HealthShare Challenge: Pre-Existing Conditions

When joining a HealthShare, it’s important to understand that HealthShares are not insurance, and there are differences between what insurances can be expected to cover and HealthShares can be expected to share. Since HealthShares share the medical expenses of their medical cost sharing community via members’ monthly contributions, and because being a part of the community is a monthly rather than annual commitment, they place some restrictions on what is shared in order to keep costs lower for members.

HealthShares and pre-existing conditions

Typically, pre-existing conditions are any condition for which a member has shown signs or symptoms, or has received treatment or taken medication for, within the two years before the start of their membership (this timeframe is known as the lookback period).

Unlike with traditional health insurance, which cannot refuse coverage to members based on whether they have pre-existing conditions, HealthShares are not obligated to share expenses related to pre-existing conditions, and in rare cases may decline membership to those who have them.

In fact, all HealthShares place limitations on, and have waiting periods for, sharing medical expenses related to pre-existing conditions. These limitations on sharing, and allowances made to members with pre-existing conditions, vary between HealthShares.

The challenge

For this installment of HealthShare Challenge, we are going to compare three HealthShares’ guidelines regarding pre-existing conditions to see how they stack up. To learn how HealthShares handle preventive sharing, read the previous installment of HealthShare challenge.

We will start off with Sedera, a HealthShare without a religious requirement for membership, which may be of interest to those seeking a medical cost sharing community that doesn’t focus on religion.

Sedera and pre-existing conditions

Sedera is notable for not having religious requirements for membership, and has been in operation since 2014. Sedera has a longer-than-average lookback period of three years, meaning more medical conditions may potentially be considered pre-existing when members start their memberships. But this is somewhat mitigated by their approach to pre-existing condition limitations: Sedera removes all pre-existing condition limits after three years of uninterrupted membership. They also do not decline membership based on pre-existing conditions; members are welcome to join as long as they are honest about their medical history.

Sedera places the following “membership longevity requirements” on sharing for pre-existing conditions:

  • For the first year, expenses related to pre-existing conditions are not shareable
  • In the second year, they are shareable up to $15,000
  • In the third year, they are shareable up to $30,000
  • From the fourth year on, they are fully shareable

Members looking to stay with a HealthShare for multiple years should consider joining one that eventually lifts limitations on sharing for pre-existing conditions; otherwise, they may be stuck paying a large portion of those expenses out-of-pocket.

Liberty HealthShare and pre-existing conditions

Liberty HealthShare is a Christian HealthShare that started in 1995. Like Sedera, Liberty HealthShare has a three-year lookback period for pre-existing conditions. Unlike Sedera, however, they may decline membership to those with pre-existing medical needs in order to prevent those expenses from straining their ability to share beyond capacity, according to their guidelines (see B. Participation is Voluntary).

If they accept a member with pre-existing medical conditions, however, that member is subject to the following restrictions on sharing for those conditions, based on their duration of membership:

  • For the first year, expenses related to pre-existing conditions are not shareable
  • In the second year, they are shareable up to $50,000
  • From the third year on, they are fully shareable

Liberty does lift limitations on sharing for pre-existing conditions after three years of membership (rather than the four years required by Sedera), but their stricter membership requirements and policy of potentially declining membership to those with pre-existing medical conditions should be key considerations for prospective members.

Altrua HealthShare and pre-existing conditions

Altrua does not have strict religious requirements for membership, though they do ask members to commit to a healthy lifestyle and agree to their statement of beliefs. But despite their relaxed requirements, they handle pre-existing conditions entirely differently than the other HealthShares in this challenge. Unlike both Sedera and Liberty HealthShare, which have three-year lookback periods, Altrua has a ten-year lookback period: meaning more conditions may potentially be considered pre-existing than with either Liberty or Sedera.

This becomes especially relevant considering Altrua places lifetime limitations on sharing for a number of pre-existing conditions, including (but not limited to) Alzheimer’s, Emphysema, Lupus, Parkinson’s, and Sickle-Cell Disease. They also place two-year limitations and five-year limitations on sharing for a number of other conditions, which are listed in their guidelines.

Prospective members should look into the lists of pre-existing conditions and their applicable limitations and the ten-year lookback period and consider whether those work for them.

Conclusion

When it comes to sharing pre-existing conditions, HealthShares are a mixed bag. Some lift limitations on pre-existing conditions after a member has been with them long enough, others place permanent limitations on sharing such conditions. Some welcome members regardless of whether they have pre-existing conditions, and others may decline membership to those with pre-existing conditions that may be expensive for their community to share.

For this challenge, Sedera struck a good balance between inclusivity and lifting limitations on sharing for pre-existing conditions after a member has been with the community for a sufficient period of time.

Current and prospective members should research HealthShares’ guidelines to see if their rules on pre-existing conditions fit their healthcare needs.

 

More to come: Since this is a complicated topic that many HealthShares handle differently, we will compare three more HealthShares in a future installment of HealthShare Challenge.

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