What is a UA?
Also known as an Unshareable Amount or member responsibility. This is very different than a traditional deductible. Since we are a month-to-month membership with no contracts. Our UA does not accrue over time. It's applied to each sharing request as they occur.
This is the amount paid by the member before the HealthShare community shares in their eligible medical expenses.
The UA gives each member a personal responsibility for their health without overburdening them with healthcare expenses.
The Unshareable Amount
The initial Unshareable Amount (UA) is a key component of how ShareWell HealthShare operates. It refers to the amount that a member is responsible for paying before any medical expenses related to a medical need become shareable within the HealthShare community. In other words, the UA is similar to a deductible in traditional insurance but works within the framework of medical cost sharing.
Here's how the UA works:
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Choosing a UA Amount: Members can choose one of three UA levels: $1,500, $3,000, or $6,000. The selected UA determines how much a member needs to pay out-of-pocket before the community steps in to share additional eligible expenses.
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Paying the UA: When a member experiences a medical need (e.g., surgery, maternity care, or an accident), they submit a sharing request to ShareWell HealthShare. The member is responsible for paying the first portion of medical expenses, up to the chosen UA. Once the UA is met, the HealthShare community shares the remaining eligible expenses.
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Multiple Medical Needs: If a member has more than one medical need within a year, they are only responsible for paying up to two UAs in a rolling 12-month period. After paying the UA for two separate medical needs, any additional eligible medical expenses exceeding $500 are fully shareable by the community without requiring another UA.
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UAs for the Same Medical Need: If a medical need spans multiple treatments or services (like ongoing care for a chronic condition), the member only needs to meet the UA once per medical need, as long as there is no recurrence of symptoms for 12 months. After that period, if the symptoms return, it may be considered a new medical need requiring a new UA.
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Changing the UA: Members have the option to change their UA amount once per membership year. However, if a member lowers their UA, a 60-day waiting period applies to sharing requests other than those caused by an accident.
In summary, the UA is a critical part of the cost-sharing process, helping to reduce the burden of everyday medical expenses while still requiring members to share in a portion of their healthcare costs