Who is eligible to join The HealthShare Plan?
Anyone who can benefit from regular exercise and is under the age of 65 can join.
Can my family members participate in medical cost sharing?
Yes, spouses and dependent children up to age 25 are welcome.
When will I get my membership or insurance card?
This is not insurance and there is no need for a card. You select your own physicians and let them know you are a member of a Medical Cost Sharing Community.
Is The HealthShare Plan available in my state?
Yes, all 50 states.
Who is SHMI?
SHMI is a facilitator for individuals and their physicians seeking the best way to manage healthcare. For 40 years, SHMI has been assisting its clients to improve healthcare services and reduce costs.
When can I enroll (or cancel)?
Members can enroll or cancel at any time; all changes must be made prior to the 20th of the month and become effective on the 1st of the following month.
Is this plan compliant with the Affordable Care Act (ACA) so that I will not incur the individual mandate penalty?
Yes, it is compliant with ACA and state mandates for healthcare.
This all sounds too good to be true! Does this really work?
Absolutely! The medical cost Sharing model has existed for over 25 years and today serves over a million members.
Can I choose my own doctors and hospitals?
Yes! There are no “preferred providers”, or network restrictions in regards to The HealthShare Plan. We know continuity of care and a trusting physician-patient relationship are crucial to better healthcare.
How are my bills reimbursed?
Preventive services are reimbursed, up to 130% of the national rate. Checks are issued to members within 30 days of receiving the itemized invoice and paid receipt. Medical bills for treatment, over the IUA, are shared through Sedera Health. Consult the Sedera Health guidelines for full details.
What do I tell my medical provider?
Let the doctor know that you are a member of a medical cost sharing community and that you will be paying for the visit at the time of service. Ask for a “prompt pay” discount. Many practices are happy to offer one since they will not have to file claims with insurance companies and wait for payment.
Which preventative services are covered?
There are three sets of free preventive services. Select the links below to see a list of covered services for each group:
For women https://www.healthcare.gov/preventive-care-women/
For children https://www.healthcare.gov/preventive-care-children/
For all adults https://www.healthcare.gov/preventive-care-adults/
How often can I go for a well visit?
One well visit per twelve month period for adults.
Are required school/camp/work, etc. physicals considered preventive care?
There is one standard preventive care visit in the ACA compliance. That visit may suffice for other physicals as well.
Is Birth Control included in ACA compliance?
Is the Bloodwork of a Preventive care visit included?
Routine bloodwork is included. Do not pay the bill in advance! Send us the bill and we will send you payment.
Is preventative vision screening covered?
Yes, but only for children.
Is preventative dental work covered?
No, regular dentistry (cleanings, x-rays and fillings) are not covered under the ACA.