GYNs and hospitals or birthing centers. Obtaining a prepayment agreement allows Zion HealthShare to share your eligible maternity expenses ahead of time.
Prepay agreements with itemized statements must be submitted within six months of your pregnancy confirmation, but it is best to obtain these documents as soon as possible. The Zion HealthShare community cannot share in any medical expenses until you have paid your IUA.
OB/GYN
A prepayment agreement from your OB/GYN is also called a global package. It will usually include appointments, blood work, and labor and delivery charges.
Hospital
If you plan to give birth at a hospital, you will need a hospital prepayment agreement in addition to your OB/GYN prepayment agreement. In most cases, the Zion HealthShare community can share your delivery charges before the baby is born.
Submitting Bills
All submitted bills related to your maternity need request must include the following information:
- Patient/Member full name
- Date of service
- Place of service
- An itemized list of charges for each service
- Procedural (CPT) codes for each service (or a detailed description of services)
Maternity FAQs
How do I know if my maternity sharing request is eligible for sharing?
Any pregnancy that is conceived prior to membership is not eligible for sharing. Your conception date will be verified based on notes from your first provider appointment.
How will I know what bills are eligible for sharing?
Once Zion HealthShare receives the necessary paperwork and itemized invoices, we will review the bills to make sure they’re eligible for sharing according to our Member Guidelines and that there are no billing mistakes.
When will Zion HealthShare share my expenses?
Each member has an initial unshareable amount (IUA) that must be paid before your maternity sharing request becomes eligible for sharing. Your IUA was selected when you registered with Zion HealthShare.
What if my healthcare provider will only bill per visit?
If your OB/GYN will not provide you with a prepayment agreement, you must submit medical bills directly to Zion HealthShare. If you do not have insurance, inform your provider you are a self-pay patient to receive a fair rate.
How do I pay my IUA?
IUAs can be paid to your provider or directly to Zion HealthShare. If you pay your IUA to Zion HealthShare directly, it helps us account for payments more easily. Please contact us if you would like to pay your IUA directly. If you pay your IUA to your provider, you must submit copies of all payment receipts.
How long do I have to submit my medical bills?
Your sharing request must be opened within six (6) months of pregnancy confirmation. Bills must be submitted within six (6) months of service. Expenses that are submitted after this deadline are not eligible for sharing.
How do my providers receive payment?
Zion HealthShare can pay the provider directly or reimburse you for eligible expenses. If your provider has a set limit for reduced charges (seven months is common), notify Zion HealthShare as soon as possible.
What if I have complications with my pregnancy?
Please contact the Maternity Department and let us know and we will work with you.
What if my provider recommends that I see other providers?
Please contact the Maternity Department prior to your first visit with your additional provider so we can discuss what services are eligible for sharing. We may require medical confirmation and a letter of medical necessity from your provider for additional services to be eligible for sharing.
What if I have medical insurance alongside my Zion HealthShare membership?
If you have primary insurance, you must declare this when you submit your sharing request. Zion HealthShare can only share after your insurance has been exhausted.
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.