(MEC) Minimum Essential Coverage Plan
Provides all 93 preventative and wellness services as outlined in the Affordable Care Act (ACA). You have access to free preventive services like flu shots, check-ups, and screening tests. Getting these recommended services is an important step toward good health and well-being.
See a list of all covered services: https://www.healthcare.gov/coverage/preventive-care-benefits/
The MEC is what allows this option to meet the individual mandate.
Care Concierge Team
A team of dedicated agents that will help you navigate health care and receive the best care possible.
Pharmacy Benefit Plan
A better way to manage maintenance medications
HIPAA Compliant International & multi-platform support. Our program searches six U.S. platforms, the World Drug Market and Pharmacy Assistance programs for the best solution for each or our members.
Health Savings Account compatible
A tax-advantaged medical savings account available to taxpayers in the United States who are enrolled in MPB Secure that can be used to pay for medical expenses with before tax dollars.
Special Membership features
Large Medical Expenses
Use Medical Cost Sharing for catastrophic expenses
Initial Unshared Amount (IUA) Options - Choice of $1000, $2000, or $5000.
Maximum Number of IUA’s Annually - 3 per membership unit
Medical Supplies - Medical supplies directly aid in the treatment or recovery of a sharable medical need and generally shareable within 120 days of the treatment start date as prescribed by a licensed medical provider. Supplies costs need to be over $100 to be shared. Zion Health will share in the retail or fair costs when applicable and encourage members to utilize alternative vendors such as local pharmacy or medical supply stores.
Prescription Drugs - Prescriptions for medication(s) that are billed by a provider and are related to a qualified Need are also considered sharable. With your Medical Cost Sharing providers approval, large prescription costs associated with a Need that are filled at the pharmacy can be shared.
Pre-Existing Conditions - 24-month look-back: no coverage for the first 12 months; $25K 2nd year; $50K 3rd year; $125K 4th year and beyond. (Exceptions for High Blood Pressure, High Cholesterol & Diabetes)
Maternity Benefits - Two Initial Unshareable Amounts (IUA’s) are applied to a single maternity need. Any pre-birth or post birth need of the child will be considered a separate need from the mother’s maternity care. Pregnancies are considered pre-existing if the pregnancy start date is within the first 60 days of the membership effective date.
Therapies - Physical Therapy - Shareable for inpatient treatment/up to 35 outpatient sessions per need. Speech Therapy - Shareable in relation to an illness, injury or accident/up to 35 outpatient visits per condition. Occupational Therapy - Shareable for inpatient treatment and up to 35 outpatient sessions per need, up to $7,500. Therapeutic Massage Therapy - Shareable if prescribed by a licensed medical provider related to a shared need, up to 25 sessions and up to $3,000.
Mental Health - Medications and other care is not shareable for the treatment of any mental health related illnesses unless approved by your Medical Cost Sharing provider. Sharing is limited to $3,000.
Alternative Care Treatment - Alternative medical treatments can be shared with the Medical Cost Sharing community. These alternatives generally should be considered safe and effective while being an alternative to a traditional treatment plan. Needs may be considered shareable pending prior written approval by your Medical Cost Sharing provider. Member is required to demonstrate the proposed value of the alternative treatment.
End of Life Assistance - For a Member, and/or his or her dependents, who die(s) after two years of uninterrupted Membership as a Sharing Member, financial assistance to the surviving family will be provided by the Members according to the following schedule, upon receipt of a copy of death certificate, and as listed on the Member enrollment.
$10,000 Primary Member, $10,000 Dependent Spouse, $2500 Dependent Child
Tobacco Use - $50 monthly surcharge per household.
Sharing Limits - No annual or lifetime limits unless restricted by a pre-existing condition.
Please visit the link below for the most up-to-date guidelines
Zion Health is not an insurance company. Neither this publication NOR membership in Zion Health are issued or offered by an insurance company. The purpose of these membership guidelines is to help Members understand and identify medical needs that qualify for potential reimbursement and the process by which reimbursements are made. The membership guidelines are not for the purpose of describing to prospective Members what amounts will be reimbursed by Zion Health. While Zion Health has shared all Eligible Needs of its Members to date, membership does NOT guarantee or promise that your Eligible Needs will be shared. Rather, membership in the Zion Health community merely guarantees the opportunity for Members to care for one another in a time of need and present their medical needs to other Members as outlined in these membership guidelines. The financial assistance Members receive will come from other members’ Monthly Contributions that are placed in a Benevolent Fund, and not from Zion Health.
THIS PUBLICATION AND MEMBERSHIP IN ZION HEALTH SHOULD NEVER BE CONSIDERED A SUBSTITUTE FOR A HEALTH INSURANCE POLICY. IF THE MEMBERSHIP IS UNABLE TO SHARE IN ALL OR PART OF A MEMBERS ELIGIBLE MEDICAL NEEDS, EACH MEMBER WILL REMAIN SOLELY FINANCIALLY LIABLE FOR ANY AND ALL UNPAID MEDICAL NEEDS. THESE GUIDELINES DO NOT CREATE A LEGALLY ENFORCEABLE CONTRACT BETWEEN ZION HEALTH AND ANY OF ITS MEMBERS. NEITHER THESE GUIDELINES, NOR ANY OTHER ARRANGEMENT BETWEEN MEMBERS AND ZION HEALTH, CREATE ANY RIGHTS FOR ANY MEMBER AS A RECIPROCAL BENEFICIARY, A THIRD-PARTY BENEFICIARY, OR OTHERWISE. AN EXCEPTION TO A SPECIFIC PROVISION OF THESE GUIDELINES ONLY MODIFIES THAT PARTICULAR PROVISION AND DOES NOT SUPERSEDE OR VOID ANY OTHER PROVISIONS. THE DECISION BY ZION HEALTH TO REIMBURSE A MEMBER’S ELIGIBLE NEEDS DOES NOT AND SHALL NOT CONSTITUTE A WAIVER OF THIS PROVISION OR ESTABLISH BY ESTOPPEL OR ANY OTHER MEANS ANY OBLIGATION ON THE PART OF ZION HEALTH TO REIMBURSE A MEMBER’S ELIGIBLE NEEDS.
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|Two Day||2 business days||$15|
|Next Day||1 business day||$30|
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