Preventive Services

 

Preventive Sharing

Preventive Sharing is included automatically in the Direct Membership and can be added to any Essential Membership. The Preventive Sharing feature was created to help you stay on top of your health with Annual Provider Visits (APV), child wellness exams, youth immunizations, and early detection procedures. We encourage all members to attend their annual provider visit and participate in applicable cancer screenings.

Although Zion HealthShare generally shares in expenses related to acute, unexpected medical events, we encourage our members to take proactive measures for good health. Our Preventive Sharing feature shares in certain preventive services to help you and your family stay healthy. Preventive Sharing is included in the Direct Membership and is available to Essential Members who choose to add Preventive Sharing to their membership. Preventive services do not require you to meet your IUA.

*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. 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
 

 

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 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 shareable visit date. Sharing is limited to the services provided during the office visit only, up to $175. 

Cervical cancer screenings are considered shareable only when performed during the annual provider visit. Prostate exams are considered shareable only when performed 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.

 

 

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 shareable 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 shareable beginning at the age of 45 and after six (6) months of continuous membership with preventive services. gFOBT and FIT are shareable once every twelve (12) months; sDNA-FIT is shareable 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 not shareable 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 additional 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 not shareable 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

Please see the Youth Immunization Guide below for more information.

*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 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

Please see the Youth Immunization Guide below for more information.

*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 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.