Health care done the RIGHT Way.

The Guidelines explain how ShareRight facilitates sharing. Because ShareRight is not insurance, it is important for members and those interested in becoming a member to read the guidelines to understand how the membership works. 

A full copy of the Guidelines is always available online. Please remember that the current Guidelines are always used when processing bills.

Yes, but sharing is limited for pre-existing conditions and it is important to understand what is considered pre-existing. 

Pre-existing medical conditions are conditions in which known signs, symptoms, testing, diagnosis, treatment, or use of medication occurred within 36 months prior to membership (based on medical records). A known sign is any abnormality indicative of disease, discovered on examination/diagnostic testing before joining membership. A symptom is any subjective evidence of disease. In contrast, a sign is objective.

A Pre-Existing Medical Condition is eligible for sharing after the condition has gone 36 consecutive months without known signs, symptoms, testing, diagnosis, treatment, or medication (based on medical records).

If you have been diagnosed with cancer that is in complete remission and you are only undergoing testing for surveillance purposes, then bills related to those services will not be eligible for sharing for the first 36 months of membership. If after 36 months you are without signs, symptoms, testing (other than surveillance testing), diagnosis, or treatment (medication), medical expenses related to that cancer diagnosis will be eligible for sharing.

High blood pressure or high cholesterol that is controlled through medication will not be considered a Pre-Existing Medical Condition for purposes of determining eligibility for future vascular or cardiac events.

The Pre-existing medical condition limitations do not apply to members 65 years old and older.

Members do not have deductibles. Instead, our members have a Primary Responsibility Amount (PRA).

The PRA options are as follows:

• $1,000 (65 years and older only)
• $2,500
• $5,000
• $7,500
• $10,000

The PRA is the annual amount a Member Household is responsible for before medical bills can be approved for sharing. The PRA applies only to Eligible Medical Bills. After the PRA has been met, and the co-share is applied, all Eligible Medical Bills will be submitted for sharing for the entire household. 

Preventive screenings as outlined below are subject to PRA and co-share.

• Women: Pap test—one every three years from age 21-65
Mammogram—one every year for ages 45-54,
every two years starting at age 55
• Men: PSA test—one every year, starting at age 45
• All: Colonoscopy—one every 10 years starting at age 45 or one every five years for members at high risk

As it pertains to eligible preventive care for both men and women, both the test and coordinated office visit will be eligible for sharing.

ShareRight for Seniors simplifies the healthcare experience.

• No Provider fees.
• No Co-share.
• No Pre-existing limitations.

 Here are a few things to know:

1. If you are 65 or older, you are required to have Medicare Parts A & B to join.

2. ShareRight is always secondary to Medicare Parts A & B. One great thing about this is that there are no pre-existing condition restrictions or provider fees for members with Medicare. 

3. You are welcome to use your member card to access the pass-through direct pricing on prescriptions. One thing to note, for prescription costs to be eligible for sharing, members must have Medicare Part D as well.

4. All sharing will be secondary to Medicare. There is only one PRA level available to these senior adults (see pricing calculator above). This program is available only on an individual membership basis.

5. The PRA for senior adults is $1,000 with no provider fees, no co-share, and no pre-existing limitations.