Preventive+ Member Guidelines

The Maximum Lifetime Sharing amount is $250,000 per member. 

The Maximum Sharing Amount per member per year is $25,000. 

ShareNet utilizes multiple sources and approaches to discount members’ medical bills to a reasonable amount, as is standard in healthcare today.  Eligible Medical bills are shared at the discounted rate less any Provider Fee and up to any and all limits set by the Program.

To be eligible for sharing, testing and treatment must be CMS- or FDA-approved and submitted on a CMS 1500 form or a UB and IB form, and ordered by a:

• Medical Doctor (M.D.)
• Doctor of Osteopathy (D.O.)
• Nurse Practitioner (N.P. or A.P.R.N.)
• Physician’s Assistant (P.A.)
• Doctor of Podiatric Medicine (D.P.M.)
• Dentist (D.D.S. or D.M.D.)
• Midwife
• Ophthalmologist

These CMS- or FDA-approved tests and treatments must occur at one of the following:

• Hospital
• Surgery Center
• Clinic
• Doctor’s office
• Diagnostic facility

Diagnosis and treatment are to be performed in the U.S. to be eligible for sharing, except in emergencies while traveling.

Medical bills related to a new condition, injury or illness are eligible for sharing, provided they are not listed in Section III. E. “Not Eligible for Sharing.”  These bills may be subject to limitations if they are listed in Section II. D.  “Limited Sharing.” Eligibility for sharing cannot be fully determined until after medical services are received, and bills are submitted for sharing.

Bills for active members must be received by ShareNet within 12 months from the date of service to be considered for sharing.

Most medical providers are willing to submit their bills electronically directly to ShareNet’s processor. However, in the event that a member must submit a bill for processing and/or reimbursement, it must be submitted through the online member portal.

When submitting a medical bill for processing, members are responsible for obtaining all information needed for processing per the form available online. 

Pre-existing Conditions

Pre-existing medical conditions are conditions in which signs, symptoms, testing, treatment, or use of medication occurred within 24 months prior to membership start. Routine or maintenance medications are considered treatment.

Pre-Existing Conditions are eligible for sharing after the 24th month of continuous membership.

Hospital, Emergency Room and Surgical Services

Inpatient Hospital Services Sharing is limited to $2500 per day up to the Maximum Sharing Amount per member per year of $25,000. The per day maximum includes  charges for medical professionals that provide services, room and board, medical supplies and any tests or procedures administered during your stay. Surgery and Anesthesia are not included in the Inpatient Hospital Services sharing limit.

Inpatient/Outpatient Surgical and Anesthesia services are limited to $5000 per member per membership year. Surgical services may be performed as inpatient, outpatient, or in an ambulatory surgical facility. The $5000 limit is to include all medical professionals (e.g., surgeon and anesthesiologist), operating room charges, surgical supplies, pre-surgery tests or procedures (unless otherwise described herein), and anesthesia. Surgery performed in an office is eligible for Sharing at 100% up to the annual sharing limit  after the provider fee has been paid.

Outpatient Hospital Medical Services are limited to $5000 per member per membership year.

Emergency Room Sharing is limited to $1000 per incident when there is no inpatient admission. Imaging is not included in the Emergency Room Sharing limit and will be subject to its own limits and Provider fees as described below.

Imaging

Imaging Services may be performed at any Outpatient Imaging Facility or in a hospital as part of an inpatient stay.

Sharing of X-rays is limited to $200 per day, subject to the Provider Fee being paid at the time of service. 

Imaging services that are not part of an inpatient hospital stay including ultrasound, CT scan, MRI, MRA, Diagnostic Mammograms, and PET scans are subject to a $400 Provider Fee and then are eligible for sharing at 100% up to the annual sharing limit. 

Maternity

Maternity is eligible for sharing if the mother’s due date for delivery is at least twelve months after joining ShareNet. Sharing is limited to $5,000 for hospital or birthing center delivery for mother (including antepartum care, the cost of delivery, and any complications to the mother and postpartum care) and $2,500 for baby or babies for any single pregnancy event (regardless of how many babies are born during the event) If child is added to membership within 30 days of birth, complications for the child will fall under the Inpatient Hospital services limit described herein.

Medical bills for congenital conditions are eligible for sharing as part of the baby’s need if the child is added as a member within 30 days of birth. Any medical bills related to a congenital condition in the child which first produces symptoms and is first discovered after birth will not be considered a pre-existing condition if the child is added as a member within 30 days of birth.

For ineligible maternity events, any fetal abnormalities and/or congenital abnormalities noted in medical records prior to the mother joining ShareNet, will be considered a pre-existing condition and would not be eligible for sharing. 

For delivery charges to be eligible, delivery must be performed by a Medical Doctor, Doctor of Osteopathy, or Midwife who is properly licensed, certified, and/or registered in the state of delivery.

The newborn can be a member from birth if a request to add them to the membership is made within 30 days of the date of birth.

If the mother is not a member for twelve months prior to delivery, the following are instances where maternity bills are ineligible for sharing: 

• Medical bills incurred before the newborn’s Membership Date.
• Unresolved maternity medical conditions of child or mother.

Preventive Care Services: Limitations, Intervals, and Requirements

The Preventive Care Services schedule (below and on the following pages) represents the type of medical services that are eligible for sharing, as well as the permitted interval(s) and any requirements of such medical services.

You may have to pay for services that are not coded as preventive. Ask your provider if the services you need are preventive or diagnostic/treatment. Always check what your plan will pay for before proceeding.

As it pertains to eligible preventive care for both men and women, both the test and coordinated office visit will be eligible for sharing.

Note: Bills are processed in the order they are received to apply allowances and sharing.

Sharing is limited to one (1) immunization of each type per member within the recommended ages.

Motor Vehicle Accidents- Medical bills incurred from the use of motorized vehicles will only be shareable for any amount remaining after an insurance entity or other liable third party has paid first if all other Guideline requirements have been met. In addition, medical bills related to the motorized vehicle accident will not be eligible for sharing if any of the following applies: 

• The operator of the vehicle was impaired by the use of alcohol or any illegal substances in accordance with the law.
• The vehicle was used in to race another vehicle, to perform a stunt, or in the commission of a crime.
• The operator’s age was below that required by law, or the operator was not legally licensed as required by law.

There are many variations in auto insurance policies and numerous state rules and regulations regarding auto insurance. Therefore, ShareNet has not set a minimum requirement for members regarding auto insurance.  However, for the sake of keeping monthly financial contributions low, we strongly urge you to set the highest possible limit on the medical assistance available through your auto insurance policy.

Medical transportation by ground is eligible in emergency situations or when medically necessary for transport for admission to another medical facility. Ground Transportation is limited to $500 per incident.  Medical bills for emergency flights, including domestic and international, whereby the member is transported to the United States from a different country, even if the situation is life-threatening, are not eligible for sharing. We strongly encourage you to look into other available resources. In the case of international travel, travel medical insurance can typically be purchased through a travel agent. There are also programs available for a monthly fee in case you ever have to be air-lifted.

Inpatient and Outpatient Mental Health Care

Psychological treatment, tests, or counseling. Only emergency room bills incurred to physically stabilize the patient are eligible for sharing, subject to limitations herein.

Bills incurred as the result of the abuse of drugs or alcohol, including charges for residential treatment centers.

Charges for treatment of any intentionally self-inflicted illness or injury, including suicide or attempted suicide. Only emergency room bills incurred to physically stabilize the patient are eligible for sharing, subject to limitations herein.

Medical bills for outpatient or inpatient Vision Therapy, Cardiac Therapy, Respiratory Therapy, Physical Therapy, Occupational Therapy, and/or Speech Therapy, unless part of an inpatient stay.

Skilled Care at home services

Hospice Care

Durable Medical Equipment

Prosthetics

Prescription medications are not eligible for sharing; however, members can access wholesale pricing on most Prescription Medications with their Member Card.  (see ShareNet Member Center for prices at your local pharmacy.

Dental expenses. Exception: Bills for the repair of broken teeth are eligible for sharing if:

• they were incurred due to an accident, and the accident occurred while the ShareNet member was in good standing, and
• the accident was not caused by chewing.

Expenses from Temporomandibular Joint Disorders (TMJ/TMD) are not eligible for sharing. This exclusion applies regardless of variations in diagnostic coding(i.e., micrognathia, congenital malformations of the jaw, etc.), where treatment is being rendered, or the type of practitioner providing the treatment.

Bills for sleep apnea diagnosis, treatment, or equipment prescribed or administered.

Vision correction (optometrist services, eye exams, eyeglasses, contact lenses, etc.)

Audiological expenses.

Chiropractic treatment.

Over-the-counter medications, including vitamins and nutritional supplements.

Elective, non-health related cosmetic surgery and any complications arising from such procedures. 

Weight reduction programs or procedures.

Abortions.

Medication or procedures are related to gender reassignment or change.

Infertility testing or treatment.

Sterilization or reversal.

Gestation or surrogate maternity procedures; in Vitro fertilization and associated maternity bills.

Genetic testing is ineligible unless required to determine treatment for a current medical condition. Medical records must be provided.

Medical supplies, including (but not limited to): syringes, test strips, lancets, orthotics, batteries, etc.

Medical appliances and equipment, including (but not limited to): hearing aids, breast pumps, crutches, etc.

Alternative treatment including acupuncture and any blood work or testing supporting alternative treatment. This exclusion applies regardless of the type of practitioner (naturopaths, homeopaths, medical doctors, etc.)

Non-medical expenses such as travel expenses,postage, shipping, finance charges, interest, nutritionist services, phone calls, private room upcharge, etc.

Nursing home care and/or rehabilitative housing.

Any therapy performed for developmental or educational reasons

Health or medical practice membership fees or gym membership fees.

Charges for services, supplies, or treatment from any hospital owned or operated by the United States government or any agency thereof or any government outside the United States, or charges for services, treatment, or supplies furnished by the United States government or any agency thereof or any government outside the United States, unless payment is legally required.

Charges for an injury sustained or illness contracted while on active duty in military service unless payment is legally required.

Charges for services, supplies, or treatment for the treatment of illness or injury which is caused by or attributed to war or any act of war (whether declared or undeclared, civil or international, or any substantial armed conflict between organized forces of a military nature), or participation in a riot, civil disobedience, or insurrection.

Charges in connection with any illness or injury arising out of or in the course of any employment intended for wage or profit, including self-employment.  This is typically covered under the member’s worker’s compensation insurance.

Charges in connection with any illness or injury sustained while taking part or attempting to take part in an illegal act, including but not limited to misdemeanors and felonies, or for any injury or illness that arises from or is caused during the commission of any illegal act. It is not necessary that an arrest occur, criminal charges are filed, or, if filed, that a conviction result for the Administrator to determine that an act constitutes an illegal act. Proof beyond a reasonable doubt is not required to be deemed an illegal act. The Administrator has the sole discretion to determine whether a particular act constitutes an Illegal Act.

Any charge in connection with any Illness or Injury that results from engaging in a hazardous pursuit, hobby, or extreme activity without using the recommended safety equipment. A pursuit, hobby, or activity is hazardous if it involves or exposes an individual to the risk of a degree or nature not customarily undertaken during the member’s customary occupation or if it involves leisure time activities considered by the Administrator, taking all circumstances into account, as involving unusual or exceptional risks, characterized by a threat of danger or risk of bodily harm.

To the extent that sharing under this ShareNet membership is prohibited by any law of the jurisdiction in which the member resides at the time the expense is incurred.

Any services, supplies, or treatment for which the member is not legally required to pay; or for which no charge would usually be made; or for which such charge, if made, would not usually be collected if no sharing allowances existed; or to the extent, the charge for the care exceeds the charge that would have been made and collected if no sharing allowances existed.

Charges incurred outside the United States if the member traveled to such a location for the sole purpose of obtaining services, supplies, or treatment.

Charges for services, supplies, or treatment rendered by any individual who is a close relative, as determined by the Administrator, of the member or who resides in the same household as the member.

Charges for services, supplies, or treatment rendered by facilities, physicians, or professional providers beyond the scope of their license; for any treatment, confinement, or service which is not recommended by or performed by an appropriate professional provider.

Charges for illnesses or injuries sustained by a member due to the action or inaction of any party if the member fails to provide any information as specified in the Subrogation section or as requested by ShareNet in connection with any third-party recovery.

Needs not submitted within the timely filing limit deadlines as specified herein.

Expenses which are shareable under any one section of the Member Guidelines shall not be shareable under any other section of the Guidelines.

Charges for services, treatment, or care of any kind that are provided due to a court order or are required by a court of law and/or are imposed as an alternative to, or in addition to, fine or imprisonment. This exclusion shall not apply to expenses for the illness or injury that would be shareable under the membership in the absence of court order and for which the member is legally obligated to pay.

Charges for administrative fees; completion, filing, or copying of Need forms, itemized bills, or medical reports; reports or appearances in legal proceedings, mailing, postage, or shipping and handling; missed appointments; late fees; sales tax; interest or penalties; travel time or expenses; or telephone consultations.

Charges for the release and review of medical records.

Charges for services, supplies, or treatment for transsexualism, gender dysphoria, or sexual reassignment or change, including medications, implants, hormone therapy, surgery, or medical treatment.

Charges for treatment or surgery for sexual dysfunction.

Charges for biofeedback therapy.

Charges for services, supplies, or treatments provided by your employer.

Charges for services, supplies, or treatments provided by an educational institution as required by law.

Except as medically necessary for the treatment of metabolic or peripheral-vascular illness, charges for routine, palliative, or cosmetic foot care, including, but not limited to; treatment of weak, unstable, flat, strained, or unbalanced feet; subluxations of the foot; treatment of corns or calluses; non-surgical care of toenails.

Charges for custodial care, domiciliary care, or rest cures.

Charges for travel or accommodations.

Charges for professional services billed by a physician or Registered Nurse, Licensed Practical Nurse, or licensed Vocational Nurse who is an employee of a hospital or any other facility and who is paid by the hospital or other facility for the service provided.

Charges for environmental change, including hospitalization or physician charges connected with prescribing an environmental change.

Clinical Trials, whether FDA-approved or not

Office visits, physical examinations, immunizations, and tests when required solely for sports, camp, employment, travel, insurance, marriage, or legal proceedings.

Routine foot care for treatment of; flat feet, corns, bunions, calluses, toenails, fallen arches, weak feet, and chronic foot strain.

If a member qualifies for public assistance or private benevolence programs, they must apply for the program benefit and receive an eligibility determination that the member does not qualify for the benevolence program before the bill can be considered for sharing. If the member receives assistance through the use of a program, the next three months of their monthly Share Portion will be waived.

Eligible needs will be approved for sharing when medically necessary. Medically Necessary, which is defined as health care services that are clinically appropriate in terms of type, frequency, extent, site, and duration for the diagnosis or treatment of the member’s sickness or injury and ordered by a Physician exercising prudent clinical judgment for the purposes of evaluation, diagnosis or treatment of that member’s sickness or injury. The Medically Necessary setting and level of service are that which, considering the member’s medical symptoms and conditions, cannot be provided in a less intensive medical setting. Such services, to be considered Medically Necessary, must be no more costly than alternative interventions, including no intervention, and are at least as likely to produce equivalent therapeutic or diagnostic results without adversely affecting the member’s medical condition.

• It must not be maintenance therapy or maintenance treatment;
• Its purpose must be to restore health;
• It must not be primarily custodial in nature;
• It must be a listed item or treatment allowed for reimbursement by CMS (Medicare); and
• ShareNet reserves the right to incorporate CMS (Medicare) guidelines in effect on the date of treatment as additional criteria for the determination of Medical Necessity and/or eligibility of a Need.
• The mere fact that the service is furnished, prescribed, or approved by a Physician does not mean that it is “Medically Necessary.”
• The determination of whether a service, supply, or treatment is or is not Medically Necessary may include findings of the American Medical Association and ShareNet’s own Administrator or medical advisors.

“Permitted Sharing Level(s)” means charges for Medical Care which is Medically Necessary.

for the care and treatment of illness or injury, but only to the extent that the fees charged, therefore, are within all applicable limitations and restrictions established in the ShareNet Guidelines, including, but not limited to, the following: 

• Hospitals (both inpatient and outpatient services), Ambulatory Surgery Centers, and Independent Facilities: The Permitted Sharing Level for Medical Care established by the Guidelines shall be based upon the average of 150% of the Medicare Allowable Amount for the Medical Care included in the Guidelines and 135% of the Cost of the Medical Care included in the Guidelines; provided, however, that any such Permitted Sharing Level based on the Cost of the Medical Care included in the Guidelines shall be limited to an amount not to exceed 175% of the Medicare Allowable Amount or the amount of Usual, Customary and Reasonable Fees for the Medical Care included in the Guidelines. 

• Other Medical & Surgical Services. The Permitted Sharing Level for any general medical and/or surgical Medical Care included in the Guidelines not addressed under the immediately preceding subsection or subsection (d) below may be established or calculated taking into consideration and/or based upon the average of: (i) allowable reimbursement amounts for such Medical Care included in the Guidelines according to the OPPS Reimbursement or other Medicare fee payment methodology plus an additional 50%; (ii) the Costs for such Medical Care included in the Guidelines plus an additional 35%; or (iii) the Usual, Customary and Reasonable Fees as reflected in, or determined by reference to or through the use of any other industry-standard resources or widely recognized data sources, including any resources listed above or any other fee and/or cost information, sources, lists or comparative data published or publicly available (free, for purchase or by subscription), or any combination of such resources that are sufficient, in the opinion of the Claims Delegate, to determine a Reasonable amount of Medical Care included in the Guidelines. 

• Facilities Lacking Requisite Benchmarks & Specified Services. In the event Permitted Sharing Levels for Medical Care included in the Guidelines cannot be determined - for technical reasons - in accordance with the two immediately preceding subsections, and for other Medical Care included in the Guidelines specified below, the Permitted Sharing Levels may be determined as follows: 

• • Supplies, Implants & Devices. The Permitted Sharing Level for charges for medical and surgical supplies, implants, and devices may be based upon 120% of the Cost to the Hospital or Independent Facility providing such items.

• • Professional Services. The Permitted Sharing Levels for Professional Services shall be determined based on the chart for the professional service identified. This chart is available upon request. 

• • Dialysis Services and Infusion Therapy. The Permitted Sharing Level for dialysis services and infusion therapy visits (which shall include dialysis, facility services, supplies, and medications provided during treatment) shall be determined by review of the Medicare Allowable Amount for the billing Hospital or Physician considering clinical considerations pertinent to the patient being treated. 

• • Medical Care Provided Under Direct Contract. The Permitted Sharing Levels for Medical Care provided by Directly Contracted Hospitals or Physicians will be the rates or fees established under the applicable contract; provided, however, that the amounts of such rates and fees shall be presumed to be Usual, Customary, and Reasonable only to the extent that they do not include otherwise Improper Balances, which charges shall be outside of the Permitted Sharing Levels. 

If the Permitted Sharing Level exceeds the actual charge billed for the treatment, service, or supply in question, sharing and payments to providers will be based on the actual billed charge. The Permitted Sharing Level for Medical Care will not include charges related to Unbundling, Errors, Unclear Description, or Misidentification.

If a member has insurance or is eligible/qualified for any insurance benefits or other health or welfare benefits, such as an employment-related health or welfare plan, worker’s compensation insurance, homeowner’s insurance, or fraternal benefits, the member is expected to take all reasonable steps to qualify for such payments and to exhaust benefits available under those resources before submitting a request for sharing.

In certain instances where a Need may have been caused by actions of a third-party, the member may be required to assign to ShareNet any and all rights that the member has against all parties responsible for causing the injury or illness. This is up to the total amount members shared on behalf of the member. This includes any and all amounts received by the member from a settlement, judgment, or other awards.

A member can appeal bill-sharing eligibility decisions with which they disagree if he or she believes:

• the medical records were misread, or
• the Guidelines were misapplied, or
• one or more of the member’s providers incorrectly recorded their medical history.

After a review by ShareNet, if the member disagrees with ShareNet’s decision, the member has 90 days to request a review by a Five Member Appeal Panel established by ShareNet, and the member may submit a written position statement to the Panel. A teleconference will be held wherein the Panel can ask questions of both the member and ShareNet. A simple majority vote (three out of five) will carry the decision to share or not.

While these Guidelines are not a contract for insurance, the Guidelines do outline the manner in which voluntary sharing occurs among ShareNet members. Further, you have authorized ShareNet to exercise reasonable discretion to administer its medical cost-sharing plan according to these Guidelines. Any claim or dispute arising out of, or related to, enforcement of these Guidelines after a member has exhausted his appeals provided for in Section "Sharing Appeal" shall be addressed through mediation, with each party to bear their own costs, attorney’s fees, and 50% of the mediator’s fee and with the mediation filing fee to be paid by ShareNet.

If a resolution of the dispute and reconciliation do not result from mediation, the matter shall then be submitted to an independent and objective arbitrator for binding arbitration, with each party to bear their own costs, attorney’s fees, and 50% of the arbitrator’s fee, and with the arbitration filing fee to be borne by ShareNet.

Members agree that these methods of dispute resolution shall be the sole remedy for any controversy or claim arising under these Guidelines or against ShareNet or its agents, employees, and contractors; and expressly waive their right to file a lawsuit for such disputes, except to enforce a legally binding arbitration decision.

To participate in the ShareNet Community, all members must activate a Share Account on the Virtual Share Exchange Platform. Your Share Account is a virtual account, and all deposited funds are received by America’s Christian Credit Union located in Glendora, CA, which holds them “For the Benefit of ShareNet Members.” The Share Account will display your account balances, sharing transaction history and other relevant information. The money in your Share Account is insured and is fully controlled by you except as described herein.

To activate your Share Account, you will be required to provide the necessary personal information to comply with U.S. Banking Regulations. Once your information is submitted and verified, you will be required to link your Share Account to one of your External Bank Accounts, such as Bank of America or Wells Fargo. Each month, you will fund your Share Account with an EFT (electronic funds transfer) from your external bank account.

ShareNet members will receive a Monthly Share Notice through the VSE Platform to inform them and remind them of the monthly amount that they are to contribute. The monthly amount that you are to contribute (your Total Share Amount Due) is based on the ShareNet Sharing Program Level that you have selected.

The amount specified in your Monthly Share Notice is transferred through an EFT drawn off your External Bank Account. EFTs are always for the “Total Share Amount Due.” The “Total Share Amount Due” is displayed on every Monthly Share Notice, and it will include the current Monthly Share Amount, any Past Due Amounts, and any relevant Service Fees.

The Total Share Amount Due may be paid manually within the VSE Platform or through Recurring EFTs that you configure within the system. You will have the ability to add, edit and delete your Recurring EFTs, as well as your linked external bank account, at any time.

Your Share Account is a financial account that you own and control. You will have the ability to add, edit and delete your Recurring EFT settings, as well as your linked External Bank Account, at any time. You may also choose to have your medical bills “anonymously” shared among the members.

Otherwise, members who share in your medical bills will be able to see your last name when they view the list of members with whom they are sharing.

Participation in the ShareNet Sharing Community is voluntary. This means that when you are selected to participate in a sharing event if you object to that particular sharing event for any reason, you may withdraw and terminate your membership during the three-day publishing period (described below) rather than participate in that sharing event.

Medical bills that are eligible for sharing are matched, allocated, and published to the membership prior to sharing. To be compliant with regulations and safe harbor statutes, ShareNet implements a member-to-member, or peer-to-peer (P2P), approach to sharing, which means that members share funds directly with one another rather than drawing funds from a pool controlled by ShareNet.

Your medical bills will be submitted to ShareNet by your Medical Providers. ShareNet will process, all bills for eligibility per the Guidelines. Eligible bills are then submitted to the Virtual Share Exchange for sharing. Amounts Approved for Sharing are allocated to your fellow members who have been matched to share in (contribute toward payment of) your bill.

Members who have been matched to share your bill will be notified through a process called “publishing” as to the amount that will be withdrawn from their Share Account for the payment of your bill. They will also be notified as to who will be receiving their funds, unless you choose the anonymous setting in your Share Account’s Sharing Permissions. Once the three-day publishing period has ended, the amount published to each member is transferred to a Virtual Bill Account for the payment of your bill.

Members who have been matched and allocated to share in another member’s medical bill may withdraw from membership prior to the expiration of the three-day Publishing Period in which case no funds will be transferred to the receiving member.

Because a member may refuse to share in a particular medical expense for any reason or no reason, the sharing process remains entirely voluntary for every member. However, as noted above, any sharing refusal requires withdrawal from membership before the end of the three-day Publishing Period.

If you have an eligible medical bill that has been approved for sharing, the VSE will create a Virtual Bill Account for the payment of that bill. Virtual Bill Accounts are unique to a specific medical bill and are linked to your Share Account. Each Virtual Bill Account is unique to a member of your household, a medical provider, and a specific bill. Amounts collected in your Virtual Bill Account(s) are restricted and are displayed as a single line-item transaction in your Share Account.

Virtual Bill Accounts remain open until the Amount Approved for Sharing has been fully collected and transferred to your Medical Provider as payment for your bill or to you as a reimbursement. While Virtual Bill Accounts are aggregated in the transactional view of your Share Account, these funds are restricted and cannot be withdrawn from your Share Account. The transfer of funds out of your Virtual Bill Account will be displayed as a single line-item transaction in your Share Account.

In order to process and pay medical bills quickly, ShareNet implements a practice called Distributed Reserving. ShareNet is NOT insurance, so we do not collect and hold medical reserves in a centralized bank account. Instead, the Monthly Share Amount is set at a level to build a small balance (or reserve) in every member’s individual Share Account. These “Distributed Reserves” enable ShareNet to plan for the ebb and flow of medical usage and payments.

Administrator – The 3^rd party company utilized by ShareNet to process members’ medical bills for discounting and eligibility determination.

Annual Unshared Amount (AUA) – The dollar amount a Household must pay toward their own Eligible Medical Bills during a 12-month period. Members may share in Eligible Medical Bills in excess of the AUA. The AUA 12-month period begins on the Membership Effective Date.

Bill Approved for Sharing – An Eligible Medical Bill that meets the criteria for sharing in the Guidelines and meets the other conditions for sharing, including whether the member’s AUA has been met and other sharing limits have not been exceeded.

Cancellation Date – The month and day membership ends due to the member’s withdrawal or administrative cancellation.

Effective Date – The date the member’s current AUA has begun.

Eligible for Sharing – Any testing, treatment, procedure, or service that meets the criteria for sharing as established in the Guidelines.

Eligible Medical Bill – An incurred medical bill that meets the criteria for sharing as established in the Guidelines. The Eligible Medical Bill may be reduced by any discounts, fees, or other sources of payment.

Illegal Drugs – Drugs that are classified as Schedule 1 in Title 21 United States Code Controlled Substances Act.

Member – Any member of the ShareNet Sharing Plan, including each family member participating in a member household.

Member Household – The related family members participating in the ShareNet Sharing Program.

Membership Date – The date a member’s participation in ShareNet begins. Medical bills incurred after this date may be considered for sharing among members.

Pre-Existing – Pre-existing medical conditions are conditions in which signs, symptoms, testing, treatment, or use of medication occurred within 24 months prior to membership start. Routine or maintenance medications are considered treatment.

Primary Member – An adult member that is the main contact for the household membership.

Provider Fee – The portion of a medical bill that a member pays to a healthcare provider at each visit.

Auto-Share (Recurring EFT) – a Sharing Permission enabling a Primary Member to set up recurring electronic funds transfers (EFTs) to transfer the Total Share Amount Due specified in their Monthly Share Notice.

External Account – an existing bank account that is linked to the Primary Member’s Share Account and is used to transfer via EFT the Total Share Amount Due into the Share Account each month.

Manual Share – a function that enables a Primary Member to initiate an “on-demand” EFT to transfer the Total Share Amount Due specified in their Monthly Share Notice.

Permissions – are auto-enable functions (ex. Auto- Share) that are set and managed by the Primary Member.

Share Account – the member-controlled virtual account that is linked to both your External Account and your deposit account at America’s Christian Credit Union and is used for all sharing transactions and activities.

Grace Period – the number of days between the Share Due Date and Past Due Date.

Monthly Share Amount – the sum of the Share Portion and Required Miscellaneous Portions published in the Share Notice.

Past Due Date – the day of the month that a delinquent Total Share Amount Due becomes past due.

Past Due Reminders – Share Notice Reminders are sent to members who have not paid their Share Notice and are past due.

Payment Reminders – Share Notice Reminders sent only to members who pay manually instead of automatically, and only if the Total Share Amount has not yet been paid.

Previous Balance – is the sum of any past due, unpaid amounts published in the Share Notice.

Required Miscellaneous Portion – an amount set by the HCSO to fund certain described activities, such as its administrative and program expenses.

Share Due Date – the day of the month by which the Total Share Amount Due must be transferred via EFT in full.

Share Notice – the written notification to a member that details the Total Share Amount Due for the month.

Share Notice Date – similar to a statement date or invoice date, it is the day of the month that the Share Notice is published and distributed.

Share Payment (Funding) – transferring funds (Total Share Amount due) from a member’s External Account to their Share Account.

Share Portion – the portion of the Monthly Share Amount that is collected and used specifically for member-to-member sharing of eligible medical bills.

Total Share Amount Due – the sum of the Monthly Share Contribution Amount (Share Portion and Required Miscellaneous Portion), Optional Portion (auto-enabled by the member), Service Fee, and any past due amount (Previous Balance).

Adjusted Amount – the discounted or repriced amount.

Approved for Sharing – the portion of the Adjusted Amount that is eligible for sharing as per the program Guidelines.

Bill Status – References the processing stage/state of a specific Need or bill.

Charge Amount – the gross amount billed by the Medical Provider.

Explanation of Sharing (EOS) – is a notice sent to a member detailing the eligibility status of a bill, any discounted amounts, and what portion of the remaining Charge Amount has been shared by ShareNet members and any remaining amount that must be paid by the member.

Member Responsibility – the portion of the Adjusted Amount calculated to be member’s responsibility and will not be shared.

Need – is a grouping of medical bills by a medical event such as knee surgery. Individual medical bills may sometimes be referred to as a “Need.”

Published Amount -the portion of the Adjusted Amount that is eligible for sharing and has been published/allocated to the members for sharing.

Received Date – the date that ShareNet receives the medical bill and begins processing the bill for eligibility.

Service Date – the date that the member (patient) received services from the medical provider.

Shared Amount – the Published Amount that has been shared and collected in the member’s Sharing Account.

Sharing (Member-to-Member Transfers) – moving funds from a sending member’s Share Account to a receiving member’s Virtual Bill Account.

Available Balance – the total sum that is available for sharing a new eligible medical bill and/or Withdrawal. It is the Total Balance minus the Pending Balance minus the Restricted Balance.

Debits & Sharing – The “Negative (-)” transactions debited out of the member’s Share Account, which would be Miscellaneous Required Portion (i.e. Debits), Optional Portion, and Share Portion.

Deposits & Credits – The “Positive (+)” transactions that are credited to the member’s Share Account, such as EFT Transfers (i.e. Deposits) and Shared Funds Received (i.e. Credits) that a member might receive to pay their eligible medical bill.

Pending Balance – the sum of EFT(s) that have been initiated but have not yet posted to the member’s Share Account.

Restricted Balance – the sum of funds that have been credited to the member’s Share Account for purpose of paying an eligible medical bill.

Total Balance – the sum of the Pending Balance, Restricted Balance, and Available Balance in a member’s Share Account.