In the ShareWELL HealthShare community, medical expenses are eligible for sharing, provided they align with the Member Guidelines and adhere to the sharing process. Below is a general overview of what is typically shareable with ShareWELL HealthShare:

 

1. Medical Expenses After the Unshared Amount (UA)

After a member meets their Unshared Amount (UA), the following types of expenses may be eligible for sharing:

• Hospital visits and treatments: Includes both inpatient and outpatient care.

• Emergency room visits: Costs associated with emergency medical care.

• Surgeries and medical procedures: Must be prescribed by licensed medical professionals.

• Prescription medications: Related to shareable conditions.

• Maternity care: Including prenatal, postnatal, and delivery-related expenses.

• Specialist visits: When recommended by a primary care provider.

• Durable medical equipment (DME): Such as crutches, wheelchairs, and oxygen tanks, when prescribed.

• Diagnostic testing and laboratory work: Related to eligible medical needs.

 

2. Preventive Services

Certain preventive services are shareable without requiring the UA:

• Annual provider visits: Coverage details may vary; refer to your specific membership plan.

• Screenings: Such as mammograms, colorectal cancer screenings, and cervical cancer screenings during the annual visit.

• Youth immunizations: As outlined by CDC guidelines for members under 18 years old.

 

3. Maternity Services

• Routine office visits and lab work: For prenatal and postnatal care.

• Standard ultrasounds: Coverage details may vary; refer to your specific membership plan.

• Delivery costs: For ob-gyn, hospital, or midwife-assisted home births.

• Postpartum checkups: Following delivery.

 

4. Emergency and Acute Care

Emergency medical expenses, whether they occur in or outside of the U.S., may be eligible for sharing, particularly when they involve sudden onset conditions requiring immediate care.

 

5. Specialized Treatments

• Therapeutic treatments: Such as physical therapy, chiropractic care, acupuncture, and massage therapy, when related to a shareable condition. Coverage limits may apply; refer to your specific membership plan.

• Genetic testing: Related to treating shareable conditions like cancer.

 

6. Additional Treatments

• Alcohol and drug abuse treatment: Coverage limits may apply; refer to your specific membership plan.

• Organ transplants: Subject to pre-existing condition phase-in limitations.

• Home healthcare: When prescribed by a physician.

• Hospice care: With certification of terminal illness.

 

No Overall Annual or Lifetime Maximums

 

ShareWELL HealthShare does not impose annual or lifetime maximum limits on the total amount of medical expenses that can be shared within the community. However, certain specific types of medical expenses or conditions may have limits or restrictions, especially when related to pre-existing conditions or certain treatments.

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Each shareable expense must follow the submission guidelines for timely requests and documentation. ShareWELL requires transparency regarding any other insurance or third-party assistance to prevent overlapping coverage.

For detailed information, please refer to the ShareWELL Member Guidelines.