During the 24-month period prior to a new member’s activation date, any condition for which the member has been examined, taken medication, had symptoms, or received treatment for is considered a “condition existing prior to membership.” Members have a waiting period in the first year before pre-existing conditions are shareable. Even in these cases, we will negotiate with providers to help you receive any possible discounts on your medical costs. (SEE EXCEPTIONS BELOW.)
Although pre-existing conditions are generally not shareable, we also want to be there for each other and ease one another’s medical burdens as much as possible. For that reason, we have put into place a framework for sharing pre-existing conditions in our Member Guidelines. One of the many ways we differ from traditional insurance is that we have a phase-in period for these pre-existing conditions. This means that beginning in your second year of membership, if the need meets guidelines for sharing, Zion Health can share up to the amounts listed below:
After year four of your membership, expenses related to pre-existing conditions will remain shareable at a maximum of $125,000 in a 12-month rolling period. This period resets every membership year.
- Exceptions For High Blood Pressure, High Cholesterol, And Diabetes
High blood pressure, high cholesterol, and diabetes (types 1 and 2) "WILL NOT" be considered pre-existing conditions as long as the member has not been hospitalized for the condition in the past 12 months and is able to control it through medication and/or diet.
- Exceptions For Other Medical Conditions
Zion Health recognizes that each member’s situation is different. Zion Health reserves the right to make exceptions for certain medical conditions on a case-by-case basis. Zion Health makes decisions in service to the community as a whole.