Why Does LaaSy Health Provide HealthShare?

Over 90% of events in healthcare take place in the outpatient setting like office visits, mammograms, routine medications, etc.--what we refer to as Everyday Care. LaaSy Health provides directpay access to members for this Everyday Care. However, 5-7% of events are large medical needs like ER visits, hospitalizations, pregnancy care, surgeries, etc. which are expensive. LaaSy Health provides access to a NON-INSURANCE solution called HealthShare. In this arrangement, a community of users agree to pay for routine or Everyday Care themselves, and then have the community pay the balance of large medical needs after the member has paid his/her share called IUA. LaaSy Health offers two IUA levels of $1000 and $2500. This approach of paying directly for smaller everyday care expenses, and being a member of the HealthSharing community for large medical expenses, saves LaaSy Health members over 50% for their complete healthcare.

Is HealthShare Insurance?

No. Insurance arrangements are a contract whereby one party agrees to be legally responsible for and accept another party’s risk of loss in exchange for a payment—a premium. HealthSharing is an arrangement whereby members agree to share medical expenses through the act of voluntary giving. HealthSharing does not assess applicants’ health risks because neither the HealthShare nor its members are assuming financial liability for any other member’s risk. Unlike insurance, the focus of HealthShare is to provide an avenue for members to help each other bear their immediate healthcare expenses.When health care costs are paid by someone other than the person receiving care, as is typically the case when an insurance company or government entity agrees to cover such costs, the healthcare model can be undermined. HealthShares believe many of the current problems with the healthcare system are the direct result of restricting personal freedom and responsibility through dependence on third-party payers. HealthSharing is designed to allow members to help one another while maintaining freedom of choice and personal responsibility.ontract whereby one party agrees to be legally responsible for and accept another party’s risk of loss in exchange for a payment—a premium. HealthSharing is an arrangement whereby members agree to share medical expenses through the act of voluntary giving. Zion Health does not assess applicants’ health risks because neither Zion Health nor its members are assuming financial liability for any other member’s risk. Unlike insurance, the focus of Zion Health is to provide an avenue for members to help each other bear their immediate healthcare expenses.When health care costs are paid by someone other than the person receiving care, as is typically the case when an insurance company or government entity agrees to cover such costs, the healthcare model can be undermined. Zion Health believes many of the current problems with the healthcare system are the direct result of restricting personal freedom and responsibility through dependence on third-party payers. Zion Health is designed to allow members to help one another while maintaining freedom of choice and personal responsibility.

Does HealthShare Charge Monthly Premiums?

Because HealthSharing is not insurance, it does not charge premiums. Rather, HealthShare members freely choose to assist other members with their medical expenses by contributing a predetermined amount each month via a membership. Ninety percent (90%) of each member’s monthly membership are designated solely for assisting other members’ needs.

Are HealthShares Legal?

HealthShares are nonprofit organizations, and are required to abide by certain state and federal regulations.

Does HealthShare Comply With The Affordable Care Act Requirements?

HealthShare is not a substitute for insurance as defined by the Affordable Care Act and therefore does not meet the requirements by itself.

How Does HealthShare Handle Medical Claims?

Does HealthShare Use Deductibles And Coinsurance?

No, the HealthSharing process differs significantly from insurance practices in this regard to the member’s advantage. When members incur an eligible medical expense that exceeds the initial unshareable amount (IUA), any amount above the IUA may be eligible for sharing. Also members are responsible for a maximum of three IUAs in a 12-month period. On the fourth medical need in a household, the member no longer needs to pay the initial unshareable amount. If the additional medical expenses are more than $500, the remaining costs are fully shareable with the community.

Do All The Monthly Contributions Go Toward Member’s Medical Expenses?

Over ninety percent of all monthly contributions go toward sharing in medical needs. Each month, less than 10% of contributions are retained by the HealthShare for administrative costs. An audit of the HealthShare’s finances is conducted each year by an independent firm and made available online.

Who Can Join the HealthShare?

Anyone between the ages of 18 to 65 can join the HealthShare by agreeing to follow the Member Guidelines and abide by the Principles of Membership. Membership expires when an individual reaches the age of 65 as those members become Medicare eligible. Newborns who are not born under an eligible maternity need to have a seven-day waiting period before they can be added to the family’s membership. “Children” under a parent’s membership may remain on the family plan until age 26, or unless he/she has a child, or unless he/she gets married.

What Kinds Of Needs Do HealthShare Members Share?

In general, needs for illnesses or injuries resulting in visits to licensed medical providers, emergency rooms, testing facilities, or hospitals are shared on a per person, per incident basis once the member has met their personal responsibility by paying their initial unshareable amount (IUA).

What Kinds Of Needs Do HealthShare Members Not Share?

Needs resulting from medical conditions that existed prior to the effective date are typically not shared or are shared in a limited capacity. For any needs that do not qualify for sharing but that create a financial burden to your family, the Additional Giving program may be of assistance. Each member has an IUA (initial unshareable amount) for which reimbursement from the Benevolent Fund will not be made.

What Amounts Do Members Share For Maternity Needs?

For a pregnancy that begins 60 days after the start of a member’s effective date, maternity needs are shared like any other need. For a pregnancy that began prior to a member’s effective date, pregnancy is treated as a pre-existing condition and not shared.

Are My Pre-Existing Conditions Always Unshareable?

Are There Conditions That Are Exempt From The Pre-Existing Conditions Clause?

Yes, high blood pressure, high cholesterol, and diabetes (types 1 and 2) will not be considered pre-existing conditions as long as the member has not been hospitalized for the condition in the past 12 months and is able to control it through medication and/or diet.

How About Medical Costs Incurred Outside The United States?

Members who are traveling abroad, eligible needs can be shared no matter where in the world they were incurred and treated. Members interested in “medical tourism” need prior written approval from the HealthShare before treatment.

What Happens If the HealthShare’s Needs Exceed The Monthly Contributions Received?

HealthShares keep separate funds to share member needs in the event that medical needs exceed the monthly contributions received. To date, all eligible needs have been shared in full without need to draw from the saved funds. However, if the rare event occurs that all needs cannot be met for a given month, HealthShare will use a prorating method to evenly distribute the available funds among members with needs. For example, if the monthly contributions received for a given month amounts to 80% of the needs submitted for that month, each member would have 80% of their eligible expenses shared that month. The HealthSharing community has not needed to prorate member needs in the past, and is well prepared in the event that needs exceed member contributions.

Can I Offer HealthSharing Through My Company Or Group?

Yes. Although HealthSharing is an individual and family program, we allow for a company contribution list. Employees who participate can be added or removed from the contributions list at any time and billed directly. Participation in the HealthSharing program is always voluntary, both from the company’s and the employee’s perspectives. Business owners choose to work with HealthShares because they value community and personal responsibility, and because they want to use a cost sharing approach to ensure provision of quality healthcare for their employees. There are numerous factors that contribute to HealthShare's greater efficiencies for both companies and employees.

Can I Choose My Own Doctors And Hospitals Without Being Penalized?

Yes. Each member’s personal freedom to select the medical providers of their choice is fundamental to the HealthShare’s philosophy. HealthSharing endeavors to provide members with information and recommendations to help them identify and receive treatment from the highest quality health provider(s). Accordingly, there are no out-of-network penalties or other restrictions. There is no penalty for the member for not using LaaSy Health’s provider community. If a member finds a better arrangement with a provider not in the LaaSy Health community, we encourage the member to share that information with us so we can perhaps add that provider to the larger LaaSy Health provider community to benefit everyone.

Can My Membership Be Dropped If I Have Very High Medical Needs?

Members cannot be dropped from the sharing program due to their medical needs. Neither membership nor monthly contribution is adversely impacted by the amount of medical expenses a member or their family members may have.

Is There A Lifetime Or Yearly Maximum Amount That Is Eligible For Sharing For Any One Person Or Family?

There are no limits on lifetime or annual maximum amounts, or even number of needs eligible for sharing for most medical needs. Some conditions, like hormone injections or hyperbaric treatments, have limits which are generally calculated per need. The Membership Guidelines which are available for review during sign up can provide more details.