Pre-Membership Conditions

Definition of a Pre-Membership Condition

A pre-existing medical condition is any illness or injury for which a member has:

• Been examined,

• Taken medication,

• Experienced symptoms, or

• Received medical treatment

...within the 24 months prior to the membership start date.

Pre-Existing Conditions for Cancer

For previously diagnosed cancers, any testing, preventive treatments, prophylactics, or medications taken by the member within 36 months before the membership start date will result in a recurrence of that type of cancer being classified as a pre-existing condition.

Exceptions That Are Not Considered Pre-Existing

Certain conditions are excluded from being classified as pre-existing, provided they meet specific criteria:

• High blood pressure, high cholesterol, hyperthyroidism, hypothyroidism, and type 2 diabetes are not considered pre-existing if:

  • The member has not been hospitalized for the condition in the 12 months prior to joining ShareWELL.

Pre-Existing Condition Phase-In Period

ShareWELL implements a phase-in period for sharing medical expenses related to pre-existing conditions. During this period, sharing is limited but increases annually:

• Year One: $0 (waiting period; no sharing allowed for pre-existing conditions).

• Year Two: Up to $30,000 maximum per need.

• Year Three: Up to $60,000 maximum per need.

• Year Four: Up to $150,000 maximum per need.

• Year Five: No sharing limit for pre-existing conditions; sharing is fully available.

Medical Record Addendums

ShareWELL may request medical records to evaluate sharing eligibility for pre-existing conditions. In cases where a medical record addendum is necessary, the following requirements must be met:

1. The addendum must be provided alongside an official document from the relevant healthcare provider.

2. The document must include:

   • The provider’s signature,

   • The signature date,

   • A description of the changes made, and

   • The reason for the changes.

In Summary
ShareWELL provides a fair and transparent approach to managing pre-existing medical conditions. By implementing waiting periods, phase-in limits, and clear exceptions, the program supports members while ensuring sustainability for the broader community.