A. Annual Household Portion (AHP)
The Annual Household Portion (AHP) is the dollar amount that a Member Household agrees to pay toward Eligible Medical Bills before any eligible bills may be shared among the Members. The AHP amount resets every 12 months on the Effective Date. Even if the AHP is not yet met, providers should still submit all medical bills to Medi-Share for processing. This ensures all Eligible Medical Bills will be applied toward the AHP and allows for the possibility of discounts.
Co-Share Option (not available for new members as of May 1, 2024): For those Members who elected the co-share option before May 1, 2024 and are participating at the 3,000, 6,000, or 9,000 AHP level, once the AHP has been met, the Member Household will be responsible for an additional 30% of their eligible medical bills until the maximum annual co-share responsibility (see chart on next page) has been met. This includes the original AHP. Provider fees are not applied to the AHP or the co-share responsibility.
For Example: A Member with a 3,000 AHP with co-share option who incurs a $100,000 eligible medical event, will pay $3,000 toward their AHP and an additional $7,000 (30% of eligible medical bills) in co-share responsibility. Once the maximum co-share responsibility of $10,000 (AHP + co-share) has been met, remaining eligible medical bills will be shared at 100%.
DPC Option: Members on the 12,000 AHP can elect the Direct Primary Care (DPC) option. DPC membership fees are eligible for sharing for members on the 12,000 AHP level with DPC option. DPC membership fees will be applied to the AHP and are eligible for sharing up to $1,800 per family, per AHP year. Members who select this option will utilize their DPC provider for annual physicals, clinical, and laboratory services in lieu of submitting those bills for sharing.
“Medi-Share brought a personal peace, that brought comfort and support to us.”
The Sullivans
Medi-Share Member
Co-Share is not available for new members, or current members wishing to switch into a co-share option as of May 1, 2024.
| Annual Household Portion (AHP) Program Level | Co-Share | Max Responsibility for Eligible Medical Bills |
|---|---|---|
| $3,000 | 0 | $3,000 |
| $3,000 w/Co-Share | 30% | $10,000 ($3,000 AHP + 30% Co-Share until $7,000) |
| $6,000 | 0 | $6,000 |
| $6,000 w/Co-Share | 30% | $10,000 ($6,000 AHP + 30% Co-Share until $4,000) |
| $9,000 | 0 | $9,000 |
| $9,000 w/Co-Share | 0 | $12,000 ($9,000 AHP + 30% Co-Share until $3,000) |
| $12,000 | 0 | $12,000 |
| $12,000 w/DPC | 0 | $12,000 ($12,000 AHP – Direct Primary Care Fees up to $1,800 can be applied to AHP) |
*Provider Fees apply to every visit, even if AHP or maximum co-share responsibility have been met, and do not count towards AHP or co-share.
B. Changing Annual Household Portion
Members may change their AHP amount. See chart below for conditions:
| AHP resets to $0 with every AHP level change | When can a Member change AHP levels? | When does the new AHP level go into effect? |
|---|---|---|
| Changing from LOWER AHP to HIGHER AHP | Anytime, unless pregnant | Effective the 1st of the next month* |
| Changing from HIGHER AHP to LOWER AHP | One level of AHP at a time, unless pregnant | Effective the 1st of the 4th month following the request to change |
* When moving from a lower to higher AHP, the request must be made by the first of the month for an effective date of the following month. If the change is requested after the first, the effective date will be the first of the second month following the request
Bills will be processed according to the member’s AHP at the time the bills were incurred. Once the AHP change is made, the Effective Date changes to the date the new AHP begins. Any change in the AHP causes the amount of Eligible Medical Bills paid toward the AHP to reset to $0.
For example: On March 30 you are an active Member with a $3,000 AHP; you have incurred $1,000 toward your AHP and are approved for a lower AHP. On July 1 your lower AHP amount becomes effective. The amount of Eligible Medical Bills paid toward your new AHP now resets to $0 on July 1. However, the bills incurred prior to July 1 will continue to be applied towards the previous $3,000 AHP.
"Medi-Share has been one of the greatest blessings God has ever given us."
The Hughes
Medi-Share Member
C. Maximum Sharing Limits
Each Member enjoys sharing of his or her Eligible Medical Bills with no annual or lifetime limit. There are some exceptions for pre-existing conditions (Section VI. F.), maternity (Section VII.), motorcycle events (Section IX. B.), and during the first month of membership (Section VI. B.).
D. Health Incentive
Medi-Share Members value a commitment to healthy living; therefore Members can be rewarded for their healthy choices, through a health incentive or in the form of a decreased monthly share. A Member Household (Head of Household and spouse) must apply as individuals and meet the criteria of certain health standards annually. Instructions and criteria can be found at MediShare.com/health-incentive. Active Health Partners are not eligible for the Health Incentive.
If a lifestyle-related condition (such as hypertension, type 2 diabetes, hypercholesterolemia, or fatty liver) is discovered during the active 12-month incentive period, Medi-Share may revoke the Health Incentive Discount.
E. Provider Fee
There is a provider fee for each office visit or hospital visit, and a fee for every emergency room visit. It is the Member’s responsibility to pay the applicable provider fee at time of service or upon being billed by the provider at a later time. The provider fee is an initial payment applied toward the total office visit charges. The provider fee does not count toward the AHP or the co-share responsibility and continues to be applied even after the AHP and the maximum co-share responsibility are met.