In an era when healthcare can feel rigid and confusing, our health share community is designed to be flexible, transparent, and member-focused. We take our role as stewards of the community’s shared resources very seriously, which is why we regularly update our guidelines to ensure they remain clear, fair, and aligned with our mission to support members responsibly.
Updates to the Member Guidelines have been made and will take effect on January 1, 2026. The changes include the introduction of a few new guidelines and clarifications to existing ones, with the goal of providing clearer expectations for current and prospective members.
Every year, the Zion HealthShare board reviews member’s suggestions regarding sharing in services that are not already part of the member guidelines. If they are approved they will be updated at the beginning of the following year.
Ashton Casper, the President of Zion HealthShare, shared that “In an era when healthcare can feel rigid and confusing, our health share community is designed to be flexible, transparent, and member-focused. We take our role as stewards of the community’s shared resources very seriously, which is why we regularly update our guidelines to ensure they remain clear, fair, and aligned with our mission to support members responsibly.”
The updated guidelines introduce new categories related to adoption, hormonal deficiencies, high-risk testing, and further clarify parameters around maternity care, tobacco use, neurodivergent disorders, medical supplies, and other services.
Adoption and Adoption Birth Expenses
Adopted children are considered the same as biological children, therefore, some medical expenses in relation to the birth may be eligible for sharing. The community can share up to $2000 for post-birth eligible expenses related to the following categories only:
- OB-GYN labor and delivery
- Cesarean
- Hospital labor and delivery
- Hospital room and board
- Anesthesiologist
Bills must be submitted within six months of the date of service and after a one-year waiting period from an active household membership. As newborns are not born through an eligible sharing request, there is a seven (7) day waiting period before adding the baby to the membership. Any medical conditions present at birth are considered as pre-membership medical conditions.
Hormonal Deficiencies
Expenses related to evaluations, treatments, or other services for hormonal deficiencies are eligible for sharing only when directly tied to an eligible sharing request.
Age-related hormonal deficiencies, including menopause, perimenopause, and male menopause, are not eligible for sharing.
High-Risk
Members classified as high-risk for specific illnesses may now receive up to $3,000 in shared expenses for high-risk testing, after the Initial Unshareable Amount (IUA) has been met and after completing the pre-membership medical condition waiting periods.
Furthermore, there have been updates to existing member guidelines that gives further clarification in the hopes of understanding.
End of Life Financial Assistance
Clarifications were added regarding eligibility, notification requirements, and submission timelines for end of life assistance. If a member passes away after one year of uninterrupted membership, financial assistance can be provided after receiving a copy of the death certificate. Required documentation must be submitted within 60 days and the membership will be withdrawn as it does not need to be active to qualify for end-of-life assistance. Remaining eligible expenses that occurred prior to the member’s passing must be submitted within 90 days for review of sharing.
Financial assistance includes:
- $10,000 for members aged 18 and older
- $3,500 for dependents aged 17 and younger
- $3,500 for children under one year old born through an eligible maternity request
Neurodivergent Disorders
The guideline previously titled “ADHD & SPD Treatment” has been updated to reflect broader terminology. Expenses related to evaluations, treatments, and prescriptions for neurodivergent disorders, including autism, ADHD, and Sensory Processing Disorder, are not eligible for sharing. Members may use Zion RxShare for applicable prescription discounts.
Tobacco and Smoked Cannabis Use
The tobacco surcharge policy remains in place, with additional clarifications. A $50 monthly surcharge applies per household with at least one tobacco user. Tobacco use includes cigarettes, cigars, smokeless tobacco, vape products, hookah, and smoked cannabis.
Failure to report use will result in a $500 fee, and sharing in eligible requests will be paused until the fee is paid. Sharing limits of $50,000 apply to four tobacco-related disease categories for members who have used tobacco within the past 15 years and those are:
- Stroke
- Tobacco-related cancers
- Heart conditions
- COPD
Insurance or other coverage
If a member has insurance, a group plan, government assistance, or another healthshare membership, those sources must be used first. Once those have been exhausted, the community may share remaining eligible expenses. Members must disclose all other coverage; failure to do so may result in ineligible expenses.
Fees, Interest, and Taxes
Fees, interest charges, and taxes on medical bills are not eligible for sharing.
Late fees or interest resulting from delayed submission of documentation are also ineligible.
Midwifery
Midwifery care from legally regulated providers is generally eligible for sharing, up to a $7,000 limit. Not all midwifery services may be eligible for sharing, and any expenses exceeding the $7,000 limit will be the member’s responsibility.
Maternity
When a child is born through an eligible maternity request, there are some preventive services that are eligible for sharing when the baby is added to the household membership within 30 days of delivery and when the services occur prior to discharge from a hospital.
These services are one in-hospital pediatrician visit, routine immunizations, routine lab work, and routine hearing tests. If a baby is born outside of the hospital, these services can be eligible for sharing as long as they are done within the first two weeks following birth.
Medical Supplies
Medical supplies related to treatment or recovery from a medical need that has been deemed eligible are generally eligible for sharing for up to 120 days from the start of treatment, as prescribed by a licensed medical provider. These expenses are shared at retail cost (or fair market cost when applicable), and members are encouraged to use vendors such as local pharmacies or medical supply stores. The following parameters are in place for prescription sharing:
- Minimum of $100 per item
- Maximum of $500 per medical need
- Cranial helmets may be eligible up to $1,500
Examples include braces, catheters, oxygen masks, and similar short-term-use items.
Sharing Requests
Clarifications to the sharing request section of the guidelines state that each medical need may result in medical expenses incurred by receiving medically necessary treatment that is proven safe and effective from licensed medical professionals and facilities, such as physicians, emergency rooms, and hospital facilities.
All diagnostic testing, including but not limited to blood and imaging tests, must be FDA-approved to be eligible for sharing and costs for testing done by laboratories and/or facilities whose results are not validated by the FDA are ineligible for sharing.
These updates take effect January 1, 2026. Current and prospective members are encouraged to review the updated 2026 Member Guidelines which are available on the Zion HealthShare website for comprehensive details and definitions.
*Zion HealthShare does not endorse or recommend the direct primary care (DPC) providers that are listed on its website. DPC providers are listed merely as a reference to assist members and not as a guarantee of sharing. Additionally, any and all treatment received from a DPC is still subject to the Member Guidelines. Members should read and understand the Member Guidelines concerning what is considered shareable and not shareable with the community.