Conditions you had before joining
Something you were already being treated for is handled differently. Here is exactly how.
What counts
Zion calls these pre-membership medical conditions. A condition counts if, in the 24 months before your membership start date, you were examined for it, diagnosed with it, took medication for it, had symptoms of it, or were treated for it.
If a condition was regarded as cured and needed no treatment and produced no symptoms for those 24 months, it is not treated as pre-membership.
The phase-in
Sharing for a pre-membership condition builds over four years rather than starting at full strength:
Year one: $0. A waiting period.
Year two: up to $25,000 per sharing request.
Year three: up to $50,000 per sharing request.
Year four: up to $125,000 per sharing request.
After four years, expenses relating to pre-membership conditions are eligible up to $125,000 in a twelve-month period, resetting each membership year.
Three common exceptions
High blood pressure, high cholesterol and diabetes (types 1 and 2) are not treated as pre-membership conditions, provided you have not been hospitalised for the condition in the twelve months before enrolling and you control it with medication or diet.
That is a large share of the people who assume they would be penalised for joining.
Your CoreMed care is unaffected
This phase-in applies to the sharing side only. Your CoreMed primary care, physical therapy, mental health and labs are part of the membership from day one regardless of your history. Your doctor does not care when you joined.
Zion HealthShare is not an insurance company. Neither this publication nor membership in Zion HealthShare are offered by an insurance company. Visit zionhealthshare.org to view your state-specific notice. State-specific notices.
Common questions
How far back does it look?
24 months before your membership start date.
What about my blood pressure medication?
High blood pressure, high cholesterol and diabetes are excepted, as long as you have not been hospitalised for it in the previous twelve months and it is controlled by medication or diet.
Does this affect seeing my CoreMed doctor?
No. Everyday care through your CoreMed clinic is unaffected by your medical history and starts immediately.
What if something is not eligible?
Sharing requests that are not eligible may still be considered through Zion's Additional Giving fund.