*Official Member Guideline
Zion HealthShare offers different membership options for individuals and families. Monthly contributions are based on the membership type (Direct or Essential), age group, and initial unshareable amount (IUA).
Determination of Household Membership
There are four membership tiers, differentiated by the number of members taking part in the household membership.
- Member Only: An individual member
- Member & Spouse: Two married members or two members in a domestic partnership
- Member & Child(ren): A member and any eligible children, without membership of a spouse or domestic partner
- Member & Family: A member, spouse or domestic partner, and any children
Spouse/Domestic Partner
Domestic Partner is an unrelated and unmarried person who shares common living quarters with a Primary Member and lives in a relationship that is not legally defined as marriage by the state in which the member resides. A spouse is a significant other in a state-defined marriage. In certain contexts, it can also apply to a civil union or common-law marriage.
Child(ren)
An unmarried child under twenty-six (26) years of age, and any child born into a membership in connection with an eligible maternity sharing request, may participate under a household membership with the Primary Member. The Primary Member is responsible for ensuring that each individual participating under the household membership complies with the Member Guidelines and Principles of Membership.
When a child turns twenty-six (26) or marries, they can no longer participate under the household membership. To ensure a continuous membership, the child must complete an application form within thirty (30) days after being withdrawn from their previous household membership.
Children who age out of a membership and choose to re-join after the 30-day time limit, will be subject to the sharing limitations for pre-membership medical conditions. Any sharing requests that occur between the time a child is withdrawn from their previous membership and beginning their own are not shareable.
Newborns
Newborns whose birth is related to an eligible maternity sharing request must be added to the household membership by the parent within 30 days of birth. In the case of a membership tier change, the monthly contribution amount will automatically be adjusted for the next contribution. If the parent does not sign-up their newborn within 30 days, any conditions present at birth or that occur before the child’s membership start date will be considered pre-membership medical conditions.
If a parent wishes to add a newborn who was not born in connection with an eligible maternity sharing request, the parent must submit a membership application form for the baby. The newborn’s membership start date can be no sooner than seven days after delivery.
Any genetic conditions or complications for newborns not born in connection with an eligible maternity sharing request are considered pre-membership medical conditions and subject to the same limitations as defined in the Pre-Membership Medical Conditions section.
Adoption
Zion HealthShare considers adopted children the same as biological children. Any physical conditions the adoptive parents are aware of prior to the legal adoption of the child are considered pre-membership medical conditions and are subject to the sharing limitations and phase-in period as defined in the Pre-membership Medical Conditions section. Adopted children cannot be added to a Zion HealthShare membership prior to birth.
Grandchildren
A grandchild (or grandchildren) may be included as part of their grandparent’s membership under the following criteria:
- The grandparent has legal custody of the grandchild.
- The grandchild lives with their grandparents at least nine months out of the year.
- There is no other group, agency, or person responsible for the grandchild’s medical needs.
Tobacco Users
Zion HealthShare members, or households with one or more tobacco users, are required to contribute a higher monthly contribution to maintain membership. The monthly tobacco surcharge is $50 per household.
A member, or one or more members within a household, who has used any tobacco product one or more times within the past year is considered a tobacco user. Tobacco products include, but are not limited to, cigarettes, cigars, chewing tobacco, snuff, pipe tobacco, and inhaled products through vape, hookah, and similar delivery devices. Smoked cannabis products are considered tobacco for the purposes of the tobacco surcharge.
If the household tobacco user(s) have not used tobacco products for over twelve (12) months, the tobacco surcharge may be removed by providing supporting documentation from the treating licensed medical provider to Zion HealthShare. However, the sharing limit will remain.
Please refer to the Tobacco Use Over 50 section.
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.