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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 our Sharing 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 HealthShare. 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 HealthShare (see VII-D).
  1. 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.

  1. 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.

  1. 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.

  1. Eating Disorder

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

  1. 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.

  1. 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.).

  1. 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.

  1. Hospice Care

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

  1. Hospital Charges

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

  1. Hysterectomy

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

  1. 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).

  1. 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.

  1. 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.

  1. 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.

  1. NaPro Technology

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

  1. 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.

  1. Naturopathic Care

Expenses for naturopathic care.

  1. 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).

  1. Physical Manipulation (Chiropractic) or Physiotherapy

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

  1. 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.

  1. Prescription Drugs

Prescription drugs are eligible for Sharing. Members have access to Drexi Pharmacy Sharing for retail prescription drugs based on the current formulary and co-share schedule.

  1. Prosthetics

Prosthetics and their replacement, if medically necessary.

  1. Sterilization Reversal

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

  1. Supplements

Supplements, including, but not limited to, phytotherapeutics, vitamins, and herbs are eligible for Sharing ninety (90) days after the onset of each related Incident.

  1. Telehealth

Telehealth visits from Providers who have provided Healthcare Services to the Member during at least one (1) prior in-person office visit are eligible for Sharing. Services from Dialcare through the Solidarity Care Card are eligible for sharing.

  1. 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.

  1. 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 HealthShare. Multiple well baby visits per year within the first two years of birth.