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OneShare Complete
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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 my minor dependents 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 10 days of a new Member’s Effective Date, the Member is entitled to a full refund, excluding the one-time application fee. However, if services have been utilized refunds will not be issued.
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.

 

Statement of Beliefs

With our origins in the Anabaptist faith:

We Believe in the authority of Scripture and the sanctity and dignity of every human life created by God with special meaning and purpose. 2 Timothy 3:16; Psalm 139:13-14

We Believe that every individual has the constitutional and religious right and duty to worship God in freedom. 2 Corinthians 3:17; U.S. Const. amend. I

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 Complete Program Disclosures

You are enrolling with the OneShare Health Complete program that provides sharing for the following:  Primary, Urgent Care, Preventive Services & Hospitalization

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), for which a member received medical treatment, advice, care or services including diagnostic measures, took prescribed drugs or showed signs and symptoms, whether treated or not, within 24 months before the Member’s effective date of their program. 
  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 Complete 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. 
    1. Pre-existing or recurring cancer is Not Eligible for Sharing.
    2. 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 determination will be made by OneShare.
    3. The Lifetime Limit for all Cancer is $500,000.

 

  1. If you use or have used tobacco or vape products, any health-related issues will not be eligible for sharing.
  1. Maternity is eligible for sharing. For the Complete membership, Maternity Sharing is eligible for members’ who conceive after the effective date of the membership and is subject to the maternity sharing limits.
  1. In addition to all other limitations and restrictions in our Guidelines, the following are not eligible for sharing: Substance Abuse treatment, abortion, durable medical equipment, dental/vision, hearing, and behavior / mental disorders.

 

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, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, RI, SC, SD, TN, TX, UT, VA, WI, WV, WY


States Not Available

MD, MA, PA, VT, VI, WA, AB, BC, MB, NB, NL, NT, NS, NU, ON, PE, QC, SK, YT
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.

 

Canceling 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. Canceling your OneShare Health membership does not meet the requirements for a Qualifying Life Event (QLE) under the Special Enrollment eligibility for the Affordable Care Act.

 

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, and will provide notice of any material update/changes. It is the Member’s responsibility to review the current guidelines in their Member Portal.

 

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. In any given month, the available sharing funds may or may not equal the amount of eligible expenses submitted for sharing. If eligible expenses exceed the available sharing funds to meet those needs, any of the following actions may be taken: 
1. A pro-rata sharing of eligible expenses may be initiated, whereby the Members share a percentage of eligible medical expenses within that month and hold back the balance of those expenses to be shared the following month, or 
2. The monthly member contribution may be increased in sufficient proportion to satisfy the eligible expenses. This action may be undertaken temporarily or on an ongoing basis. Administrative costs are subject to change by OneShare Health. 

An annual administration fee of $45.00 is due from each primary member upon their program anniversary.

 

Membership Guidelines Details

 

Each Member is responsible for reviewing the Guidelines provided at the time of enrollment, and updates when notified 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. Pre-certification from OneShare Health is required for certain Medical Expenses to be Eligible for Sharing.

 

Payment Authorization

I authorize OneShare Health, LLC to draft my checking account or debit my credit card for this initial transaction, which includes my first monthly contribution and a one-time application fee. I also give authorization to automatically draft my checking account or charge my card each month for all subsequent monthly contributions and the $45 annual administration fee due on my program year anniversary date. I also confirm that I am an authorized signer on the account I provided in my application for enrollment. 

 

Refunds

 

Within the first 10 days of a new Member’s Effective Date, the Member is entitled to a full refund, excluding the one-time application fee. However, if services have been utilized refunds will not be issued.. 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.

 

 Statement of Beliefs

 With our origins in the Anabaptist faith:

We Believe in the authority of Scripture and the sanctity and dignity of every human life created by God with special meaning and purpose. 2 Timothy 3:16; Psalm 139:13-14

We Believe that every individual has the constitutional and religious right and duty to worship God in freedom. 2 Corinthians 3:17; U.S. Const. amend. I

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 Complete Program Disclosures

You are enrolling with the OneShare Health Complete program that provides sharing for the following:  Primary, Urgent Care, Preventive Services & Hospitalization

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), for which a member received medical treatment, advice, care or services including diagnostic measures, took prescribed drugs or showed signs and symptoms, whether treated or not, within 24 months before the Member’s effective date of their program. 
  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 Complete 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. 
    1. Pre-existing or recurring cancer is Not Eligible for Sharing.
    2. 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 determination will be made by OneShare.
    3. The Lifetime Limit for all Cancer is $500,000.
  1. If you use or have used tobacco or vape products, any health-related issues will not be eligible for sharing.
  1. Maternity is eligible for sharing. For the Complete membership, Maternity Sharing is eligible for members’ who conceive after the effective date of the membership and is subject to the maternity sharing limits.
  1. In addition to all other limitations and restrictions in our Guidelines, the following are not eligible for sharing: Substance Abuse treatment, abortion, durable medical equipment, dental/vision, hearing, and behavior / mental disorders.

 

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.