Preventive Sharing

We utilize the power of Zion Healthsare to provide our Catastrophic Membership. Zion Healthshare is a nation-wide healthshare that protects you from major medical expenses. A portion of your membership is something called Preventive Sharing, which is outlined below.

About Preventive Sharing

Preventive Sharing is included automatically in the Direct Membership and can be added to any Essential Membership. The Preventive Sharing feature was created to help you stay on top of your health with Annual Provider Visits (APV), child wellness exams, youth immunizations, and early detection procedures. We encourage all members to attend their annual provider visit and participate in applicable cancer screenings.

Although Zion HealthShare generally shares in expenses related to acute, unexpected medical events, we encourage our members to take proactive measures for good health. Our Preventive Sharing feature shares in certain preventive services to help you and your family stay healthy. Preventive Sharing is included in the Direct Membership and is available to Essential Members who choose to add Preventive Sharing to their membership.

Members should submit preventive sharing requests via the Member Portal 1-2 weeks in advance so that our preventive team can issue payment in advance. Preventive services do not require you to meet your IUA.

Zion HealthShare shares specific preventive services with the Direct Membership or with the additional Preventive Sharing service added to the Essential Membership. Preventive sharing is not subject to the IUA. Members should take advantage of the Medical Advocacy service as it is a complimentary resource to help them locate low-cost facilities.

Zion HealthShare references the following resources regarding preventive sharing:

US Preventive Services Task Force

American Cancer Society

Centers for Disease Control (CDC) and Prevention Guidelines

American Academy of Pediatrics

American Academy of Family Physicians

Annual Provider Visit

Sharing for an annual provider visit is available upon membership start date and every twelve (12) months from the shareable visit date. Sharing is limited to the services provided during the office visit only, up to $175. There must be a service description or office visit in order for it to be eligible for sharing.

Cervical cancer screenings are considered shareable only when performed during the annual provider visit. Prostate exams are considered shareable only when performed during the annual provider visit and after fifty (50) years of age. If a follow-up is requested for either, it will require a separate sharing request and subsequent IUA.

Colorectal Canver Screenings

Sharing for a colorectal cancer screening is available every ten (10) years beginning at the age of forty-five (45) and after six (6) months of a continuous membership that includes the Preventive Services additional service.

Sharing is limited to $5,000 for the screening colonoscopy, anesthesia, diagnostic testing, biopsies, and pathology performed as a part of the screening. Any additional costs, services, or follow-ups will be the member’s responsibility. For high-risk members under forty-five (45), this service may be shareable with prior written approval from Zion HealthShare.

Home colorectal cancer screening tests such as high sensitivity gFOBT (guaiac fecal occult blood test), FIT (fecal immunochemical test), and sDNA-FIT (stool DNA with fecal immunochemical test) are shareable beginning at the age of 45 and after six (6) months of continuous membership with preventive services. gFOBT and FIT are shareable once every twelve (12) months; sDNA-FIT is shareable once every three (3) years up to $500 for the test.

Any additional testing resulting from a home colorectal cancer screening test, including a colonoscopy, will require a separate sharing request and is subject to the IUA.

All other colorectal cancer screenings are not shareable as a preventive service but may be considered for sharing as a separate sharing request dependent upon the reason and only with prior written approval from Zion HealthShare. All non-preventive colorectal cancer screenings are subject to the IUA.

Mammograms

Sharing for a mammogram is available after six (6) months of a continuous membership that includes the Preventive Sharing additional service and every year beginning at the age of forty (40). Sharing is limited to $600 for a 2D or 3D mammogram. The exam, appointment, and evaluation of imaging performed as a part of the screening will count toward the $600 limit. Any additional services provided will be the member’s responsibility. For high-risk members under the age of forty (40) this service may be considered for sharing with prior written approval from Zion HealthShare.

If the finding of the screening mammogram is inconclusive and warrants an ultrasound ordered by a licensed medical provider, Zion HealthShare will consider sharing in the cost which will be included in the $600 sharing limit.

All other mammograms are not shareable as a preventive service but may be considered for sharing as a separate sharing request dependent upon the reason and only with prior written approval from Zion HealthShare. All non-preventive and diagnostic mammograms are subject to the IUA.

Well Child Visits

Sharing for well child visits is available upon membership start date for members born in connection with an eligible maternity sharing request and after six (6) months of a continuous membership that includes the Preventive Services additional feature for all other members. Sharing is limited to $175 for the office visit costs, and associated immunizations are limited as outlined in the Youth Immunizations section.

Qualifying visits are for children at the following ages:

Birth
1 Month
2 Months
4 Months
6 Months
9 Months
12 Months
15 Months
18 Months
24 Months
30 Months
36 Months