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What Medical Expenses are Eligible for Sharing?

Medical costs are shared on a per person, per incident basis for illnesses or injuries incurring medical expenses after the Membership effective date when medically necessary and provided by or under the direction of licensed physicians, osteopaths, urgent care facilities, clinics, emergency rooms, or hospitals (inpatient and outpatient), or other approved providers of conventional or naturopathic care. Medical expenses eligible for sharing include, but are not limited to, home health care, physician and hospital services, emergency medical care, medical testing, imaging, ambulance transportation and prescriptions, unless otherwise limited or excluded by these Guidelines.

Total bills incurred must exceed an Annual Unshared Amount to be eligible for sharing (see VI.C.1.). A Medical Expense Need is any medically diagnosed condition for which one received medical treatment and incurred medical expenses from the same diagnosis. All medical bills related to the same diagnosis are considered as part of the same incident. Such expenses must be submitted for sharing in the manner and form specified by Solidarity HealthShareSM. This may include, but not be limited to, standard industry billing forms (HCFA 1500 and/or UB 92) and medical records.

Members share medical expenses such as:

  1. Alternative and/or Integrative Treatments

    Alternative and/or Integrative Treatments are eligible for sharing if such treatment meets the following criteria:

    1. It is prescribed by a Physician;
    2. It is prescribed for a medically diagnosed condition;
    3. It is deemed safe;
    4. It has peer reviewed evidence to support the treatment of the diagnosed condition; and
    5. It is presented for prior approval to Solidarity HealthShareSM (see VII-D).
  2. Ambulance Service

    Emergency land or air ambulance transportation to the nearest medical facility capable of providing the medically necessary care to avoid seriously jeopardizing the Sharing Member’s life or health.

  3. Braces

    New and replacement braces of the leg, arm, back, neck, or artificial arms or legs, if there is sufficient change in the Sharing Member’s physical condition to make the original device no longer functional.

  4. Cosmetic Procedures

    Cosmetic care and treatment provided for disfiguration caused by amputation, disease (including Acne), accident, or breast reconstruction following a mastectomy are eligible for sharing. All other elective cosmetic treatment, including, but not limited to, pharmacological regimens; nutritional procedures or treatments; plastic surgery; salabrasion, chemosurgery, and other such skin abrasion procedures associated with the removal or revision of scars, tattoos, or actinic changes are not eligible for sharing.

  5. Eating Disorder

    Eating disorders are eligible for sharing under the Mental Health Services (see VI.A.15.)

  6. Emergency Room Visits

    Emergency room services for stabilization or initiation of treatment for a medical emergency or condition provided on an outpatient basis at a Hospital, Clinic, or Urgent Care Facility, including when Hospital Admission occurs within twenty-three (23) hours of emergency room treatment.

  7. Fertility

    Expenses for Fertility treatments relating to the restoration or healing of the reproductive system in order to support procreation in the marital act (see NaPro Technology VI.A.16.).

  8. Home Health Care

    Skilled care services at home by a Home Health Care Agency for each related medical incident provided such home care reduces the expected medical expense and replaces hospital or nursing home services.

  9. Hospice Care

    Hospice Care is limited to thirty (30) days of respite and/or comfort care in any 30-day period.

  10. Hospital Charges

    Inpatient or Outpatient hospital treatment or surgery for a medically diagnosed condition.

  11. Hysterectomy

    Expenses related to a Hysterectomy if it is medically necessary and approved by the Solidarity HealthShareSM Ethics Board. The Sharing Member must pre-notify Solidarity HealthShareSM prior to surgery, unless it is a medical emergency.

  12. Immunizations

    Immunization and vaccinations unless the vaccine is derived from aborted fetal tissue and an alternative pro-life vaccine exists (see Moral Reflection on Vaccines Prepared from Cells Derived from Aborted Human Fetuses by the Pontifical Academy for Life).

  13. Maternity

    Medical expenses for maternity, including, but not limited to, charges and expenses arising from physician care, hospital or birthing center admissions, attendance by midwives, or home deliveries accompanied by a midwife or physician.

  14. Medical Costs Incurred Outside the United States

    Charges for the care and treatment of a medically-diagnosed condition when treatment outside the United States is financially beneficial or when traveling or temporarily residing outside the United States. Eligibility of such charges are subject to all other provisions of the Guidelines. Medical billing is requested to be submitted in English and US dollars.

  15. Mental Health Services

    Expenses for office visits, treatment, medication, and emergency hospitalization are eligible for sharing up to twenty (20) visits per membership year for psychiatric or psychological counseling, diagnosed and prescribed by a physician.

  16. NaPro Technology

    Expenses for NaPro Technology, which includes evaluation, treatment, therapies, surgeries, education and supplies.

  17. Natural Family Planning/Fertility Awareness Based Methods

    Expenses for individual instruction and the initial supplies on approved fertility awareness-based methods, also known as Natural Family Planning. Such approved methods include, but are not limited to, Creighton, Couple to Couple League, Billings, Family of the Americas, SymptoPro, and Marquette.

  18. Naturopathic Care

    Expenses for naturopathic care.

  19. Organ Transplant

    This includes, but is not limited to, expenses incurred in evaluation, screening, transportation, the candidacy determination process, organ transplantation, organ procurement, follow-up care, immuno-suppressant therapy, and re-transplantation (Catechism of the Catholic Church, no. 2296).

  20. Physical Manipulation (Chiropractic) or Physiotherapy

    Up to twelve (12) visits per membership year for treatment of musculoskeletal disease or injury prescribed by a Physician.

  21. Physical Therapy

    Up to twenty (20) visits per membership year for physical therapy by a licensed physical therapist in accord with a Physician’s order to improve body function.

  22. Prescription Drugs

    Prescription drugs and supplements, including, but not limited to, phytotheuraputics, vitamins, herbs, and approved drugs are eligible for sharing ninety days (90) days before and after each related medical diagnosis or incident. Also, refer to Solidarity PharmacySM Program for discounts on recurring prescription drugs.

  23. Prosthetics

    Prosthetics and their replacement, if medically necessary.

  24. Sterilization Reversal

    Reversal of a tubal ligation or vasectomy but limited to one reversal attempt only.

  25. Therapies

    Other therapies such as occupational, respiratory, and speech therapy by a licensed therapist in accord with a Physician’s order to improve function are eligible up to twenty (20) visits per membership year.

  26. Wellness Visits

    Charges for one (1) wellness exam or physical per Membership year, for which there are no medical symptoms or diagnoses in advance, including but not limited to routine check-ups, labs, immunizations, imaging and other services (pap smears, screening colonoscopies, Prostate-Specific Antigen (PSA) tests, screenings, mammograms; excluding 3D mammograms) as per the wellness policy of Solidarity HealthShareSM. Multiple well baby visits per year within the first two years of birth.