Glossary of Terms
Here is a list of commonly used words associated with Zion HealthShare’s medical cost-sharing community.
Here is a list of commonly used words associated with Zion HealthShare’s medical cost-sharing community.
A fund made up of voluntary contributions from members of our medical cost sharing community, and the generous donations of others, for the purpose of supporting other members who have unshareable medical expenses. The allocation of these funds is decided on a case-by-case basis by the Additional Giving Committee.
A sharing request for ineligible medical expenses. The request and expenses must align with the Principles of Membership and may be considered for sharing from the Additional Giving fund.
Contributions in excess of the monthly contribution for the household membership, additional services, and IUA.
Optional services that may be added to, or included with, existing memberships. These include preventive sharing, Teladoc®, Rx Share, and LifeWorks.
An individual, DPC, marketing organization, or others certified to offer Zion HealthShare memberships. Depending on state laws and requirements, as well as their own preferences, affiliates may or may not be compensated for doing so.
The maximum amount that may be shared per member, per year. Zion HealthShare does not have annual or lifetime sharing limits for eligible medical expenses. However, some expenses may be subject to limitations according to our Member Guidelines.
The date Zion HealthShare receives a complete membership application.
A household’s identified combination of membership type, membership tier, membership age group, and membership IUA.
A fund, made up of monthly contributions from members, for the exclusive purpose of paying for, or reimbursing, the cost of members’ eligible medical expenses.
A marketing organization or employer certified to offer Zion HealthShare memberships that is not compensated.
Anomalies of body structure or function that are present at birth or that are identified or diagnosed within the first year of life.
The uninterrupted period of time when a household or individual has been an active member of the medical cost sharing community, by which sharing limitations requiring phase-in or waiting periods are determined.
A list of all members who contribute, whether it be through direct billing from Zion HealthShare or through their employer.
The date medical services were rendered on behalf of a member.
A sharing request that is eligible for sharing with the medical cost sharing community.
A group of members, including the primary member, their spouse or domestic partner, and/or unmarried children under 26. A household can only have one household membership.
A membership associated with, and applied to all members of, a household. Individual members within the household can have unique membership start and termination dates.
A member, and applicable dependents thereof, who have withdrawn from membership or have had their membership revoked.
A sharing request ineligible for sharing by the medical cost sharing community, for reasons stipulated in our Member Guidelines and Principles of Membership.
The amount members are required to pay on their own before associated eligible medical expenses may be shared. Members have six months from the initial date of service to meet their IUA.
An individual who has successfully completed a prescribed program of study in one of a variety of health fields, and who has obtained a license or certificate indicating their competence to practice in that field (MD, DO, ND, NP, PT, PA, Chiropractor, etc.), and whose license or certificate is both active and recognized by the state where services are rendered.
The maximum amount that may be shared by a member for the lifetime of their membership. Zion HealthShare does not have annual or lifetime sharing limits for eligible medical expenses. However, some expenses may be subject to limitations according to our Member Guidelines.
A membership-based practice of sharing eligible medical expenses between members.
The collective body of all active members of Zion HealthShare (also referred to as the “Zion HealthShare community,” or “community”).
A nonprofit organization whose primary purpose is to care for the needs of its members and facilitate each member’s ability to care for one another. A medical cost sharing organization is not an insurance company.
A service, procedure, medication, evaluation, or treatment necessary to restore or maintain physiological function, and that is provided in the most cost-effective setting consistent with the member’s condition. The fact that a provider may prescribe, administer, or recommend services does not always make them eligible for sharing. This applies even if the recommended service is not listed as a membership limitation or mentioned in the Member Guidelines. To help determine medical necessity, we may request medical records and information from licensed medical professionals.
The reason for which a member submits a sharing request. This includes, but is not limited to, preventive visits, maternity, an accident, or a serious medical incident.
The individual(s) within a household, or dependent(s) thereof, who, demonstrated by their participation, have agreed to abide by our requirements and are thereby eligible to share medical expenses with other members in accordance with the Member Guidelines, and their membership type. This includes the primary member, their spouse or domestic partner* and any unmarried children (by birth, marriage, or legal guardianship) under the age of 26.
*Domestic Partner is an unrelated and unmarried person who shares common living quarters with a Primary Member and lives in a relationship that is not legally defined as marriage by the state in which the member resides.
Any amount paid by the member for medical costs that is not shareable with the medical cost sharing community. These amounts are in addition to the IUA.
There are a variety of available options for the primary member to choose from, featuring different IUAs, sharing limits, and monthly contributions.
The age group, as defined by Zion HealthShare, which the oldest household member belongs to.
The IUA that is chosen by the primary member, usually at the time of joining, and applied to the household’s sharing requests.
The date on which a person’s membership begins.
Determined by the number of individuals participating in a household membership and their relationship to the primary member.
Defined as either Direct or Essential.
A membership is considered withdrawn when the member either requests they be withdrawn from the medical cost sharing community, ages out, or fails to submit timely monthly contributions (for more than ten days past the contribution date). Members who are withdrawn from the medical cost sharing community are eligible for reinstatement, unless they were withdrawn due to aging out at 65. Members have 30 days from the membership withdrawal date to reinstate their membership and qualify for continuous membership. Both withdrawal and revocation of membership causes a membership to become inactive until it is reinstated (if eligible).
Members voluntary sharing of one another’s medical expenses.
A set monetary amount voluntarily submitted by a member and placed in the care of Zion HealthShare, for the purpose of maintaining active membership and sharing in the medical expenses of fellow members. Funds are disbursed each month for members’ medical expenses, other than the small portion of these funds allocated for administrative and vendor costs, as allowed by law.
Any illness or injury for which a person has been examined, been diagnosed, taken medication, had symptoms, or received medical treatment within 24 months prior to their membership start date.
The member who created the household membership. The primary member may or may not be the oldest member in the membership household.
Membership may be revoked for multiple reasons including, but not limited to, a violation of our Principles of Membership. Members who have their membership revoked may not have it reinstated or reestablished. Revocation of membership causes a membership to become inactive.
Medical expenses are shareable with the medical cost sharing community when they qualify in accordance with the Member Guidelines and are determined to be eligible for sharing.
The maximum amount that can be shared for any individual sharing request or type of medical service, as described in the Member Guidelines.
A form required to notify the medical cost sharing community of a member’s medical need and associated medical expenses.
See the applicable sections of the Member Guidelines for qualifying requirements.
Identified as either regular, surgery, preventive, maternity, alternative, or Additional Giving depending on the type of medical services and treatment the member is receiving.
An additional monthly charge of $50 a month for a membership household wherein one or more members uses tobacco as defined in our Member Guidelines.
A medical expense incurred by a member that is excluded from sharing based on our Member Guidelines and Principles of Membership.