What Costs Do We Share?
Medical costs are shared on a per person, per incident basis, for illnesses or injuries incurring medical expenses when treated by physicians, urgent care facilities, clinics, emergency rooms, or hospitals (inpatient and outpatient).
Members share these kinds of costs:
- Inpatient or Outpatient hospital treatment or surgery for a medically diagnosed condition
- Doctor’s visits related to each medical incident
- Prescriptions 45 days before and after each related medical incident (Tier 4 perscriptions within 45 days after acute illness)
- Physical therapy and home health care for each related medical incident
- Total bills incurred per incident over the Single, Couple or Family Annual Unshared Amount*
Expenses we do not share together but not limited to:
- Pre-existing conditions for the first 12 months of participation
- Dental/Vision services or procedures
- Medical costs less than the Single, Couple or Family Annual Unshared Amount*
- Expenses other than accidents, acute illness or injury, are not eligible for sharing within the first 60 days of membership.
See Sharing Guidelines for complete list of shared and unshared costs.
*A medical expense eligible for sharing must exceed an Annual accumulative Unshared Amount which is $500 for a single, $1,000 for a couple, $1,500 for a family and is calculated upon each member's enrollment date until their next annual renewal date.