One of the most common questions asked is: “Why aren’t certain medical expenses eligible for sharing?” It is an important question, and understanding the answer helps clarify how Zion HealthShare works and how our community stays affordable and sustainable.
The Purpose of Sharing
Zion HealthShare exists to help members share the cost of unexpected and significant medical needs. Members contribute each month so funds are available when serious health events arise. This focus allows the community to support one another during life’s big health challenges, while keeping monthly contributions manageable.
Why Some Expenses Are Not Eligible for Sharing
Not every medical expense aligns with that purpose. Here is how the guidelines work and why certain costs remain the responsibility of the member.
- Routine or Preventive Care: Outside of the one annual provider visit available when Preventive is added to a membership, routine services such as checkups, dental cleanings, and vision exams are predictable and planned. Because these expenses are expected, they are considered personal responsibilities rather than eligible for sharing.
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Medical Expenses Below Your Initial Unshareable Amount (IUA): Each member agrees to an Initial Unshareable Amount when they join. This is the portion a member pays for each medical event before expenses become eligible for sharing.
- Important note: Once a family has met their IUA for three separate medical events within the same rolling year, the IUA no longer applies to additional medical events over $500 during that period.
- Elective or Cosmetic Procedures: Procedures done for appearance or convenience are not eligible for sharing because they are not medically necessary.
- Pre-Membership Conditions: Health conditions that existed before joining may have waiting periods or limitations. These guidelines help protect the community and keep sharing fair for all members.
- Lifestyle-Related Treatments Expenses tied to certain activities or choices, such as injuries resulting from illegal activities, may not be eligible for sharing because they fall outside community guidelines.
The Big Picture
Zion HealthShare is designed to share in large, unexpected medical needs, not every healthcare expense that may come up along the way. By setting clear guidelines around what is eligible for sharing, the community can remain affordable and available when members face serious or unplanned medical situations.
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 the 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, 2026.
Note
The Member Guidelines that go into effect January 1, 2026, 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, 2026, the sharing request will be reviewed for sharing eligibility according to the Member Guidelines in effect at that time.
Zion HealthShare is not an insurance company. Neither this publication nor membership in Zion HealthShare are offered by an insurance company. Visit ZionHealthShare.org to view your state-specific notice.