Mammography and Colonoscopy eligible for sharing. Work with your MPB.Health Concierge team when ever you need to seek care or have a catastrophic need.
They will help you access quality healthcare at a reasonable cost, they will assist you in being a self pay patient. You will not be alone. You will have assistance every step of the way.
For larger or more catastrophic events, seek care telling the hospital or provider that you are a self pay patient. You will only be responsible for your initial unshared amount.
Preventative Needs Sharing:
Mammography* after age 40 - 6 month waiting period
(Thermography may be substituted with pre-approval)
Colonoscopy* after age 50 - 6 month waiting period
(*earlier if medically indicated)
Childhood Immunizations - Ages 01-16 - as required by CDC
Choice of $1000, $2000, or $5000.
What is an IUA?
The out of pocket amount the member has prior to cost sharing for the NEED. 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 not does not reset annually. It remains open with all medical expenses related to the Need being shared until symptom free for 12 months.
Members usually benefit with an IUA vs a yearly deductible
What is a NEED?
A "Need is the ALL of the medical expenses surrounding a new illness, accident or diagnosis.
Any member household that experiences 3 IUA's within a membership year may have any further medical expense fully shared after only reaching a $500 threshold to further protect the member
Medical supplies directly aid in the treatment or recovery of a sharable medical need and generally shareable within 120 days of the treatment start date as prescribed by a licensed medical provider.
Supplies costs need to be over $100 to be shared. Zion Health will share in the retail or fair costs when applicable and encourage members to utilize alternative vendors such as local pharmacy or medical supply stores.
Prescriptions for medication(s) that are billed by a provider and are related to a qualified Need are also considered sharable. With your Medical Cost Sharing providers approval, large prescription costs associated with a Need that are filled at the pharmacy can be shared. Does NOT cover maintenance medications.
OptumRx is included .
Pre-Existing Conditions - 24-month look-back:
Exceptions for High Blood Pressure, High Cholesterol & Diabetes
as long as there has not been a hospitalization for the condition in the past 12 months and able to control through medication or diet.
Two Initial Unshareable Amounts (IUA’s) are applied to a single maternity need.
Any pre-birth or post birth need of the child will be considered a separate need from the mother’s maternity care.
Pregnancies are considered pre-existing if the pregnancy start date is within the first 60 days of the membership effective date.
Maternity Needs eligible after a 60 day waiting period.
Please see Maternity Sharing Guidelines PDF for more information.
New baby visits are shared
Physical Therapy - Shareable for inpatient treatment/up to 35 outpatient sessions per need.
Speech Therapy - Shareable in relation to an illness, injury or accident/up to 35 outpatient visits per condition.
Occupational Therapy - Shareable for inpatient treatment and up to 35 outpatient sessions per need, up to $7,500.
Therapeutic Massage Therapy - Shareable if prescribed by a licensed medical provider related to a shared need, up to 25 sessions and up to $3,000.
Medications and other care is not shareable for the treatment of any mental health related illnesses unless approved by your Medical Cost Sharing provider. Sharing is limited to $3,000.
Alternative medical treatments can be shared with the Medical Cost Sharing community.
These alternatives generally should be considered safe and effective while being an alternative to a traditional treatment plan.
Needs may be considered shareable pending prior written approval by your Medical Cost Sharing provider.
Member is required to demonstrate the proposed value of the alternative treatment.
For a Member, and/or his or her dependents, who die(s) after two years of uninterrupted Membership as a Sharing Member, financial assistance to the surviving family will be provided by the Members according to the following schedule, upon receipt of a copy of death certificate, and as listed on the Member enrollment.
$10,000 Primary Member, $10,000 Dependent Spouse, $2500 Dependent Child
Included in the membership.
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.