Eligible medical bills may be submitted for sharing when the medical expense exceeds the IMR ($500 or $1000) per incident (applied Per Day or Per Stay).
Login to the Member Center and click Submit Medical Bill. You may also click here to find a video on how medical bills are shared.
What is an Initial Member Responsibility (IMR)?
The IMR is the dollar amount that is each Member's responsibility before Eligible Medical Bills may be submitted for sharing. The IMR will apply to each Incident, either one 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. Please review Guideline Section IV: A for more information.
An Incident is the occurrence of an illness or an injury of a Member, requiring a diagnosis of symptoms and treatment of a specific condition. For the purposes of determining the Initial Member Responsibility (IMR), an Incident is considered "Per Day" for all medical services occurring on that day. An Incident is considered "Per Stay" for all inpatient treatments or procedures that span multiple days without discharge.
PER DAY: For medical services not occurring during an admission to a facility, the IMR will apply one time Per Incident, Per Day (based on date of service), including but not limited to:
Urgent Care visit
Prescriptions filled same day
Single Day Emergency Room visit
Outpatient Physical, Speech, or Occupational Therapy
Home Health Care
Telehealth Visit (beyond included with membership)
PER STAY: For medical services occurring during an inpatient treatment or procedure that spans multiple days without discharge, the IMR will apply one time, Per Incident Per Stay, including but not limited to:
Facility/Hospital/Surgical Center Charges* (in-patient or out patient)
Physician and provider services during admission
Ancillary bills (facility charges other than room and board, such as x-rays, medication, laboratory services, etc.)
Maternity IMR: There is an additional Maternity $3,000 that is applied per maternity event.
When using global billing, the maternity Incident 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. Please review Medi-Share Value Guidelines Section IV: C for more information. You may also review this video tutorial to learn more about the differences between “Per Day” and “Per Stay”.