Understanding Pre-Membership Medical Conditions
*Official Member Guideline
To keep membership contributions low for all members, we implement a waiting period for sharing of medical conditions that existed prior to a member’s membership start date. We call such medical conditions: pre-membership medical conditions. This section defines pre-membership medical conditions and outlines related sharing limitations.
Definition of a Pre-Membership Medical Condition
A pre-membership medical condition is anything for which a member has
- been examined,
- been diagnosed,
- taken medication,
- had symptoms, or
- received medical treatment
within the 24 months prior to their membership start date. Sharing requests related to pre-membership medical conditions are only shareable if the condition was regarded as cured and did not require treatment or present symptoms for 24 months prior to the membership start date.
Pre-Membership Medical Condition Phase-In Period
Pre-membership medical conditions have a phase-in period wherein sharing is limited. Starting from the membership start date, there is a one-year waiting period before pre-membership medical conditions are shareable. After the waiting period, the shareable amount increases with each membership year.
Shareable amounts for pre-membership medical conditions:
- Year One: $0 (waiting period)
- Year Two: $25,000 maximum per sharing request
- Year Three: $50,000 maximum per sharing request
- Year Four: $125,000 maximum per sharing request
After four years of membership, expenses related to pre-membership medical conditions will be shareable up to a maximum of $125,000 in a 12-month period. The shareable maximum resets each membership year.
Exceptions for High Blood Pressure, High Cholesterol, & Diabetes
High blood pressure, high cholesterol, and diabetes (types 1 and 2) are not considered pre-membership medical conditions as long as
- the member has not been hospitalized for the condition in the 12 months prior to joining, and
- the member is able to control the condition through medication or diet.
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.