IV. Details of Sharing

A. Annual Household Portion

The Annual Household Portion (AHP) is $500 for all Medi-Share 65+ Members. The AHP is the dollar amount that a Member agrees to pay toward Eligible Medical Bills before any eligible bill may be shared among the Members. The AHP amount resets every 12 months on the Effective Date.

B. Maximum Sharing Limits

Each Member enjoys sharing of his or her Eligible Medical Bills with no annual or lifetime limit. There are exceptions for motorcycle events (section VI. A.)

C. Medicare Allowable and Approved Treatment

Because Medi-Share 65+ Members are enrolled in Medicare Parts A and B, sharing of Eligible Medical Bills will be secondary to Medicare. Once the AHP has been met, the portion of Eligible Medical Bills that Medicare has not paid (the difference between the Medicare allowable amount and the amount paid) will be approved for sharing, subject to the provisions of these Guidelines.

Medical bills will be eligible for sharing in those instances where Medicare Parts A and B have approved treatment, but do not pay all or part of the treatment, except for those conditions or services listed below in Sections IV. G. and H. This includes copayments, coinsurance, deductibles, and “excess charges or fees”, (as defined by Medicare). It is the Member’s responsibility to know what conditions and services are covered by Medicare. See www.medicare.gov or call 1 800 MEDICARE (1 800 633 4227) for more information.

D. Hospitalization Expenses

1. Copayments for hospitalization expenses from the 61st through the 90th day of any Medicare “benefit period” (as defined by Medicare).
2. Copayments for any hospital confinement beyond the 90th day in a “benefit period,” up to 60 days during the Member’s lifetime.
3. Medicare-eligible hospital charges for a period of up to 365 additional days during the Member’s lifetime after the Member has exhausted all Medicare hospital benefits.

E. Out of Country Urgent Care

Sharing for Members who are traveling out of the country or serving as missionaries outside of the United States will be limited to medically necessary urgent care as Medicare does not pay for medical care received outside of the United States. Eighty percent of the billed charges for out of country urgent care that Medicare would have paid if it was provided in the United States, up to a $150,000 lifetime maximum, will be eligible for sharing.

F. Blood

The cost of the first three pints of blood or equivalent quantities of packed red blood cells, including transportation and processing costs, if the blood is purchased, rather than donated, from a blood bank or a blood donor will be eligible for sharing.

G. Lifestyle Issues

Members must follow the Christian lifestyle and agree to the Statement of Faith. This is essential for Eligible Medical Bills to be shared. Members who do not follow the Christian lifestyle will have their membership canceled. Examples of behavior that can lead to non-sharing and/or cancellation of membership include, but are not limited to:

• the use of tobacco in any form, including the use of e-cigarettes, vaping, or nicotine replacement
• the use of Illegal Drugs
• the abuse of drugs including legal drugs, such as, alcohol, prescription and over-the-counter medications
• sexual relations outside of Biblical Christian marriage
• participation in activities that represent a willful disregard for personal safety

H. Pre-Existing Medical Conditions or Related Conditions

A medical bill for diagnosis or treatment of a pre-existing medical condition will be eligible for sharing, provided it meets the other requirements for sharing contained in these guidelines and the member joined during their 6-month Medigap Open Enrollment Period* or with Guaranteed Issue rights.

In the event a Member does not meet the criteria above, pre-existing conditions will be eligible for sharing once the Member has been faithfully sharing for six consecutive months.

*The Medigap Open Enrollment Period is the 6-month period that starts the month a senior 65 or older enrolls in Medicare Part B.

“My wife and I have had numerous visits to the hospital because of kidney stones and I am battling a back injury that will certainly add some additional doctor visits in the near future. Through what can be a tense and worrisome experience, we not only did not have to worry about the financial burden, we were assured and supported by people that cared and prayed for us during those challenging times.”

—CRAIG

I. Medical Conditions and Services Not Eligible for Sharing

If a medical bill is related to a diagnosis, treatment, or procedure that is ineligible for sharing in any way, then that medical bill is also ineligible.

A condition or service will not be eligible for sharing if:

1. the medical bills related to that condition or service have not been submitted to or processed by Medicare;
2. the charges have already been paid by Medicare;
3. the services are not approved by Medicare Part A or B, except for urgent care when out of the country (see Section IV. E.)

Listed below are additional treatments, medical conditions, procedures, and services that are ineligible for sharing:

• Expenses related to non-Biblical lifestyles and choices – including but not limited to:
  • Abortion of a live fetus (baby).
  • Alcohol and drug related injuries and illnesses.
  • Bill(s) originally received by CCM more than 6 months from the date of the Medicare EOB.
  • Charges that do not follow proper coding guidelines.
  • Fertility/Infertility care—including but not limited to: birth control procedures (such as IUD, and/or related supplies), infertility testing and treatment, sterilization or reversals (vasectomy and tubal ligation).
  • Illegal acts—Any charges for any condition, disability or expense resulting from being engaged in an illegal occupation or in the commission of or attempted commission of a crime.
  • Intentionally self-inflicted injuries (e.g. suicide or attempted suicide).
  • Pre-existing conditions are not eligible for sharing if a member joined Medi-Share 65+ outside of their 6-month Medigap Open Enrollment Period or without Guaranteed Issue Rights.
  • Related conditions—Members do not share medical bills for diagnosis or treatment of any medical condition or complications associated with or resulting from a diagnosis, treatment or procedure that is not eligible for sharing.
  • Sexually transmitted diseases (STDs) including HIV – Exceptions include innocent transmission via transfusion, rape, work-related needle stick, or sex within marriage.
  • Skilled nursing facility care from the 101st day and beyond.

J. Conflicts of Interest

Medical bills will be ineligible for sharing if the provider or ordering provider is related to the Member by blood, marriage, or adoption or if the Member has a financial interest in the provider.

K. Extra Blessings

The Extra Blessings program is to assist members with eligible adoption expenses after two events (see Section VIII.) or significant bills that are ineligible for sharing because they exceed the sharing limits in these guidelines, including the maternity sharing limits. To be considered for Extra Blessings, the dates of service must occur after the member has been faithfully sharing for 12 months.

If a condition is ineligible for sharing based on Sections IV. I. or J., it is NOT eligible for Extra Blessings.

Extra Blessings gifts are used to fund the eligible Extra Blessings needs at 100% unless the needs exceed the Extra Blessings contributions, in which case they will be distributed on a pro-rated basis. At the end of each quarter, any Extra Blessings contributions remaining after all eligible pending Extra Blessings needs have been met may be used for general sharing. For more information, Members should contact Member Services at (800) 264-2562.

L. Program Blessings

Members may qualify for public assistance or private benevolence programs. Those who use programs such as these will receive an incentive in the form of a share credit.

“With a sudden diagnosis of brain cancer, my wife’s medical expenses began to quickly mount. As we soon discovered, the Medi-Share ministry would become a large part of our lives. Although our faith has remained strong, we were not expecting the level of support and partnership we have received from the Medi-Share staff, as well as the prayers and sharing support of the other members.”

—RONALD