SUMMARY OF SHARING

SHARING DETAILS

$500,000 per member per membership year

As an Impact member, after your PRA has been met, you pay 10% of all Eligible Medical Bills as a Co-Share. The remaining 90% is Published for Sharing to the Impact Membership.

There is a Co-Share limit of $5,000 per household per membership year

Eligible expenses are limited to $50,000. Does not apply to newborns added within 30 days of birth.

Eligible expenses are limited to $50,000-lifetime max. (Stroke, cancer, heart conditions, and COPD).

When submitting a bill for processing, it must be submitted electronically using the Medical Expense Form available at www.ImpactHealthSharing.com/forms.

$75 specialist provider fee & 10% Co-Share once PRA has been met. Eligible for sharing if performed by a qualified provider with up to 5 visits per member per membership year. Outpatient Mental Health providers are considered Specialists for provider fee purposes and are subject to the PRA and Co-Share.

Pre-Existing Medical Conditions are conditions in which signs, symptoms, testing, diagnosis, treatment, or use of medication occurred within 36 months prior to membership (based on medical records).

A known sign is any abnormality indicative of disease, discovered on examination/diagnostic testing before joining membership. A  symptom is any subjective evidence of disease. In contrast, a sign is objective. If you have been diagnosed with cancer that is in complete remission, and you are only undergoing testing for surveillance purposes, then bills related to those services will not be eligible for sharing for the first 36 months of membership.
 
If after 36 months you are without signs, symptoms, testing (other than surveillance testing), diagnosis, or medical treatment, medical expenses related to that cancer diagnosis will be eligible for sharing.
  • Cancer Treatment
  • Elective Cardiac Procedures
  • Inpatient/Outpatient Surgery (not in the doctors’ office)
  • Non-Emergency Hospital/Facility Admission
  • Organ Tissue/Transplant Procedures
  • Maternity

 

Please Note:

  1. Pre-Notification of medical bills does not guarantee eligibility or sharing
  2. If a member or their provider does not pre-notify Impact, the member is subject to an
    additional co-pay of $1,000 for the illness or event

Present Your Member card at the Pharmacy

Prescription drugs are eligible for sharing when not related to a Pre-Existing Medical Condition, and

  • After $25 for generic
  • After $50 on branded meds when generic is unavailable
  • Rx must be purchased using the member ID
  • Members pay 100% upfront at the pharmacy
  • Psychotropic medications and birth control are not eligible for sharing
  • Sharing max for RX is $1200 per member per membership year after the PRA has been met

There are four options available for your personal PRA.*

 

$2,500

5,000

$7,500

$10,000

The larger your PRA, the smaller your monthly sharing fee will be.

Primary Responsibility Amount (PRA) is the dollar amount a household must pay toward their own Eligible Medical Bills during a 12-month period before their Eligible Medical Bills can be published and shared by the membership. The PRA 12-Month period begins on the Membership date.

All Eligible Medical Bills are subject to the annual PRA and Co-Share except the annual/well office visit and lab allowance as detailed in Section III D of the Membership Guidelines.

 

*PRA is $1,000 for Impact Members over the age of 65.

At the time of receiving service from a medical care provider, members pay the following:

  • $0 for Telemedicine via Member Portal Only
  • $50 for Primary Care
  • $50 for each Allergy Test/Serum Injection
  • $75 for Specialist/Urgent care and Outpatient Surgical Facilities
  • $150 for Emergency Room or Inpatient Hospitalization

 

These fees are not applied to the PRA and are paid by the member even if the member has met the PRA for the year.

Virtual Mental Health Care is eligible for sharing through a teletherapy provider approved by Impact. Members must pay 100% of the session consult fee at the time of service and must provide the necessary information to Impact for payment processing via the Medical Event Form.

Virtual Mental Health is considered a Specialist for provider fee purposes.

Members under the age of 6 receive one annual visit. Additional visits will follow routine well-child guidelines as dictated by the American Academy of Pediatrics. These additional visits are subjected to PRA and Co-Share. Well-Child care is defined as recommended routine check-ups and associated lab work, excluding vaccinations and/or immunizations.

Wellness Visits and Diagnostic tests are eligible for sharing as follows:

(Both the annual/well office visit and $150 tab allowance are 100% sharable and not subject to
the PRA or Co-Share.)

One annual/well office visit for members 6 years and older per membership year, and includes
$150 allowance to be used towards any of the labs listed below

  • Complete Blood Count with Differential and Platelets
  • Comprehensive Metabolic Panel
  • Lipid Profile with Lipoprotein Particle Assessment
  • Hemoglobin A1C
  • Vitamin D-25 OH
  • C-Reactive Protein
  • Fecal Occult Blood Test
  • Pap Smear
  • PSA

Impact Health Sharing Membership Guidelines

Impact Health Sharing is NOT insurance and these Guidelines are not a contract for insurance. The Guidelines do, however, outline the way in which voluntary sharing of healthcare expenses occurs among members. To see the complete Guidelines click here.

SHARING SPECIFICS

Not eligible for sharing.

Not eligible for sharing.

year

$50 for each Allergy Test/Serum Injection

Not eligible for sharing.

Subjected to 10% Co-Share once PRA has been met

Subjected to 10% Co-Share once PRA has been met

Medical transportation to the nearest facility is eligible in emergency situations or when medically necessary for admission to another medical facility.

Air ambulance is limited to $25,000 lifetime max per member

Subjected to 10% Co-Share once PRA has been met

Subjected to 10% Co-Share once PRA has been met.$150 provider fee.

Not eligible for sharing.

Not eligible for sharing.

Genetic testing is only sharable for an existing medical condition (that is not a pre-existing condition). Routine genetic testing is not eligible for sharing.

Treatment related to genetic defects, hereditary diseases, or congenital conditions present before membership are not eligible for sharing.

Fetal abnormalities and/or congenital abnormalities noted in medical records prior to the mother joining Impact Health Sharing will be considered a pre-existing condition and would not be eligible for sharing.

Subjected to 10% Co-Share once PRA has been met

Routine Mammogram once every year for ages 45-54 and once every 2 years for 55 and over.

Subjected to 10% Co-Share once PRA has been met

  • Eligible if Mother has been a member for 12 months
  • Sharing is limited to $150,000 per single pregnancy event (not including baby’s bills).

Not eligible for sharing.

Treatment related to motorcycle accidents is limited to $100,000 per incident once the PRA has beenmet, subject to Co-Share.

Can be added to membership within 30 days of birth.

Fetal abnormalities and/or congenital abnormalities noted in medical records prior to the mother joining Impact Health Sharing will be considered a pre-existing condition and would not be eligible for sharing.

Not eligible for sharing.

Subjected to 10% Co-Share once PRA has been met.

Subjected to 10% Co-Share once PRA has been met.

No provider fee, and Combined limit of 50 visits per member per membership year.

Subjected to 10% Co-Share once PRA has been met.

$75 provider fee.

Subjected to 10% Co-Share once PRA has been met

Subjected to 10% Co-Share once PRA has been met

Not eligible for sharing.

Subjected to 10% Co-Share once PRA has been met

Pre-notification required.

Subjected to 10% Co-Share once PRA has been met

Routine Colonoscopy once every 10 years starting at age 45, or once every 5 years for members at high risk.

Not eligible for sharing, unless related to an eligible medical injury or illness.

DME related to an eligible need is eligible for sharing for up to $500 per member per membership year, toward the rental or purchase once the PRA has been met.

DME expenses are also subjected to PRA and Co-Share.

Not eligible for sharing.

Skilled care at home services for an eligible need are limited to 40 visits per member per membership year by a registered ARNP, LPN, or RN. A visit is limited to a maximum block of 4 hours.
Subjected to 10% Co-Share once PRA has been met.

Hospice care services eligible for sharing when prescribed by a physician and is subject to a lifetime limit of $15,000 per member once the PRA has been met and subject to Co-Share

$150 Provider fee

Subjected to 10% Co-Share once PRA has been met

Not eligible for sharing

Subjected to 10% Co-Share once PRA has been met

Not eligible for sharing.

Not eligible for sharing.

Not eligible for sharing.

Prostheses are eligible for sharing, up to two max per lifetime for the same condition once PRA is met, and also subject to Co-Share.

Not eligible for sharing.

Subjected to 10% Co-Share once PRA has been met, and only if related to a specific disease or disorder.

Subjected to 10% Co-Share once PRA has been met.

$75 provider fee

Not eligible for sharing.

Routine vision not eligible for sharing.

Medical conditions such as Glaucoma or Cateracts and services related to a medical injury or illness are sharable.

Not eligible for sharing.

Healthcare Cost Share is a company that exists to help individuals, families, and businesses receive better health care options, and to stop overpaying for health care coverage. We have partnered with Impact Health Sharing to bring a viable alternative to traditional healthcare insurance coverage. If a penny saved is truly a penny earned, find out how well it pays to pay less for your Healthcare coverage.

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