Direct Membership

Choice of $1000, $2500, or $5000.

The Initial Unshared Amount is the out of pocket amount, or the member responsibility amount,  hat the member has chosen to pay up to for their own medical needs.

The initial Unshareable Amount (abbreviated to IUA).

Instead of having to meet a high deductible, then paying coinsurance for the remainder of their medical bills, members pay their IUA of either $1,000, $2,500, or $5,000, then 100% of their remaining eligible bills become shareable with the community.

The IUA model protects the member when large medical events occur.

Member households are only responsible for up to 3 IUAs in a 12-month period. Instead of resetting each calendar year, the 3-IUA limit begins in the month of the first need. For example, if a family experiences three medical needs between the months of April and September, any additional needs would not be subject to the IUA until the following April.

Members usually benefit with an IUA vs a yearly deductible

All qualified medical expenses after IUA is met are shareable  at 100% and without an annual or lifetime limit.    

The IUA is met one time for the Need and does not reset annually.  It remains open with all medical expenses related to the Need being shared  until symptom free for 12 months.  

IUAs are calculated per need, which means they only need to be paid once per condition. This includes ALL of the medical expenses surrounding a new illness, accident or diagnosis.

Complications and follow-up treatments for a single condition are considered a part of the same need and are not subject to an additional IUA.

Once the total expenses for any new need exceed the Initial Unshared Amount, the member no longer contributes to the need and further medical expenses are shared by the community.

A new need would only be opened once a member has been treatment-free for 12 months.

Member households are only responsible for up to 3 IUAs in a rolling 12-month period.

Instead of resetting each calendar year, the 3-IUA limit begins in the month of the first need. For example, if a family experiences three medical needs between the months of April and September, any additional needs would not be subject to the IUA until the following April.

Any member household that experiences 3 IUA's within a rolling 12 month period may have any further medical expense fully shared after only reaching a $500 threshold  to further protect the member

Pre-Existing Conditions - 24-month look-back: a pre-existing condition is considered if you have had symptoms of, been diagnosed with, or been treated for this condition within the past 24 months.

• Months 1-12: No sharing,  
• Months 12-24: Sharing up to $25,000 
• Months 24-36:Sharing up to $50,000,  
• After 36 Months: Sharing up to $125,000 for the pre-existing condition.

Exceptions for High Blood Pressure, High Cholesterol & Diabetesas long as there has not been a hospitalization for the condition  in the past 12 months and able to control through medication or diet.

$50 monthly surcharge per household.
Furthermore, there is a sharing limit for smokers age 50 or more of $50,000 for Heart Conditions, Cancer, COPD & Stroke.