Pre-Existing Conditions And Provisional Membership

October 13th, 2014

Pre-existing conditions are medical conditions with symptoms, medication, or treatment in the past 36 months. Among the top three questions asked about Liberty HealthShare is this: "How do you handle pre-existing conditions?"

First, Liberty HealthShare accepts members who have pre-existing conditions. However, we limit sharing in those conditions over a three year period. In the first year of membership costs associated with the pre-existing condition are not eligible for sharing for that condition only. During the second and third years of membership, the pre-existing condition is eligible to share up to $50,000. Starting with the 37th month of membership, the pre-existing status may be removed.

Second, Liberty HealthShare deliberately helps people change their chronic health conditions through its provisional program. The Provisional Program is for those pre-existing conditions particularly responsive to lifestyle changes. Conditions like type II diabetes, hypertension, heart disease, obesity, or smoking are examples. Each member's medical history questionnaire is evaluated by Liberty’s Health & Wellness Director, Sue Rohr, R.N., and her team. Sue speaks with prospective members to discuss enrolling them in the provisional program.

With each provisional member's consent and agreement, Sue custom designs specific nutritional and exercise plans to help them live healthier. Sue says, “The health coaches are just the tools for the program. It’s the members that make the program a success; it’s their strength, dedication, and determination to become healthier.” There is an $80 per month fee for provisional members. Many Liberty HealthShare members have reached their health goals and have subsequently had their provisional fees dropped.

Liberty HealthShare’s provisional program is working. Liberty HealthShare Executive Director Dale Bellis states, “The provisional program is close to my own heart. Several years ago, I did not qualify for our regular program as I was overweight, had out-of-control diabetes, and smoked cigars."

Bellis continued, "However, after a talk with my doctor one day, I had a "man in the mirror" moment and decided to make a life change. I threw away my cigars, went on a diet, and started to exercise.”

Dale joined a local Cross Fit Gym and turned to Sue Rohr for monitoring. She assessed his medical condition and mapped out a plan which included a low-fat, low-carbohydrate diet, along with an exercise program and regular monitoring.

Dale lost 60 pounds, brought his blood sugar levels to a pre-diabetic range, and worked his way to the first leg of the Akron Marathon!

Liberty HealthShare wellness coaches speak with provisional members on a scheduled basis to see how things are going and whether they have encountered any obstacles with regard to their wellness goals. “I e-mail members menus and speak with them regularly. In fact, some members plan their schedules around my weekly calls," says Sue.

It is clear that taking care of our bodies requires work and accountability. Our health is a precious gift from God that must be treated respectfully. It is our spiritual and ethical responsibility to take responsibility for our health. For those reasons, Liberty HealthShare encourages members to be health-conscious, to eat right and exercies, and to make other healthy choices to maintain their health.

Tags:
healthtrachealth-and-wellnesspersonal-responsibility