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.
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.
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.
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)
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
- 30 Months
- 36 Months
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.