Terms & Definitions

ISA is an acronym for “Individual Shared Amount” and is the member’s responsibility per incident or illness. After the ISA is met, AHS will share the remainder of the medical billings at 100%, subject to AHS guidelines and specific membership plan details. The ISA resets annually.

Group: A group is 20 or more units from an individual church, district, ministry, or employer. A group must have an assigned representative and submit the monthly contributions with a single payment to receive the group discount.

Unit: A unit is any member 18 years or older. Children from the same family under the age of 18 qualify as one unit collectively. Example: husband = 1 unit; wife = 1 unit; children under 18 = 1 unit; total = 3 units. Each child 18 and older qualifies as his/her own unit.

Social Security Exempt is when a person has signed an IRS Form 4029 and does not pay Social Security and Medicare taxes.

Congenital Conditions relate to abnormalities or genetic conditions that are discovered at or prior to birth or soon thereafter.

HealthCare Sharing Ministries (HCSM) are not insurance, but rather facilitate the voluntary sharing of one another's medical needs. They do not guarantee payments for any medical bill. The programs offered are not insurance products, and any member needs to be aware of the differences. Please feel free to call if you have any questions.

Pre-authorization means getting a medical procedure approved for sharing by AHS before it is scheduled or performed (See Page 2).

Elective Non-Emergency Procedures are medical procedures that are scheduled by the patient.

Financial Assistance (FA) is a term many hospitals use when determining rates for self-pay persons who do not have insurance. The term “financial assistance” is simply the path hospitals often use to reduce a bill from the original raw bill. Many of these FA programs require disclosure of annual income.

Federal Poverty Guidelines (FPG) are income levels used to determine eligibility for various medical assistance programs. Hospitals often multiply the FPG times 2 or 3 to determine their sliding scale rates. Even those with significant incomes can qualify for partially reduced bills.

Medicare: Most US citizens qualify for Medicare benefits beginning on the first day of the month they turn 65. Medicare typically covers medical costs at an 80/20 rate. 80% of the Medicare rate is paid, leaving the member to pay only 20% of the greatly reduced rate. Medicare “Part A Hospital” is usually free. “Part B Physicians” has a monthly fee. There are other alphabets such as “Part D” which covers medications. You can learn more on the web at Medicare.gov or by visiting your local Social Security office.

Medicaid is a state-managed program that is primarily based on income, and generally covers more than Medicare. Medicaid varies state by state, but if qualifying, it may cover the needs of children, pregnant women, elder care, etc. A Medicaid application is often required by hospitals before going on to the next step in their bill negotiation process. A Medicaid “denial” usually means a person is over income or resources. A denial opens the way to proceed to the Financial Assistance process. Medicaid is a taxpayer-funded program.

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