Guidelines

(Following each of these points is important for your sharing success)

1. Pre-authorization is required if you want to have a medical case shared in the program. Call Anabaptist HealthShare (AHS) at 540-738-2640 or email info@sharing.health to pre-authorize. Without a case being pre-authorized, the guidelines do not allow those bills to be shared unless it was a genuine emergency. All non-emergency bills must have been pre-authorized by the AHS team. This pre-authorization should occur prior to any scheduling, especially surgery scheduling, due to the varying rates charged by providers.

2. Emergency cases should get prompt attention at a MedExpress/Urgent Care/prompt care type facility, where appropriate. Use an emergency room as a last resort. Please notify AHS promptly afterwards.

3. "Self-pay" or "Uninsured" is how you report to any medical provider.

A sharing group is not insurance, so do not mention AHS . Doing so confuses providers and makes bill management more difficult.
Have all bills sent to your address. Once you receive them, submit them to AHS for processing.

4. Unpaid is how you submit medical bills to AHS. Do not pay any bill yourself that you plan to turn into AHS for sharing. Bills should be emailed, faxed, or mailed to AHS as soon as received. Bills submitted after 90 days of the date of service may not be eligible for sharing. Also, keep submitting any repeat bills and all notices from the hospital so AHS can stay updated on the current billing status. AHS guidelines do not allow for sharing of bills that members pay on their own unless instructed to do so by the AHS team.

5. Stewardship of Resources requires that bills are not paid above what is reasonably required by hospitals. The first bills you receive are typically inflated by several hundred percent! All AHS members agree to cooperate fully with the AHS team as they work with the hospitals’ procedures in fnding the bottom line. This may include applying for financial assistance and Medicaid.

6. A Genuine Spirit of Sharing in a group of believers is a beautiful example of loving our neighbors as we love ourselves. When members conscientiously use this program like they would want others to use it increases sharing power.

7. Patience and much longsuffering are needed to deal with the medical system. Hospital billing systems are designed to keep you on edge with their recurring billing cycles and collection efforts. Thank you in advance for your patience as the AHS team works diligently on your behalf. Great results are achieved when everyone works patiently together!

Plan Levels & Participation

All family members in the program are required to be on the same sharing plan level. Children over 18 may choose their own sharing plan level. Maternity cases are not eligible for sharing unless both spouses are in the program (or they make the membership contribution equivalent).

Changing Levels

If a member changes to a lower sharing level, bills for any current or previous conditions will be shared at the lower level. If a member changes to a higher level, bills related to any illnesses, injuries, or symptoms experienced prior to switching will be subject to a 12 month wait period before shared at the higher plan level.

Medicare Eligible Members 65 and over

This Sharing Plan requires Medicare-eligible members 65 and over to be covered under Medicare parts A and B. Plan ISA applies per case. If a member is enrolled in Medicare parts A and B, the monthly contribution amount is reduced to only: - $60 per month for the Standard Plan. - $85 per month for the Complete Plan. - Pharmaceuticals are shared if the member is also enrolled in Medicare Part D. Plan ISA applies.

There is a 75/25 sharing for Social Security exempt members over 65 after ISA is met. Any social security exempt individuals 60 and over must come with a group of at least 20 units in order to be eligible for AHS membership.

Members are encouraged (but not required) to include personal medical coverage as part of their auto insurance. Whatever the case, a $5,000 ISA applies per accident. This $5,000 ISA applies to all motorized vehicles including, but not limited to, ATVs, UTVs, e-bikes, e-scooters, tractors, and any horse-drawn vehicles or implements.

If you wish to have your job-related injuries shareable at AHS, you will need to enroll in the AHS Workers Aid Plan (See Page 9). Anyone legally required to have Workers Compensation coverage is not eligible to participate in the Workers Aid Plan.

Pre-existing Conditions

A pre-existing condition is any health issue accompanied by any current or former signs or symptoms indicating a need for medical attention. Pre-existing conditions do not require an official diagnosis or active treatment by a physician. On both the Standard and Complete plans, some pre-existing conditions are eligible for sharing after a 12-month wait period and are subject to the following guidelines: Standard plan up to $12,000 per year, per person; Complete plan up to $18,000 per year, per person. However, all pre-existing organ failure (including diabetes, heart conditions, kidney dialysis, etc.), and pre-existing genetic or congenital conditions are not eligible for sharing. Medical equipment needed to treat or maintain these conditions and any extended health issues resulting from these conditions are also not eligible for sharing. However, AHS will aid in bill negotiating for all members with any of the above pre-existing illnesses.

Congenital Conditions

If it is a shareable maternity and both parents are members of either the Standard or Complete plan, birth defects, and congenital conditions of a new infant are eligible to be shared up to a lifetime maximum of $150,000 per child. AHS can assist in enrolling members in available financial aid programs.

Wellness Checkups, Screenings, Physicals

Wellness procedures, if ordered by a doctor, become shareable after 12 months of membership. The ISA does apply. Multiple wellness procedures occurring within a 30day period can be considered a single case, with a single ISA. Example: Physician ordered labs and Mammogram done at the same time.

Physical Therapy

Incident-related physical therapy is shareable on the Standard and Complete plans.

Mental or Behavioral Treatments

will be reviewed on a case-by-case basis by the AHS Medical Review Committee.

Maternity

Maternities are shareable on the Standard and Complete plans if the due date is a minimum of 10 months after enrollment and both parents are members of Anabaptist HealthShare.
Please notify AHS as soon as a pregnancy is confirmed.
Maternity through a hospital or midwife includes:
Sharing for all bills related to the maternity case including prenatal checkups.
Up to 2 ultrasounds (unless additional ultrasounds are deemed necessary by a medical doctor).
3 chiropractic visits, these can be used as either chiropractic, massage or pelvic floor therapy.
Tongue or lip ties and circumcision are shared within the maternity case if done within 30 days of birth.
The cost of a doula is not shareable.
If an infant has ongoing medical needs after 30 days of birth, the infant becomes its own case separate from the maternity case.
If the birth is the first child, the child rate is due on the first day of the month following the birth.
If the child is not added to the plan, its medical needs will not be shared after the first day of the month following the birth.

Recurring or "new" cancers after a pre-existing cancer are shareable after a documented cancer-free period of 10 years and having been a member of AHS a minimum of 2 years. Cancer is always shareable for members who have never had cancer before becoming a member.

Medical Treatments in Mexico

Cancer treatment is the only medical treatment AHS shares in Mexico. Cancer treatment in Mexico is shareable up to $20,000 on the Standard Plan and up to $30,000 on the Complete Plan if it was not pre-existing cancer. Note: AHS does not share full treatment in both Mexico and the USA. Any amount paid to a Mexican clinic will need to be deducted from treatment in the USA. Any amount paid in the USA will need to be deducted before Mexico sharing. These limits do not apply to AHS members who are missionaries and residing in Mexico.

Alternative Treatment

AHS does not share alternative, functional, integrative, natural, or non-FDA approved treatments. This includes any treatment done at these facilities. The AHS program is designed to share medical necessities such as surgeries, injuries, cancer, heart disease, births, etc. The modest contribution rates of AHS are not designed to share the continuing treatments often recommended by alternative clinics. AHS is not opposed to alternative treatment, but this sharing program is not designed to share those costs and members are encouraged to research their options well in advance of any treatment.

Lyme Disease

After the annual ISA is met which applies for chronic conditions, AHS shares up to $4,000 per year, per case for Lyme treatment for a maximum of 3 years. Lyme patients may seek treatment at the provider of their choice. This includes alternative treatment. Note: If diagnosed early, the normal routine of antibiotic treatment has often been successful.

Medical Equipment

Medical equipment prescribed by a medical doctor is eligible for sharing up to $10,000 (lifetime limit per member. Examples include, but are not limited to defibrillators, insulin pumps, oxygen concentrators, etc.).

Adoptions

New family members added by adoption are eligible for a sharing contribution of up to $6,000 to assist with verified adoption costs. A $1,500 ISA and 12-month wait period applies. Adoption-sharing contributions are made after the adoption has been finalized. The new child may register with AHS as a new member and pre-existing condition exclusions would apply. In order to be shareable, both parents must have been members prior to the bills being incurred.

AHS shares medical bills incurred outside the United States on a limited basis.

Long and short term mission sharing may be approved by AHS on a case-by-case basis.
For leisure travel, AHS recommends acquiring travel insurance.

Traveling for Medical Procedures

There may be times when, at the discretion of AHS, a member is asked to travel for a medical procedure.

Charity

A portion of member contributions may be used for hardship cases and other charitable causes.

Exclusions

Any illnesses, accidents, or cases that result from the following: Alcohol, tobacco, vaping, illegal drugs, abuse of legal drugs, and intimate relationships outside of marriage.
Pre-existing Conditions (See Page 3).
Infertility Treatments are not shareable. However, pregnancies resulting from such treatments are shareable according to the member’s plan.
Contraceptives and related costs are not sharable. This includes vasectomies and tubal ligations.
Organ Transplants are not sharable.
Alternative Treatment (See Page 4).
Medical Bills not Pre-authorized by AHS: Except for emergency room and Urgent Care visits, all medical expenses must be pre-authorized by AHS.
International Life Flights are not shareable.
Bariatric Weight Loss Surgeries or complications resulting from such surgeries are not sharable.
Hearing Aids needed due to aging.
Long Term Care: Nursing Home and Hospice Care.
Chiropractic Visits are not normally shareable.
Dental & Vision are not shareable (unless accident-related).
Unreasonably Costly Procedures or Medications: Procedures and medications which are considered unreasonably expensive, uncommon, or experimental may not be eligible for sharing, at the discretion of AHS.

AHS’s heart is to serve its members, rather than trying to find reasons to avoid doing so. Should you have a need that is not eligible for sharing, please contact AHS to review available options!

Medical Bill Policy

AHS is not Insurance. The AHS team members serve as Patient Advocates for members of the sharing program in resolving medical bills.
Best Available Path: It is the policy of AHS to utilize the best available path provided by a hospital to reach the bottom line of a member's bill. This path could include using: self-pay rates, income-based rates, Medicaid, Medicare, Financial Assistance, catastrophic bill rates, plain community pricing, etc. All bills remain a member’s bills. AHS is not a guarantor of payment.
Working Together: All members of AHS agree to fully cooperate with the AHS Patient Advocates as they work with hospitals to find the final amount owed for bills. This could include submitting tax forms to verify income etc., as required by a hospital. If a member would rather find their own path in getting to the bottom line for a bill, that bill will not be shareable in the AHS program.

Worker's Aid Plan

Worker's Aid Plan is an economical job-related injury and time off work mutual aid program. If you wish to have your job-related injuries shared at AHS, you will need to enroll in the AHS Workers Aid Plan. Anyone legally required to have Workers Compensation coverage is not eligible to participate in the Workers Aid Plan. Note For Family Farms: The Workers Aid Plan is required for anyone 18 years of age and over working on the family farm. (This applies to any new enrollments beginning January 1, 2024)

Anabaptist HealthShare is a 501(c)(3) nonprofit corporation that has organized this Worker’s Aid program as a branch of its ministry to the Anabaptists.

Membership Eligibility: Members of the Worker’s Aid Plan must be members of traditional Anabaptist churches. This requires adherence to the Dordrecht Confession of Faith or similar Confessions, and adherence to the core tenants of Anabaptist theology. The definition of “member” is any employee or employer who is enrolled in the plan including self-employed individuals.
Monthly Sharing Amount: $24 per month.
One-time Entry Contribution: $50 per worker.
$2,000 ISA: annually, per case. This is the individual member’s responsibility.
$5,000 ISA: for on-the-clock auto-related injuries:** Members are encouraged to include personal medical coverage as part of their auto insurance. This $5,000 ISA applies to all motorized vehicles including, but not limited to, ATVs, UTVs, e-bikes, e-scooters, tractors, and any horse-drawn vehicles or implements.
No Annual Limit: 100% of medical bills are eligible for sharing after the first $2,000 is met.
Pre-authorization: All non-emergency room procedures must be pre-authorized by an AHS representative. Emergency Rooms should be used only if the need is not treatable at a Prompt Care, etc. All members agree to accept counsel from their church deacon and/or AHS advisors in the case of larger bills. Larger bills will be shared as funds are available. In all cases, due diligence will be made to achieve satisfactory payment arrangements with both providers and members. Members should always seek to be good stewards of the health care system, using the least costly alternatives whenever feasible. It may be financially prudent to travel some distance to a health care provider that offers a better rate.
Work-related Sharing: This sharing plan shares work-related accidents and injuries incurred during employment or self-employment activities. Those experiencing vehicle and buggy related accidents should seek assistance from any applicable auto insurance or mutual aid as a first resort.
Pre-existing Conditions: are not eligible for sharing.
Time Off Work: Up to two calendar months of lost work time may be shared at two-thirds (66%) of regular wages earned. Sharing begins after one week of lost work time.
Enrollment: Please contact AHS for more information or to enroll.

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