Summit Life and Health Solutions

2-Catastrophic

OneShare Catastrophic
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Authorizations

 

  • I authorize OneShare to collect my voluntary Monthly Contribution as a recurring monthly transaction.
  • I authorize my first Monthly Contribution to be processed immediately upon completion of my enrollment.
  • I authorize OneShare to contact providers to obtain the release of my medical records, and the medical records of all enrollees on the application.

 

Acknowledgements

 

  • I affirm that the name and personal information provided on this form are true and correct.
  • I affirm that I understand and accept the disclosures presented above.
  • I understand that a OneShare Health care sharing program is not health insurance and is not a substitute for health insurance.
  • I understand that a OneShare health care sharing program is not health insurance and is not a substitute for health insurance.
  • I understand that enrollment in OneShare is voluntary, that contributions for the sharing of medical expenses are voluntary, and that members are free to cancel membership at any time.
  • I understand that there are no representations, promises or guarantees that my medical expenses will be paid.
  • I understand that enrollment in OneShare is voluntary, that contributions for the sharing of medical expenses are voluntary, and that members are free to cancel membership at any time.
  • I also understand that any funds that I may receive for medical expenses do not come from an insurance plan but are voluntary contributions by the members.
  • I understand that the Guidelines, program details, and Monthly Contribution Amounts may be adjusted at any time.

 

Refunds

 

Within the first 30 days of a new Member’s Effective Date, the Member is entitled to a full refund, including the one-time application fee. After the first 30 days, a refund for the most recently paid period may be processed if the request is submitted within 10 days of their scheduled billing date. However, if services have been utilized refunds will not be issued. Refunds will be processed as a credit to the same card or account provided for billing. Requests involving refunds shareable by check may be delayed up to 30 business days.

 

Statement of Beliefs

With our origins in the Anabaptist faith:

We believe in the sanctity and dignity of every human life, and that God created every life for a special meaning and purpose. Psalm 139:13-14

We believe that every individual has the constitutional and religious right to worship God in freedom.

2 Corinthians 3:17

We believe and agree in the biblical and ethical principle of sharing with those who are less fortunate and who experience medical needs. Galatians 6:2

We believe and agree that it is our responsibility to God and our fellow members to engage in accountable, healthy living, and to avoid habits and behaviors which are harmful to the body. 1 Corinthians 6:19-20

We believe in the power of prayer to save lives, to heal lives, and to unite our members in common purpose and community, and we believe that prayer should be a fundamental practice of daily life. 1 John 5:14; Philippians 4:6-7

 

                                                          OneShare Catastrophic Program Disclosures

You are enrolling with the OneShare Catastrophic program that provides sharing for the following: Hospitalization and Emergency room services

You Understand that:

  1. There is a 24-month pre-existing condition waiting period for shared services. This means any expenses incurred will not be eligible for sharing for any condition(s) you've been treated for, received medical advice for, taken prescriptions for or had surgery for in the past 24 months prior to joining the membership.
  1. For non-preexisting conditions that are eligible for sharing, this membership shares expenses incurred by you and eligible members when you have an emergency room visit, hospitalization or in/outpatient surgery after you have met the applicable visit fee or ISA. Members may be responsible for additional expenses when utilizing a non-PPO provider. Waiting periods may apply.
  1. There is a surgery waiting period. This means that the membership will not share in expenses related to any surgery during the waiting period other than emergency or life-threatening cases. The surgery sharing waiting period for the Catastrophic membership is 90 days.
  1. For Members who have never been diagnosed or received treatment for any type of Cancer, sharing is eligible after a 90-day waiting period from the member’s effective date. If a member is diagnosed with cancer within the 90-day waiting period, the diagnosis and treatment expenses related to that specific Cancer, recurrence or metastasis of that Cancer are not eligible for sharing. After the 90-day waiting period any newly diagnosed cancers are eligible for sharing. 
    • Pre-existing or recurring cancer is Not Eligible for Sharing.
    • If the Member has been diagnosed or received treatment for Cancer within 5 years of Member effective date, cancer is Not Eligible for Sharing. After the 5-year period has expired, a member may request cancer sharing. To be considered, you must provide Medical reports for review and the determination will be made by OneShare.
    • The Lifetime Limit for all Cancer is $500,000; each Incident cannot exceed the Maximum Limit Per Incident or the Lifetime Sharing Maximum.
  1. If you use or have used tobacco or vape products, any health-related issues will not eligible for sharing.
  2. Maternity is not eligible for sharing on the Catastrophic Memberships.

 

Kentucky Revised Statute 304.1-120(7):

NOTICE: UNDER KENTUCKY LAW, THE RELIGIOUS ORGANIZATION FACILITATING THE SHARING OF MEDICAL EXPENSES IS NOT AN INSURANCE COMPANY, AND ITS GUIDELINES, PLAN OF OPERATION, OR ANY OTHER DOCUMENT OF THE RELIGIOUS ORGANIZATION DO NOT CONSTITUTE OR CREATE AN INSURANCE POLICY. PARTICIPATION IN THE RELIGIOUS ORGANIZATION OR A SUBSCRIPTION TO ANY OF ITS DOCUMENTS SHALL NOT BE CONSIDERED INSURANCE. ANY ASSISTANCE YOU RECEIVE WITH YOUR MEDICAL BILLS WILL BE TOTALLY VOLUNTARY. NEITHER THE ORGANIZATION OR ANY PARTICIPANT SHALL BE COMPELLED BY LAW TO CONTRIBUTE TOWARD YOUR MEDICAL BILLS. WHETHER OR NOT YOU RECEIVE ANY PAYMENTS FOR MEDICAL EXPENSES, AND WHETHER OR NOT THIS ORGANIZATION CONTINUES TO OPERATE, YOU SHALL BE PERSONALLY RESPONSIBLE FOR THE PAYMENT OF YOUR MEDICAL BILLS.

States Available

AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, RI, SC, SD, TN, TX, UT, VA, WA, WI, WV, WY


States Not Available

MD, PA, VT
Product
$0.00 per Month for Member
$0.00 per Month for Member + 1
$0.00 per Month for Family

Health Care Sharing Disclosures

 

You are enrolling in a Health Care Sharing Ministry administered by OneShare Health, LLC (OneShare). A Health Care Sharing Ministry is not health insurance, and it does not guarantee or promise that your medical bills will be paid. A Health Care Sharing Ministry is a group of individuals who share a common set of ethical or religious beliefs and share medical expenses in accordance with those beliefs.

 

The members of this Health Care Sharing Ministry voluntarily share medical expenses with one another, and OneShare coordinates this medical sharing. OneShare programs should not be considered as a substitute for an insurance policy. You are always liable for your own unpaid medical bills. 

 

OneShare Health Disclaimer


ONESHARE HEALTH, LLC (ONESHARE) IS NOT AN INSURANCE COMPANY BUT A RELIGIOUS HEALTH CARE SHARING MINISTRY (HCSM) THAT FACILITATES THE SHARING OF MEDICAL EXPENSES AMONG MEMBERS. As with all HCSMs under 26 USC § 5000A(d)(2)(B)(ii), OneShare’s members are exempt from the ACA individual mandate. OneShare does not assume any legal risk or obligation for payment of member medical expenses. Neither OneShare nor its members guarantee or promise that medical bills will be paid or shared by the membership. Available nationwide, but please check www.onesharehealth.com/legal-notices for the most up to date state availability listing.

 

No Promise to Pay

 

Neither OneShare nor its members promise or guarantee payment or sharing of your medical expenses, or assume any risk therefore. You remain responsible for your unpaid medical bills.

 

Voluntary Participation

 

Enrollment in OneShare is not a contract for insurance. Participation in OneShare is voluntary. Enrollment as a OneShare member is voluntary, and the sharing of monetary contributions is voluntary. You are free to cancel your membership at any time. OneShare requests that a voluntary sharing contribution be made for each month you are enrolled, to facilitate the sharing of requests published on behalf of other members.

 

Cancelling Membership

If you wish to cancel your membership in the OneShare Health programs, you are required to submit notice to OneShare Health in writing 15 days prior to the end of your current month. Your sharing opportunity will end the last day of your current month.

 

Guidelines

 

OneShare manages member sharing contributions by establishing guidelines that define which medical bills are eligible for sharing (“Guidelines”). Neither the Guidelines, nor anything else presented by OneShare, constitutes a contract for insurance. The Guidelines do not constitute a legally binding agreement, a promise to pay, or an obligation to share. The Guidelines specify what type of expenses are eligible for sharing requests. OneShare reserves the right to exclude sharing eligibility for any pre-existing conditions, whether disclosed at the time of your enrollment or discovered after the effective date of the membership. OneShare reserves the right to update and change its Guidelines at any time.

 

Administration

 

Upon receiving an eligible medical need from a Member or Provider, OneShare Health will assign the medical need for sharing in accordance with the Guidelines, less the amount required to be pre-shared (Individual Sharing Amount). Voluntary membership contributions are received from each member monthly. Up to 40% of membership contributions may be applied towards administration of the Health Care Sharing Ministry, charitable causes, and general overhead costs. This does not include third party contracts and distribution compensation. Administrative costs are subject to change by OneShare Health.

 

Membership Guidelines Details

 

Each Member is responsible for reviewing the Guidelines provided at the time of enrollment, and to abide by the terms of the Guidelines. It is your responsibility to understand which of your Medical Expenses are eligible for cost sharing, and which Medical Expenses are not eligible for cost sharing. Members are also provided with a toll-free number to contact Member Services with any questions they may have. Precertification from OneShare Health is required for certain Medical Expenses to be Eligible for Sharing.

 

Refunds

 

Within the first 30 days of a new Member’s Effective Date, the Member is entitled to a full refund, including the one-time application fee. After the first 30 days, a refund for the most recently paid period may be processed if the request is submitted within 10 days of their scheduled billing date. However, if services have been utilized refunds will not be issued. Refunds will be processed as a credit to the same card or account provided for billing. Requests involving refunds shareable by check may be delayed up to 30 business days.

 

 Statement of Beliefs

 With our origins in the Anabaptist faith:

We believe in the sanctity and dignity of every human life, and that God created every life for a special meaning and purpose. Psalm 139:13-14


We believe that every individual has the constitutional and religious right to worship God in freedom.

2 Corinthians 3:17


We believe and agree in the biblical and ethical principle of sharing with those who are less fortunate and who experience medical needs. Galatians 6:2


We believe and agree that it is our responsibility to God and our fellow members to engage in accountable, healthy living, and to avoid habits and behaviors which are harmful to the body. 1 Corinthians 6:19-20


We believe in the power of prayer to save lives, to heal lives, and to unite our members in common purpose and community, and we believe that prayer should be a fundamental practice of daily life. 1 John 5:14; Philippians 4:6-7

 

                                                              OneShare Catastrophic Program Disclosures

You are enrolling with the OneShare Catastrophic program that provides sharing for the following: Hospitalization and Emergency room services

You Understand that:

  1. There is a 24-month pre-existing condition waiting period for shared services. This means any expenses incurred will not be eligible for sharing for any condition(s) you've been treated for, received medical advice for, taken prescriptions for or had surgery for in the past 24 months prior to joining the membership.
  1. For non-preexisting conditions that are eligible for sharing, this membership shares expenses incurred by you and eligible members when you have an emergency room visit, hospitalization or in/outpatient surgery after you have met the applicable visit fee or ISA. Members may be responsible for additional expenses when utilizing a non-PPO provider. Waiting periods may apply.
  1. There is a surgery waiting period. This means that the membership will not share in expenses related to any surgery during the waiting period other than emergency or life-threatening cases. The surgery sharing waiting period for the Catastrophic membership is 90 days.
  1. For Members who have never been diagnosed or received treatment for any type of Cancer, sharing is eligible after a 90-day waiting period from the member’s effective date. If a member is diagnosed with cancer within the 90-day waiting period, the diagnosis and treatment expenses related to that specific Cancer, recurrence or metastasis of that Cancer are not eligible for sharing. After the 90-day waiting period any newly diagnosed cancers are eligible for sharing. 
    • Pre-existing or recurring cancer is Not Eligible for Sharing.
    • If the Member has been diagnosed or received treatment for Cancer within 5 years of Member effective date, cancer is Not Eligible for Sharing. After the 5-year period has expired, a member may request cancer sharing. To be considered, you must provide Medical reports for review and the determination will be made by OneShare.
    • The Lifetime Limit for all Cancer is $500,000; each Incident cannot exceed the Maximum Limit Per Incident or the Lifetime Sharing Maximum.
  1. If you use or have used tobacco or vape products, any health-related issues will not eligible for sharing.
  2. Maternity is not eligible for sharing on the Catastrophic Memberships.

Kentucky Revised Statute 304.1-120(7):

NOTICE: UNDER KENTUCKY LAW, THE RELIGIOUS ORGANIZATION FACILITATING THE SHARING OF MEDICAL EXPENSES IS NOT AN INSURANCE COMPANY, AND ITS GUIDELINES, PLAN OF OPERATION, OR ANY OTHER DOCUMENT OF THE RELIGIOUS ORGANIZATION DO NOT CONSTITUTE OR CREATE AN INSURANCE POLICY. PARTICIPATION IN THE RELIGIOUS ORGANIZATION OR A SUBSCRIPTION TO ANY OF ITS DOCUMENTS SHALL NOT BE CONSIDERED INSURANCE. ANY ASSISTANCE YOU RECEIVE WITH YOUR MEDICAL BILLS WILL BE TOTALLY VOLUNTARY. NEITHER THE ORGANIZATION OR ANY PARTICIPANT SHALL BE COMPELLED BY LAW TO CONTRIBUTE TOWARD YOUR MEDICAL BILLS. WHETHER OR NOT YOU RECEIVE ANY PAYMENTS FOR MEDICAL EXPENSES, AND WHETHER OR NOT THIS ORGANIZATION CONTINUES TO OPERATE, YOU SHALL BE PERSONALLY RESPONSIBLE FOR THE PAYMENT OF YOUR MEDICAL BILLS.

Summit Life and Health Solutions  • Susan Bencivenga  • Phone: (303) 591-1871  • susanb@summitlifehealth.com

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