*Official Member Guideline
The Zion HealthShare medical cost sharing community chooses not to share in some medical expenses. Decisions for sharing eligibility are made to benefit all members by keeping monthly contributions low and sharing in medical expenses based on our Principles of Membership. The following expenses are excluded from sharing with the Zion HealthShare community.
Abortion
Expenses for the abortion of a living, unborn baby are not shareable.
ADHD & SPD Treatment
Expenses for evaluations, treatments, and prescriptions related to ADHD and SPD are not shareable. Members can use Zion HealthShare’s discount prescription program, Zion RxShare, for any prescribed medications that are available at a pharmacy.
Allergy Treatments
Allergy testing and medication is excluded from sharing. Members can take advantage of Zion RxShare to receive prescription discounts. Sharing requests related to non-seasonal allergies, such as an emergency room visit for an allergic reaction, may be considered for sharing.
Breast Implant Removal
Breast implant removal is ineligible for sharing.
Conflict of Interest
In keeping with the Principles of Membership, and in the interest of protecting the Zion HealthShare community, medical expenses incurred by a member that obtains medical treatment from a provider with which the member has an affiliation, partnership, personal or business relationship, or the like, and receives financial gain, is not considered shareable.
Dental
Dental services, such as caps, crowns, root canals, fillings, wisdom tooth extraction, anesthesia, sedation, and cleanings are not shareable. Tooth damage caused by an accident or injury (e.g., car accident) may be considered for sharing.
Diabetic Medication & Supplies
Any medical expenses related to supplies, testing, medication, or other implements used to treat diabetes are not shareable.
Fees & Interest
Any late payment fees or interest charges that may accrue to medical bills before a member meets their IUA are the member’s responsibility—they are not shareable, and do not count toward the IUA. Additionally, any late payment fees or interest charges caused by a member’s delay in providing necessary documentation to Zion HealthShare are not shareable.
Credit card transaction fees associated with a payment by the member are ineligible for sharing.
Fertility
Expenses related to fertility evaluations and treatments are ineligible for sharing.
Genetic Screening
Genetic screenings and/or genetic counseling are ineligible for sharing.
Hearing Aids
Expenses related to hearing aids are ineligible for sharing.
Injuries Obtained from Certain Acts
Injuries or illnesses resulting from a criminal act, euthanasia, assisted suicide, participation in a riot, or other such acts that would violate the Principles of Membership are not shareable.
Injuries or illnesses resulting from being under the influence of alcohol or drugs while committing a criminal act, such as operating a motor vehicle while impaired, are not shareable.
Medical Noncompliance
Failure or refusal to comply with a physician treatment plan or leaving a facility against medical advice (AMA) may result in ineligibility of the sharing request and any complications that arise.
Medically Stable Conditions
A shareable medical need may be considered medically stable when the condition is chronic and further treatment will not likely result in improvement. At this point, the sharing request is subject to review and may result in determination of ineligibility for future sharing.
Mental Health
Expenses related to medications or other treatment for any mental health illness or condition are not shareable. Mental health conditions may include anxiety, depression, mental illnesses, and other psychological conditions. Through LifeWorks, Zion HealthShare members may have access to regular, preventive mental health consultations. LifeWorks is available as an additional service to any membership. Members can use Zion HealthShare’s discount prescription program, Zion RxShare, for any prescribed medications that are available at a pharmacy.
Sleep Apnea
Sleep apnea equipment and testing are not shareable.
Sterilization
Elective sterilization, such as tubal ligation and vasectomy, is not shareable.
Surrogacy
Expenses related to a surrogate pregnancy, whether or not the surrogate is a member, are not shareable.
TMJ (Temporomandibular Disorder)
Expenses related to evaluation and treatment of Temporomandibular Disorder, TMJ and other similar conditions are ineligible for sharing.
Vision
Vision expenses related to hardware, such as glasses and contacts, are ineligible for sharing. Expenses to correct refraction, including but not limited to Lasik, PRK, lens implants, and/or other surgical or non-surgical visual acuity procedures and treatments not related to cataract surgery, are also ineligible for sharing.
Vitamins & Supplements
The cost of vitamins and supplements is not shareable.
Member Guideline Notice
Notice
Please note all article sections formatted like this are official member guidelines and will be marked “*Official Member Guideline” when applicable. Anything else is simply helpful information to assist you in understanding the member guidelines and how to use your Zion HealthShare Membership.
Members who call the Zion HealthShare office asking about eligibility of medical expenses will be given an opinion, not a decision. Sharing Requests and medical expenses cannot be authorized over phone. For more information on submitting bills to Zion HealthShare, review the Member Guidelines or login to your Member Portal.
These guidelines are effective as of May 1, 2024.
Note
The Member Guidelines that go into effect May 1, 2024 will only be applicable to sharing requests that are submitted on or after that date. If a sharing request was submitted prior to May 1, 2024 the sharing request will be reviewed for sharing eligibility according to the Member Guidelines in effect at that time.