While HealthShares are not health insurance, they do share some similarities, such as the way healthcare costs are paid. Both HealthShare members and insurance subscribers have their monthly bill partly determined by the number of people in the household. The basic structure typically includes single, couple, and family households. Despite these similarities, however, it is crucial to note some key differences.
Limit on family size
Upon reviewing multiple health insurance options, it becomes apparent that a typical “family plan” includes parents/guardians and any dependent children, regardless of family size. However, this is not the case for HealthShares. Generally, a HealthShare family membership consists of adult members and around four dependent children, with an average maximum of six members. For larger families, an additional monthly fee per extra family member may apply. While this extra cost may vary slightly between HealthShares, potential members with large families should be prepared for extra fees.
Similar to insurance, unmarried children can be considered dependent into their 20s, usually up to the age of 26. Once adult children marry or turn 26, they will need their own HealthShare membership.
Adding babies or adopted children to a HealthShare membership
In most cases, health insurance grants new parents 60 days to enroll a newborn in their health plan. Having a child counts as a significant life change, allowing parents to find a new insurance plan if desired. In contrast, most HealthShares work on a shorter time frame, often requiring new children be enrolled within 30 days of birth. Though HealthShare guidelines may differ, it is generally advisable to enroll a newborn or newly adopted child as quickly as possible. While a few HealthShares may allow 60 days for enrollment, most do not. It is essential to carefully review the HealthShare’s guidelines thoroughly to understand their timelines and submit all paperwork and requests as quickly as possible.
Children born as part of a maternity need
It is important to note that most HealthShares enroll babies born as part of an eligible need differently than babies born outside of membership (for example, if the parents weren’t members during the pregnancy and birth, or they had their baby before the waiting period had expired). However, a child born outside of an eligible medical need can still be included in the parent(s)’ membership after birth. If a member is adding a newborn outside of an eligible maternity need, there will be:
- a slightly shorter time frame to add the baby to the parents’ membership.
- some services/conditions shared with a standard maternity need may not be shareable. This could include wellness checkups for the baby, or sharing for costs related to any conditions the child had prior to birth.
Depending on individual financial situations and the baby’s health, these differences may be insignificant or substantial. When considering enrolling a baby in a HealthShare outside of a maternity need, carefully consider the potential impact on the child’s health.
All HealthShares operate differently. A certain HealthShare may have more stringent or generous rules, so thorough research is essential before making a decision.
Why these differences?
HealthShare membership maternity sharing guidelines primarily tie back to the goal of keeping member costs low overall. Additional monthly costs for larger families help balance membership costs for smaller ones, while restricting sharing for prenatal conditions outside a maternity need serves the same purpose.
Understanding the general structure and procedures for family memberships in a HealthShare can be helpful for those considering joining one as a family. Thoroughly reviewing the policies of a HealthShare is essential to avoid any surprises and ensure the best possible experience.
