Medi-Share FAQs

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Medi-Share Value FAQs

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Submitting Bills

Do all medical bills count toward your Initial Member Responsibility (IMR) or toward sharing?

  • Only Eligible medical bills count toward your IMR for sharing. Please reference the Medi-Share Value Guidelines section VI. Details of Sharing.

How do I submit my medical bills?

  • Eligible medical bills may be submitted for sharing when the medical expense exceeds the IMR ($500 or $1000) per day or per stay.
  • Login to the Member Center and click Submit Medical Bill.

What is an Initial Member Responsibility (IMR)?

  • The IMR is the dollar amount, either "per day" or "per stay," that is each member's responsibility before Eligible Medical Bills may be submitted for sharing. The IMR will apply one time per day for all medical services occurring on that day, or one time per stay for all medical services occurring during an inpatient treatment/procedure that spans multiple days without discharge.
    1. PER DAY: For medical services not occurring during an admission to a facility, the IMR will apply one time per day (based on date of service), including but not limited to:
      1. Office visit
      2. Urgent Care visit
      3. Prescriptions filled same day
      4. Single Day Emergency Room visit
      5. Emergency Transport
      6. Laboratory Services
      7. Radiology Services
      8. Outpatient Physical, Speech, or Occupational Therapy
      9. Outpatient/Office Infusion
      10. Home Health Care
      11. Telehealth Visit (beyond included with membership)
    2. PER STAY: For medical services occurring during an inpatient treatment or procedure that spans multiple days without discharge including but not limited to:
      1. Facility/Hospital/Surgical Center Charges* (in-patient or out patient)
      2. Physician and provider services during admission
      3. Ancillary bills (facility charges other than room and board, such as x-rays, medication, laboratory services, etc.)
      4. Anesthesia Charges
      5. Pathology Services
      6. Diagnostic Consultations/Interpretation
    3. Maternity IMR: There is an additional Maternity $3,000 that is applied per maternity event.
      1. When using global billing, the IMR is considered “per stay” and the IMR and Maternity IMR are applied to the collective maternity care global bill. The Member should request global billing from the provider to avoid unnecessary “per day” IMRs.

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