*Official Member Guideline

Sharing requests are submitted on a per member, per medical need basis. A medical need is the reason for which a member submits a sharing request. This includes, but is not limited to, preventive visits, maternity, an accident, or a serious medical incident. Each medical need may result in medical expenses incurred by receiving medically necessary treatment that is proven safe and effective from licensed medical professionals and facilities, such as physicians, emergency rooms, and hospital facilities.

When a member has a medical expense to be shared, the member must submit a sharing request. Once their sharing request is open, the member must submit original, itemized bills for the medical expense within six months of treatment. Bills submitted more than six months after the date of service may be considered ineligible for sharing. There is no lifetime limit on the number of eligible expenses that may be shared.

Determination of a Sharing Request

Expenses related to the same medical need, whether expenses for a single incident or separate incidents, will be shared as one sharing request. 

Maximum Shareable Amount

There is no annual or lifetime maximum for any member or membership household. However, some expenses may be subject to limitations according to these Member Guidelines. 

Insurance, Third-Party Administrators, & Government Assistance Plans

In the event that a Zion HealthShare member is also covered by any relevant insurers, third-party administrators, or government assistance plans, and a medical need arises, the member’s insurance, third-party administrator, or government assistance plan shall be primarily responsible for the payment of the member’s medical expenses. 

Members must submit a sharing request within six months of the medical need informing Zion HealthShare of their coverage by insurance, third-party administrator, or government assistance plan, upon which the insurance, third-party administrator, or government assistance plan will be primarily responsible for the payment of the member’s medical expenses. Upon final payment by the primary insurance, third-party administrator, or government assistance plan, Zion HealthShare will review remaining expenses for eligibility for sharing.

Failure to disclose coverage with an insurance, third-party administrator, or government assistance plan may result in ineligibility for sharing. This includes, but is not limited to, any form of coverage through a non-member spouse, family member, employer, or government entity. If you have primary insurance coverage, Zion HealthShare will be the secondary payor, and some expenses not covered by insurance may be shareable.

Exceptions may be made for maternity sharing requests. Contact Zion HealthShare prior to your provider visit.

Appeals

If a member believes that a sharing limitation was incorrectly placed or a determination of not shareable was provided on their sharing request, they may submit an appeal. Members may submit an appeal only if their membership remains active throughout the appeals process. All appeals are reviewed by a committee, which includes at least one Zion HealthShare board member, as well as trained medical professionals.  All appeals results are final and may not be appealed again.

Appeal requests must be submitted within thirty (30) days of the sharing request determination and must be submitted by the member, not the member’s providers. Zion HealthShare may request additional information from providers if needed.   

To file an appeal, send the medical evidence, a written explanation, and any other supporting documentation to determinations@zionhealthshare.org.