KEY TERMS
A membership-based non-insurance arrangement established for the purpose of sharing legitimate medical expenses between members.
The accepted health care services and supplies provided by health care entities that are appropriate to the evaluation and treatment of a disease, condition, illness or injury and consistent with the applicable standard of care.
An employee of a member business, or dependent thereof, who has agreed in writing to abide by the requirements of the HSC organization and is thereby eligible to participate in the sharing of medical needs with other members.
Term applies universally to both member businesses, member organization and/or members, depending on context used.
The required principles and ongoing behavioral code attested to by members, as required for membership.
The effective period of time in which a member is eligible for participation in healthcare cost sharing. Open Enrollment will be held every year from October 15 to December 15 regardless of when a plan first comes into effect.
Minimum Essential Coverage (MEC) is a requirement of the Affordable Care Act. Membership in HealthShare Connection does not provide Minimum Essential Coverage as required by any federal or state law. This MEC coverage is provided under the ERISA based plan provided through National Health Benefits.
The monthly contribution to the benevolence fund facilitated by HSC by participating businesses in order to maintain their employees’ active membership in medical cost sharing. Participating employees may be required to contribute, at the employer’s direction, via payroll withholding.
A medical necessity that exceeds the Member’s Non-Sharable Amount (NSA) caused by an injury or illness to an eligible member or participating dependent.
The annual Non-Sharable Amounts will be $1500 for per need for the first 3 needs for an individual member, and $1500 per need for the first 5 needs for a family of members.
Any pre-existing Medical condition is any condition for with the patients already received medical advice or treatment prior to enrollment in HSC. Events, that result from a Pre-existing Medical Conditions are subject to sharing limitations (as presented in these Guidelines) unless 36 months immediately prior to membership effective date has passed without any signs or symptoms of the condition, without any treatment needed, without any medication prescribed or taken, and without any suspicion by the patient or doctors that the condition is resurfacing. This applies whether or not the cause of the symptoms is unknown or misdiagnosed (except as provided in these guidelines).
The amount of the Need expense request that remains after the member’s Non-Shared Amount (NSA) has been met, and falls within the Guidelines for sharing within the membership.
An eligible Need that meets the requirements as determined by the HSC Membership Guidelines .