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.

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).

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.

Social Security Exempt

Social Security Exempt individuals are not eligible for Medicare. Social Security exempt folks under 60 years old may apply on an individual basis. However, Social Security exempt folks 60 years and older must apply with a group (10 or more paying members).

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: It is expected that all AHS members have “medical coverage” as part of their auto insurance.
    AHS is a secondary provider and will share auto accident related  expenses after a member’s insurance is depleted. However, there is a household minimum of $5,000 per accident that is required by either the member’s auto insurance or member, AHS will share the expense after the initial $5,000 is met.
  • 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.

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

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.