Guidelines

We’re here to help

We’re Not Health Insurance

 

This is not insurance. We work hard to avoid a long list of exclusions and fine print. Our heart is to serve our members, rather than trying to find reasons to avoid service. Should you have a need that is not eligible for sharing, please contact AHS to review available options!

Pre-existing Conditions

On both the Standard and Complete Programs pre-existing conditions are eligible for sharing after a 12-month period and subject to the following guidelines: Standard Program up to $10,000 per year; Complete Program up to $15,000 per year.

However, all pre-existing cancers, pre-existing organ failure (including diabetes, heart conditions, kidney dialysis, etc.), and pre-existing genetic abnormalities/syndromes that require ongoing maintenance are not eligible for sharing. AHS is available to aid in bill negotiating for all members with any of the above pre-existing illnesses. Exceptions may be made for large group enrollments.

Maternity:
If a birth occurs in less than 10 months after becoming a member, that maternity case will not be shareable. Exceptions can be made if a doctor or midwife verifies an early or pre-mature birth in which the due date for the pregnancy was at least 10 months after taking out membership.

Congenital Conditions

If both parents are members of either the Standard or Complete Program, birth defects and congenital conditions are eligible to be shared up to a lifetime maximum of $150,000 per child. AHS can assist in enrolling members in available financial aid programs.

Medical Equipment

Medical equipment prescribed by a medical doctor is eligible for sharing up to $10,000 per member (lifetime limit). Examples include but is not limited to defibrillators, insulin pumps, oxygen generators/tanks, etc.

Maternity

Maternity through hospital includes sharing for all bills related to the maternity case including prenatal checkups and up to 2 ultra-sounds (unless additional ultra-sounds are deemed necessary by a medical doctor).

Maternity through mid-wife includes sharing for all maternity bills and 1 ultra-sound. If an additional ultra-sound(s) is deemed necessary by a medical doctor the maternity case will be considered high-risk and ISA will increase to “maternity through hospital” rate (Standard $3,000/Complete $1,500).

If a birth occurs in less than 10 months after becoming a member, that maternity case will not be shareable. Exceptions can be made if a doctor or midwife verifies an early or pre-mature birth in which the due date for the pregnancy was at least 10 months after taking out membership. Also, note that Maternity is not shareable in the “Catastrophic” membership plan. This includes any medical needs of both mother and child. 

Definitions

ISA

ISA is an acronym for “Individual Shared Amount” and is the per incident or illness member’s responsibility prior to being eligible for group sharing. After the ISA is met, the remainder of the medical bill is eligible for 100% sharing, subject to AHS guidelines, sharing funds availability, and specific membership program details.

Group

A group is defined as 20 or more units from an individual church, at a single location. Employers and Christian Ministries can also qualify as groups if they meet the 20-Unit requirement. A group should assign a contact person. 

Social Security Exempt

Social Security Exempt individuals are not usually eligible for Medicare or Medicaid. Social Security exempt persons under 60 years of age may apply on an individual basis. However, Social Security exempt persons 60 years and older must apply with a group (20 or more paying members).

Unit

A Unit is any member 18 years or older. Children from the same family under the age of 18 also qualify as one unit collectively. Example: Husband – 1 Unit; Wife – 1 Unit; Children under 18 – 1 Unit; Total = 3 Units. (Children over 18 also qualify as their own Unit.)

Medicare Parts
A & B

Medicare Parts A & B are required for all members who are Medicare eligible.

Congenital Conditions

Congenital Conditions relates to maternity and refers to genetic abnormalities that are discovered at or prior to birth.

Terms

Changing Program Levels

If a member changes to a lower sharing level, bills for any
current or previous conditions will be shared at the lower level’s guidelines. If a member changes to a higher level, bills related to any illnesses, injuries, or symptoms experienced prior to the switch will be shared according to the previous program’s guidelines. In summary, medical expenses will be shared according to the member’s program guidelines at point of experience or symptoms. members).

Items not routinely shared

 

  • Auto related injuries:Members are encouraged, (but not required) to include personal medical coverage as part of their auto insurance. Whatever the case, the first $5,000.00 of an auto related injury will not be shareable. This is per accident. 
  • Work related injuries: It is expected that work related injuries are covered by worker’s
    comp. AHS does have a Worker’s Aid plan add-on that shares job related injuries and time off work
    expenses for only $22.00 per month. However, this is not worker’s comp insurance.
    (see “Worker’s Aid Program” details for more information)
  • Organ transplants.
  • Non-FDA approved or alternative medicine.
  • Mental or behavioral illnesses will be reviewed on a case by case basis by the AHS team.
  • Medical bills not pre-authorized by AHS: Except for emergency room visits, all medical expenses must be pre-authorized by AHS.

Are medical treatments in Mexico shareable?  

  • Catastrophic Plan: Not shareable.
  • Standard Plan: Up to $20,000 per cancer case only.
  • Complete Plan: Up to $30,000 per cancer case only.

Non-Medicare Members 65 and over

There is a 75/25% sharing of the cost (Anabaptist HealthShare shares 75%) for non-Medicare members over 65 after ISA is met. Any non-Medicare individuals over 60 must come with a group to be eligible for AHS membership.

Medicare Eligible Members 65 and over

This Sharing Plan has the expectation that any Medicare eligible member reaching the age of 65 will be covered under Medicare parts A and B. If a member is enrolled in Medicare parts A and B, the monthly contribution amount is reduced.

For the Standard plan, it is reduced to $50 per month.
For the Complete Plan, it is reduced to $75 per month.

Pharmaceuticals are shared if the member is also enrolled in Medicare Part D. (Program ISA’s apply)

Exclusions

Any illnesses, accidents, or cases that result from the following:

  • Alcohol
  • Tobacco
  • Illegal drugs
  • Abuse of legal drugs
  • STDs, pregnancies, or any illnesses related to intimate relationships outside of marriage.

All pre-existing conditions are subject to a 12-month waiting period before they are eligible for sharing.

Pre-existing cancer cases are not eligible for sharing. Exceptions may be made for group enrollments.

See “Pre-existing Conditions” for more information concerning pre-existing conditions

Frequently Asked Questions

Are Doctor’s office/wellness visits shareable? 

Most doctor office visits are less than a plan’s ISA and therefore do not qualify for sharing. However, if the doctor’s office visit is in relation to an illness or injury that is eligible for sharing, the doctor’s bill is included in the “case” and eligible to be shared on both the Standard and Complete plans, after the ISA is met. If the bill is less than your plan’s ISA, you pay the bill as “self-pay”, but send AHS the receipt if the visit is part of an eligible case. 

When is a Maternity case not Shareable?

If a birth occurs in less than 10 months after becoming a member, that maternity case will not be shareable. Exceptions can be made if a doctor or midwife verifies an early or pre-mature birth in which the due date for the pregnancy was at least 10 months after taking out membership. Also, note that Maternity is not shareable in the “Catastrophic” membership plan. This includes any medical needs of both mother and child. 

Are medical treatments in Mexico shareable?  

  • Catastrophic Plan: Not shareable.
  • Standard Plan: Up to $20,000 per cancer case only.
  • Complete Plan: Up to $30,000 per cancer case only.

What Happens if a Member falls behind in submitting the monthly sharing contribution?

The Member will be reminded by AHS of the need to bring the account current. No bills will be eligible for sharing on an account overdue 30 days unless satisfactory arrangement has been made with AHS to bring the account current. If the Member fails to bring the account with 60 days, that account will become “inactive”. If a former Member wishes to reinstate an inactive account, it will be considered a new member application, requiring a new application and a $100 sign-on contribution. 

 

How should Elective procedures be handled?

Please get pre-authorization from AHS prior to scheduling an elective procedure. There may be discounts that are best negotiated prior to the procedure. AHS will handle the negotiation and payment for all eligible surgeries. Simply present as self pay and forward the bills unpaid to AHS as soon as you receive them. 

What about Medical Emergencies?

If you have an emergency, please utilize UrgentCare or other secondary emergency facilities whenever appropriate. Members do not need AHS approval for Hospital ER visits but use discretion when contemplating whether a visit is necessary. If the ER visit results in a hospital stay or the ER bill is larger than your plan’s ISA, do not pay the bill. Simply present as self pay, and forward the bills to AHS as soon as you receive them. AHS will handle the bill negotiations and payments. 

Your Trusted Alternative to Traditional Health Insurance.

 

We are recognized by the U. S. Department of Health and Human Services as a “Health Care Sharing Ministry”.

We are a 501(c)(3) public charity

We are a non-profit corporation.

We are a qualified ACA Exemption.