Starting on your health coverage journey is confusing. The traditional health insurance field is growing complex and expensive. Hence, many people are opting for health share plans. Once you are a member of a health-sharing program, you become a part of a unique system where individuals pool their resources to help pay each other’s medical expenses. However, to use the membership in the best way possible, it is important that you understand how health shares function. So here are five key aspects of health share programs you need to understand thoroughly.
What is the Health Share Program?
Starting with the basics, health share plans are very different from a traditional insurance plan. It is a collaborative approach to handling health costs, where each member contributes a monthly amount to a common pool. This amount goes towards paying eligible medical expenses for a member within the community.
The health-sharing model thrives on shared beliefs, mutual support, and common values. This makes it community-driven rather than purely financial alliance. For medical expenses to be considered shareable, it is important that members pay the monthly contribution in a timely manner.
Health Share Plans are Not Health Insurance
Health share plans, unlike traditional insurance, are cooperatives. They are often faith-based, with members agreeing to cover a certain portion of each other’s medical costs. There are key legal and practical differences between health shares and health insurance. Also, many states exempt health-share plans from laws and regulations that govern health insurance.
A major difference between the two types of health coverage options is that health-share plans are allowed to come up with their own processes for distributing money to members who file for claims. Some plans do not cover wellness visits, preventative care, and dental or vision medical costs. These programs have an annual unshared amount similar to the deductible in a traditional health insurance plan.
Know the Guidelines
You need to dive deeper into the health care plan in order to get familiar with the guidelines and responsibilities. Every health care plan has its own guidebook regarding the sharing request submissions, eligible expenses, and reimbursement protocols. When going through your health share plan’s guidelines, make sure you go:
- Pre-share amount: This is the amount you pay out-of-pocket before the expenses become shareable with the community.
- Eligible expenses: Understand the spectrum of medical costs that are considered shareable, from preventive care to major procedures. Federal and state laws require insurance companies to accept customers with preexisting medical conditions and prevent insurers from charging those customers higher premiums. Since health-share plans aren’t insurance, they aren’t subject to these requirements. One of the more popular health-share plans doesn’t cover pre existing conditions until the member has paid into the cooperative for three years.
- Provider networks: Most eHealth share programs do not restrict the members to a provider network. However, some may require that you visit the providers in a preferred network. But they will still share if you go out-of-network but at a reduced rate.
The medical costs for common pre-existing conditions can be astonishing. It is important that you pay attention to this aspect of your health-sharing program since not all programs cover preexisting conditions.
Focus on Healthy Lifestyle
As a health share plan member, you agree to live a healthy lifestyle. You can ward off significant health issues by engaging in regular activities. Health share programs have started offering preventative sharing nowadays, which allows the cost-sharing for services like preventative screenings and annual checkups.
These preventative services will be beneficial for both your well-being and your budget. Health share programs encourage members to lead a healthy lifestyle. They have a proactive approach towards healthcare, which aims to prevent diseases before they start or catch them in the more treatable stages.
Sharing Request Process
Dealing with medical bills can be intimidating. However, understanding how to manage it is a critical part of your health share membership. So make sure that you review the bills for accuracy and adhere to the health share plan’s submission guidelines. Maintain organized records of your medical interactions to simplify the sharing process and leverage your membership effectively.
In case the plan has a reimbursement protocol, they will expect you to pay your medical bill and submit a request to be reimbursed. Most of these plans will have step-by-step instructions. So make sure you take some time to read the fine print to ensure that you are submitting the request properly.
Engage With Your Community
The community forms the essence of health-sharing plans. Remember, you are more than just a member. You are part of a collective that runs on mutual support. Many health-sharing programs extend beyond the financial assistance and offer resources like prayer networks and counseling. Connecting with fellow members can enhance the support you receive.
Bottom Line
Getting a grip on the basis of your health-sharing programs is key to maximizing the benefits you receive. Understanding the guidelines, adeptly handling medical expenses, and maintaining a healthy lifestyle while also engaging with the community will ensure that you get the best from your health-sharing journey.
