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

  • Physical therapy and home health care for each related medical incident

  • Total bills incurred per incident over the Single, Couple or Family Annual Preshare Amount*

  • Care for medical emergencies

  • Chiropractic Care

These are the kinds of expenses we do not share (not limited to those below) :

  • 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 Preshare Amount*

  • Abortions, Contraceptives, Sex Changes

  • Cosmetic Procedures which are not medically necessary

  • Gastric Bypass/Sleeve or other types of bariatric/weight loss surgeries

See Sharing Guidelines for a complete list of shared and unshared costs.

*A medical expense eligible for sharing must exceed an accumulative Annual Preshare Amount which is $500 for a single, $1,000 for a couple and $1,500 for a family.  It is calculated on each member’s initial effective date and renews annually.