You Understand that:
1. There is a 24-month pre-existing condition waiting period.
2. This membership shares expenses for primary care, urgent care, emergency room, hospital, or surgery within the Provider network after you meet the visit fee or ISA. Non network provider expenses may also be shared. The Nonnetwork provider services can result in higher medical bills and member sharing responsibility.
3. Waiting periods apply for surgery and other medical costs. There is a 90 day waiting period for all medical services except acute illness, accident injury and immunizations. There is also a surgery waiting period which varies by program tier. Please refer to your member guide for details.
4. For Members who have never been diagnosed or received treatment for any type of Cancer, sharing is eligible after a 90-day waiting period from the member’s effective date. If a member is diagnosed with cancer within the 90-day waiting period, the diagnosis and treatment expenses related to that specific Cancer, recurrence or metastasis of that Cancer are not eligible for sharing. After the 90-day waiting period any newly diagnosed cancers are eligible for sharing.
a. Pre-existing or recurring cancer is Not Eligible for Sharing.
b. If a Member was diagnosed, or treatment was received, for Cancer within 5 years of the Member effective date, Cancer expenses are Not Eligible for Sharing. If a Member was diagnosed, or treatment was received, for Cancer more than 5 years prior to the Member effective date, that Member will be eligible for sharing in newly diagnosed Cancer expenses, after the 90-day waiting period. To be considered, you must provide Medical reports for review and determination will be made by OneShare.
c. The Lifetime Limit for all Cancer is $500,000; each Incident cannot exceed the Maximum Limit Per Incident.
5. If you use or have used tobacco or vape products, any health-related issues will not be eligible for sharing.
6. Maternity is not eligible for sharing on the Basic or Enhanced Memberships. For the Crown Membership, Maternity Sharing is eligible for members’ who conceive after the effective date of the membership and is subject to the maternity sharing limits.
Kentucky Revised Statute 304.1-120(7):
NOTICE: UNDER KENTUCKY LAW, THE RELIGIOUS ORGANIZATION FACILITATING THE SHARING OF MEDICAL EXPENSES IS NOT AN INSURANCE COMPANY, AND ITS GUIDELINES, PLAN OF OPERATION, OR ANY OTHER DOCUMENT OF THE RELIGIOUS ORGANIZATION DO NOT CONSTITUTE OR CREATE AN INSURANCE POLICY. PARTICIPATION IN THE RELIGIOUS ORGANIZATION OR A SUBSCRIPTION TO ANY OF ITS DOCUMENTS SHALL NOT BE CONSIDERED INSURANCE. ANY ASSISTANCE YOU RECEIVE WITH YOUR MEDICAL BILLS WILL BE TOTALLY VOLUNTARY. NEITHER THE ORGANIZATION OR ANY PARTICIPANT SHALL BE COMPELLED BY LAW TO CONTRIBUTE TOWARD YOUR MEDICAL BILLS. WHETHER OR NOT YOU RECEIVE ANY PAYMENTS FOR MEDICAL EXPENSES, AND WHETHER OR NOT THIS ORGANIZATION CONTINUES TO OPERATE, YOU SHALL BE PERSONALLY RESPONSIBLE FOR THE PAYMENT OF YOUR MEDICAL BILLS.
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You are enrolling in a Health Care Sharing Ministry administered by OneShare Health, LLC (OneShare). A Health Care Sharing Ministry is not health insurance, and it does not guarantee or promise that your medical bills will be paid. A Health Care Sharing Ministry is a group of individuals who share a common set 0f ethical or religious beliefs and share medical expenses in accordance with those beliefs.
The members of this Health Care Sharing Ministry voluntarily share medical expenses with one another, and OneShare coordinates this medical sharing. OneShare programs should not be considered as a substitute for an insurance policy. You are always liable for your own unpaid medical bills.
ONESHARE HEALTH, LLC (ONESHARE) IS NOT AN INSURANCE COMPANY BUT A RELIGIOUS HEALTH CARE
SHARING MINISTRY (HCSM) THAT FACILITATES THE SHARING OF MEDICAL EXPENSES AMONG MEMBERS. As with all HCSMs under 26 USC § 5000A(d)(2)(B)(ii), OneShare’s members are exempt from the ACA individual mandate. OneShare does not assume any legal risk or obligation for payment of member medical expenses. Neither OneShare nor its members guarantee or promise that medical bills will be paid or shared by the membership. Available nationwide, but please check www.onesharehealth.com/legal-notices for the most up to date state availability listing.
Neither OneShare nor its members promise or guarantee payment or sharing of your medical expenses, or assume any risk therefore. You remain responsible for your unpaid medical bills.
Enrollment in OneShare is not a contract for insurance. Participation in OneShare is voluntary. Enrollment as a OneShare member is voluntary, and the sharing of monetary contributions is voluntary. You are free to cancel your membership at any time. OneShare requests that a voluntary sharing contribution be made for each month you are enrolled, to facilitate the sharing of requests published on behalf of other members.
OneShare manages member sharing contributions by establishing guidelines that define which medical bills are eligible for sharing (“Guidelines”). Neither the Guidelines, nor anything else presented by OneShare, constitutes a contract for insurance. The Guidelines do not constitute a legally binding agreement, a promise to pay, or an obligation to share. The Guidelines specify what type of expenses are eligible for sharing requests. OneShare reserves the right to exclude sharing eligibility for any pre- existing conditions, whether disclosed at the time of your enrollment or discovered after the effective date of the membership. OneShare reserves the right to update and change its Guidelines at any time, and will provide notice of any material updates/changes. It is the Member’s responsibility to review the current guidelines in their Member portal.
Upon receiving an eligible medical need from a Member or Provider, OneShare Health will assign the medical need for sharing in accordance with the Guidelines, less the amount required to be pre-shared (Individual Sharing Amount). Voluntary Membership contributions are received from each Member monthly. Up to 40% of Membership contributions may be applied towards administration of the Health
Care Sharing Ministry, charitable causes, and general overhead costs. This does not include third party contracts and distribution compensation.
In any given month, the available sharing funds may or may not equal the amount of eligible expenses submitted for sharing. If eligible expenses exceed the available sharing funds to meet those needs, any of the following actions may be taken:
1. A pro-rata sharing of eligible expenses may be initiated, whereby the Members share a percentage of eligible medical expenses within that month and hold back the balance of those expenses to be shared the following month, or
2. The monthly member contribution may be increased in sufficient proportion to satisfy the eligible expenses. This action may be undertaken temporarily or on an ongoing basis Administrative costs are subject to change by OneShare Health.
An annual administration fee of $45.00 is due from each Primary Member upon their Program Year anniversary.
Each Member is responsible for reviewing the Guidelines provided at the time of enrollment, and to abide by the terms of the Guidelines. It is your responsibility to understand which of your Medical Expenses are eligible for cost sharing, and which medical expenses are not eligible for cost sharing. Members are also provided with a toll-free number to contact Member Services with any questions they may have. Pre-Certification from OneShare Health is required for certain medical expenses to be Eligible for Sharing.
You authorize OneShare Health, LLC or its designee to draft your checking account or debit or credit card for this initial transaction, which includes your first monthly contribution and a one-time application fee. You also give authorization to automatically draft my checking account or charge my card each month for all subsequent monthly contributions as well as the $45 annual administration fee. You also confirm that you are an authorized signer on the account you provided in your application for enrollment.
OneShare Health Programs are not available for children under the age of 18 as the Primary Member.
Primary Member Age Change: Your monthly contribution will increase at your program anniversary following the date you reach the next age bracket.
Primary Member Resident State Change: Your monthly contribution may increase/decrease in accordance with a change in the Primary Member’s resident state. Your monthly contribution based upon your resident state will be reflected in your next billing cycle following the date of notification.
Family Contributions: For families of 6 or more, a $50 additional contribution applies to each additional member after the first 5 family Members. Monthly Contribution may increase/decrease in accordance with changes made to member/family enrollment in the program.
OneShare memberships terminate at the end of the month in which a member attains age 65.
Within the first 10 business days of a new Member’s Effective Date, the Member is entitled to a full refund, excluding the one-time application fee. However, if services have been utilized, refunds will not be issued. After the first 30 days, a refund for the most recently paid period may be processed if the request is submitted within 10 days of their scheduled billing date. However, if services have been utilized, refunds will not be issued. Refunds will be processed as a credit to the same card or account provided for billing shareable by check may be delayed up to 30 business days.
Within the first 10 Business Days after the Effective Date, a Member can elect to make a Program Change, without an application fee, or OneShare Health approval. After the first 10 Business Days after the Effective Date, an increase in Program or Tier, a decrease in ISA, resulting in a higher monthly contribution, will be subject to OneShare Health’s medical question review and approval. A Member may elect to reduce their Program or Tier, or increase their ISA, resulting in a lower monthly contribution and the change will not require OneShare Health’s medical question review and approval. The program change will become effective at the next billing cycle following OneShare Health’s approval and the application fee will apply. A program change request form must be signed and submitted by the Member for any program change Request. Adding or deleting dependents to or from the Membership is not considered a program change.
If you wish to cancel your Membership in the OneShare Health programs, you are required to submit notice to OneShare Health in writing 15 days prior to the end of your current month. Your sharing opportunity will end the last day of your current month. Canceling your OneShare Health Membership does not meet the requirements for a Qualifying Life Event (QLE) under the Special Enrollment eligibility for the Affordable Care Act.
If your monthly recurring contribution attempt is declined and has been attempted three times with no approved transaction, and the amount attempted remains unpaid on the next occurrence of your billing day, your Membership will be reviewed for non-payment and pending cancellation status. If you are placed in non-payment, a non-payment notice will be issued, communicating a date that your Membership will be cancelled if the minimum contribution is not paid. If this date passes and the minimum contribution is not paid, your Membership will be cancelled as of the date communicated in the non-payment notice. Cancellation due to Non- Payment of your monthly contribution does not meet the requirements for a Qualifying Life Event (QLE) under the Special Enrollment eligibility for the Affordable Care Act.
By becoming a Member of OneShare Health, you agree to use the Dispute Resolution and Appeal process as the exclusive means for resolving legal disputes and to not file a lawsuit. You agree not to engage in litigation against OneShare Health, its affiliates, nor its staff or directors for any reason related to health care or Membership. You agree that, after exhausting your Level One and Level Two appeals, your final legal option is to submit your dispute to arbitration with the Institute for Christian Conciliation (ICC) or the American Arbitration Association (AAA).
You acknowledge and expressly agree that OneShare may communicate with me any information related to my OneShare Membership, including but not limited to Program updates and newsletters, via e-mail. You attest that you have access to and will regularly check the e-mail address you have provided to OneShare and will update OneShare promptly of any change in your e-mail address.
With our origins in the Anabaptist faith:
We Believe in the authority of Scripture and the sanctity and dignity of every human life created by God with special meaning and purpose. II Timothy 3:16; Psalm 139:13-14
We Believe that every individual has the constitutional and religious right and duty to worship God in freedom. 2 Corinthians 3:17; U.S. Const. amend. I
We Believe and agree in the biblical and ethical principle of sharing with those who are less fortunate and who experience medical needs. Galatians 6:2
We Believe and agree that it is our responsibility to God and our fellow members to engage in accountable, healthy living, and to avoid habits and behaviors which are harmful to the body. I Corinthians 6:19-20
We Believe in the power of prayer to save lives, to heal lives, and to unite our members in common purpose and community, and we believe that prayer should be a fundamental practice of daily life. I John 5:14; Philippians 4:6- 7
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