The HealthShare Plan FAQS
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? 
Yes.

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.
STATS FAQS
What is STATS?
All members of The HealthShare Plan are also enrolled in the SHM.FIT association. The organization promotes good health through exercise. You can report your general results and be paid for doing so.

What is SHM.FIT?
SHM.FIT is our exercise association; there is no added cost to join. Members report their STATS monthly and are paid for doing so. 

What are the STATS?
The basic statistics: weight, height, resting pulse, high pulse, and the number of thirty minutes or more exercise sessions you did last month. For example, a session can be a walk, yoga, cycling, weightlifting, or a CrossFit class. 

How do members submit STATS?
They can download the SHMI STATS app from Google Play or submit directly on our website on the STATS tab. 

How much does SHMI pay for STATS?
SHMI pays $10 for each month a member submits their statistics. STATS payments are sent quarterly. Members must submit STATS at least two out of the three months to be eligible for payment.

Why do you want my STATS?
Your STATS are part of a national study on the importance of exercise. 

Can my STATS results affect my membership?
No, STATS are not used to adjust contributions or end membership.  

Will I lose my membership in The HealthShare Plan if I do not submit STATS?
No, submitting STATS is voluntary.

SHARING FAQS
How do medical bills get paid? 
See your doctor and pay - up to the amount you might owe, typically up to $500. 
Enter that bill in your Sedera App at the time. The App manages the process. 

How would medical emergencies be handled for international travel situations? 
Medical needs incurred internationally would be sharable with the community in the same way as any other legitimate medical need within the U.S. If the member’s out-of-pocket costs exceeded their IUA. 

What about the Premiums? 
Sharing medical costs is not insurance, so there are no premiums. Members freely choose to assist other Members with their medical expenses by contributing a pre-determined amount each month; called a “share.” 

Are there any specific medical conditions that have an exclusion or waiting period? 
The Guidelines state that health conditions that have been diagnosed or that have exhibited observable symptoms within 3 years of the Membership effective date will not be sharable for a period of time. 

Are there any specific medical conditions that have an exclusion or waiting period? 
A look-back period of 36 months applies to all prior medical conditions for Sharing. Any prior medical condition that has not exhibited symptoms during the 36 continuous months prior to membership effective date is considered cured and will have no sharing restrictions. Prior medical conditions will become eligible for sharing based on the Member’s tenure with Sedera, as indicated by the guidelines. Sharing restrictions do not apply for high blood pressure, as long as the member has not been hospitalized for high blood pressure in the 36 months prior to membership and the condition is controlled through medication and/ or diet. However, medication for treatment of high blood pressure as a chronic condition will not be shared. 

If I have large amounts of medical expenses, how will that affect my membership? 
Members are not dropped from this program due to their medical needs. Neither your Membership nor your monthly share is affected by the amount of medical expenses you or any family members may have. 

How are very large medical expenses handled? 
There is no maximum limit to the amount that  will be shared towards a specific medical need. Very large medical bills have access to a reserve fund set up for this. Our sharing manager, Sedera Health, reserves the right to negotiate medical expenses with providers, and to prorate available funds, as necessary, in order to address all member’s medical expenses.   
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