If you’re considering joining Zion HealthShare, or if you have received a determination that a sharing request relates to a pre-membership condition, you may wonder why a waiting period exists. The answer comes down to fairness and long term sustainability for the entire community.
What Are Pre-Membership Medical Conditions?
Pre-membership medical conditions are medical issues that existed before you joined Zion HealthShare. This can includes illnesses, injuries, diagnoses, or symptoms that were present or treated prior to your membership start date.
How Does Zion HealthShare Determine if a Condition Is Pre-Membership?
When you submit a sharing request, your medical records are reviewed to better understand the history of the condition. Medical records typically include notes from past visits, diagnoses, test results, and reported symptoms.
If a condition, or something closely related to it, appears in your records before your membership began, it is considered a pre-membership medical condition. This review process helps ensure consistency, accuracy, and fairness for all members of the community.
Why Is There a Waiting Period?
Zion HealthShare is built on shared responsibility. If someone were to join only when they needed expensive care, it would place a financial burden on the community and increase monthly contributions for everyone.
The waiting period helps prevent that imbalance. It encourages long-term participation and helps keep membership affordable while allowing the community to continue sharing medical expenses in a sustainable way.
How Does the Waiting Period Work?
- Year 1: Waiting period for pre-membership conditions
- Year 2: Eligible for sharing up to $25,000
- Year 3: Eligible for sharing up to $50,000
- Year 4 and beyond: Eligible for sharing up to $125,000 per membership year
After four years of active membership, expenses related to pre-membership medical conditions may be eligible for sharing up to $125,000 in a 12-month period. This maximum resets each membership year.
Can I Wait to Submit My Sharing Request After the Waiting Period Ends?
Yes, you may choose to wait to submit a sharing request until the waiting period has passed. At the same time, your health matters most. We encourage you to seek care when you need it and not delay treatment due to uncertainty. Zion HealthShare is here to support you whenever you are ready to move forward.
Is Zion HealthShare a Good Fit if I Have a Pre-Membership Medical Condition?
Zion HealthShare can still be a good option for many individuals who have pre-membership conditions, even with a waiting period in place. You will have immediate support for new and unexpected medical needs that arise after joining.
Whether Zion HealthShare is the right fit depends on your personal health needs, timing, and budget. Some individuals may prefer other options if they need immediate help with an existing condition. We encourage you to compare your choices carefully and decide what works best for you.
The Big Picture
Zion HealthShare is built on trust, transparency, and shared responsibility. The waiting period helps protect the community, keeps monthly contributions affordable, and allows members to continue supporting one another through unexpected medical needs. This structure helps maintain fairness and stability for everyone in the community.
*Official Member Guideline
Definition of a Pre-Membership Medical Condition
A pre-membership medical condition is anything where a member has experienced one or more of the following:
- been examined,
- been diagnosed,
- taken medication,
- had symptoms,
- a personal history of or known increased risk of conditions that may arise or worsen in pregnancy, or
- received medical treatment
within the 24 months prior to their membership start date. Sharing requests related to pre-membership medical conditions are only eligible for sharing if the condition was regarded as cured and did not require treatment or present symptoms for 24 months prior to the membership start date.
Exceptions for High Blood Pressure, High Cholesterol, & Diabetes
High blood pressure, high cholesterol, and diabetes (types 1 and 2) are not considered pre-membership medical conditions as long as
- the member has not been hospitalized for the condition in the 12 months prior to enrolling, and
- the member is able to control the condition through medication or diet.
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 the 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 January 1, 2026.
Note
The Member Guidelines that go into effect January 1, 2026, will only be applicable to sharing requests that are submitted on or after that date. If a sharing request was submitted prior to January 1, 2026, the sharing request will be reviewed for sharing eligibility according to the Member Guidelines in effect at that time.
Zion HealthShare is not an insurance company. Neither this publication nor membership in Zion HealthShare are offered by an insurance company. Visit ZionHealthShare.org to view your state-specific notice.