CHA Sharing Choices for 2020

Traditional Sharing

This sharing program offers help with most healthcare needs on a percentage basis. Among other things, its members help each other with well-patient checkups, diagnostic work, surgery, ambulance, emergency room, hospital stays, diabetic supplies, optional dental and vision assistance, etc. See Overview of shareable and non-shareable items for more details. Monthly share contributions vary by age and are calculated for each person in the family up to five children. There are no shares calculated for the sixth and any succeeding children. There is an Annual Member Responsibility (AMR) of $1,000 per person with a maximum of $2,000 per family. After this is satisfied, CHA shares bills at 80%, with the remaining 20% being the member’s responsibility. This sharing program has a maximum shareable amount of $40,000 per person per year, and the board of directors will continue to consider each case that exceeds this maximum and offer additional assistance where needed through the Brother-to-Brother Fund. Diabetic supply assistance as well as the optional Vision Sharing and Dental Sharing programs are available exclusively with the Traditional Sharing. As with all sharing programs offered through CHA, you remain personally responsible for your medical expenses. There is no guarantee that any medical expense you submit will be shared by other members.

Emerald Care Sharing

This sharing program is for those who prefer to handle their own health care costs for the most part but would like to have some help available for major health care expenses. As with all the sharing programs offered through CHA, you remain personally responsible for your medical expenses. There is no guarantee that any medical expense you submit will be shared by other members. The monthly shares are based on units. A single person is one unit, each spouse in a family is one unit, and all children in a family comprise one unit. There is a maximum sharing amount of three units per household regardless of the number of children enrolled. Members of the Emerald Care Sharing (ECS) will have an Incident Member Responsibility (IMR) of $5,000 per incident, meaning they are personally responsible for the first $5,000 of each incident before it is eligible for sharing. Because all sharing under ECS is on a “per incident” basis, all bills are handled as self-pay. This means the provider will bill the member, who will assemble all bills pertaining to the incident and submit them to CHA along with the appropriate documentation as per CHA Guidelines. All bills should be negotiated by the member to obtain a fair and reasonable price for the services rendered. CHA’s repricing team can help with this if needed. Once the bill has been determined to be shareable, CHA will share 100% of the approved, negotiated charges after the member’s IMR of $5,000 has been satisfied. Payment is usually issued to the member who in turn issues payment to the provider. There is an annual sharing limit of $100,000 per person, and a lifetime limit of $125,000 per illness. Because of the lower cost of ECS, there is a limited list of shareable items. See Overview of shareable and non-shareable items.

Diamond Care Sharing

The Diamond Care Sharing (DCS) is for those who are willing to contribute a bit more than with ECS monthly and consequently are able to submit more items for sharing from DCS. The monthly shares are based on units as with Emerald Care Sharing, with a maximum sharing amount of three units per family. The DCS has an Annual Member Responsibility (AMR) of $1,000 per person. Incidents must exceed $1,000 to be eligible for sharing, even after the AMR has been satisfied. As with ECS, all bills are handled as self-pay and the member is responsible to assemble and submit the bills to the office along with the appropriate documentation to be considered for sharing. All bills should be negotiated by the member to obtain a fair and reasonable price for the services rendered. If assistance is needed, CHA’s repricing team can help. Approved bills are shared at 100% on DCS after the member’s AMR of $1,000 has been satisfied. Payment is usually issued to the member who in turn issues payment to the provider. There is an annual sharing limit of $200,000 per person and a lifetime limit of $125,000 per illness. See Overview of shareable and non-shareable items for more details about what is eligible for sharing. As with all sharing programs offered through CHA, you remain personally responsible for your medical expenses. There is no guarantee that any medical expense you submit will be shared by other members.

Both the Emerald Care Sharing and Diamond Care Sharing are offered with an optional companion sharing program called ExtenCare, which offers an additional $100,000 sharing per year. There is an additional cost per unit per month to add this.

Sharing Details

Sharing Program Overview
Traditional Sharing
Emerald Care Sharing (ECS)
Diamond Care Sharing (DCS)
Share Pricing Varies from $72 to $311 per person per month based on member’s age $54 per unit per month with a maximum of 3 units or $162 per household $190 per unit per month with a maximum of 3 units or $570 per household
Member Responsibility Annual Member Responsibility (AMR) of $1,000 per person with maximum of $2,000 per household per year Incident Member Responsibility (IMR) of $5,000 per incident Annual Member Responsibility (AMR) of $1000 per person
Incident threshold to qualify for sharing All approved bills are applied to AMR or shared as per CHA Guidelines Incident must exceed $5,000 to be eligible for sharing – only the amount over $5,000 will be shared. Incident must exceed $1,000 to be eligible for sharing even if AMR has already been satisfied
Submission of Medical Bills Bills may be submitted to CHA directly by the provider, or may be sent to the member to submit to CHA with documentation All bills are sent to the member, who will assemble bills for the incident & submit to CHA with proper documents All bills are sent to the member, who will assemble bills for the incident & submit to CHA with proper documents
Handling of discounts Discounts are taken off total amount billed before anything is applied to AMR or shared by CHA Discounts are taken off total amount billed before anything is applied to IMR or shared by CHA Discounts are taken off total amount billed before anything is applied to AMR or shared by CHA
Sharing percentage 80% after AMR is satisfied when primary; 100% of remaining bill when secondary to other coverage 100% after IMR is satisfied 100% after AMR is satisfied
Annual sharing limit $40,000 per person $100,000 per person (unless enrolled in ExtenCare) $200,000 per person (unless enrolled in ExtenCare)
Illness sharing limit No lifetime limit or illness limit Lifetime limit of $125,000 per illness (unless enrolled in ExtenCare) Lifetime limit of $125,000 per illness (unless enrolled in ExtenCare)
Help beyond the sharing limits Bills that exceed the $40,000 limit are eligible for board review and further donations An additional $100,000 per person per year is available by participating in the ExtenCare companion program at an additional cost of $24 per unit per month. To receive help from ExtenCare, you must be enrolled before the incident begins.
Pre-existing clauses No pre-existing clauses or waiting periods Incidents for which you are receiving treatment (other than routine medication) when you join ECS or DCS (whether or not you have been a member of a different sharing program with CHA) will not be shareable. (exclusion for returning missionaries) New incidents which begin after becoming a member will be shareable.
Member Responsibility for Maternity Cases OB bills are paid by case year based on the year in which the pregnancy begins with only one AMR and Annual Limit per pregnancy Since each pregnancy is considered one incident, IMR of $5,000 will apply to each pregnancy. (Only inpatient bills are eligible for sharing.) OB bills will have a new Annual Member Responsibility each year, even when one pregnancy spans portions of two years.
Secondary to Other Assistance & Other Provisions This sharing program is secondary to all other insurance or medical aid with the exception of state aid who is always the payer of last resort. These sharing programs are secondary to all other types of coverage or financial assistance with the exception of state aid who is always the payer of last resort. If funds that are shared by CHA for the payment of medical bills are not used for this purpose, membership in the sharing program will be terminated.

Overview of Shareable and Non-Shareable Items

Traditional Sharing
All shareable items are applied to AMR and/or shared.
Emerald Care Sharing
All shareable items are subject to being part of a qualifying incident.
Diamond Care Sharing
All shareable items are subject to being part of a qualifying incident.
Shareable only means an item or expense is eligible for consideration to receive an allocation of the sharing resources. It does not guarantee any form of payment.
Ambulance Shareable Not Shareable Shareable up to $5,000
Anesthesia Shareable Shareable Shareable
Assistant Surgeon Shareable Shareable Shareable
Breast & Eye Prostheses Shareable Not Shareable Shareable
Cataract Surgery Shareable Shareable Shareable
Chemotherapy & Radiation Shareable Not Shareable Shareable
Chiropractic Care Up to 12 manipulative treatments per year are shareable as well as procedures that would be shareable if performed by medical personnel Not Shareable Not Shareable
Consultations Shareable Shareable Shareable
Critical Care Unit Shareable Shareable Shareable
Delivery Room Shareable Shareable Shareable
Dental Accidents Shareable with limitations Shareable with limitations Shareable with limitations
Diabetic Supplies Up to $150/mo for non- insulin dependent, $300/mo for insulin dependent, not subject to AMR or 80% limit Not shareable Not shareable
Diagnostic Testing Shareable Shareable Shareable
Disc Decompression Therapy Shareable Not Shareable Not Shareable
Durable Medical Equipment Some DME shareable - See Guidelines for complete list. Not shareable Limited to apnea monitor, bili blanket, home infusion pump, insulin pump, CGM, nebulizer, orthotics
Emergency Room Shareable Shareable Shareable
Home Health Up to 24 licensed personnel visits per year shareable Not Shareable Up to 24 licensed personnel visits per year shareable
Hospice Shareable Not Shareable Shareable
Hospital Room & Board Shareable Shareable Shareable
Intensive Care Unit Shareable Shareable Shareable
Maternity Care & Delivery Shareable except for take-home meds (includes pre-existing pregnancy) Inpatient charges only are shareable - (pre-existing pregnancies excluded) Shareable - (pre-existing pregnancies excluded)
Mental Health Treatment Shareable with exclusions Shareable with exclusions Shareable with exclusions
Nursery & Neo-natal Nursery Shareable Shareable Shareable
Office & Out-patient Surgery Shareable Shareable Shareable
Office Visits Shareable Shareable (excludes OB) Shareable
Operating Room Shareable Shareable Shareable
Out-patient IV Shareable Not Shareable Shareable
Physician Charges for Inpatient Care Shareable Shareable Shareable
Plastic Surgery for Reconstruction Limited Sharing Not Shareable Limited Sharing
Prescriptions & Injections Limited to meds used in hospital or surgery, chemo drugs, RhoGam or Progesterone for OB use Shareable during in-patient hospital stay or emergency room treatment only Shareable as part of incident; excludes immunizations and maintenance medications
Pulmonary Procedures Shareable Shareable Shareable
Radiation Shareable Not Shareable Shareable
Recovery Room Shareable Shareable Shareable
Skilled Nursing Shareable Shareable Shareable
Supplies for Outpatient Burn, Accident, and Respiratory Needs Shareable Shareable Shareable
Surgeons' Fees Shareable Shareable Shareable
Surgical Implants, including prosthetic, excluding dental Shareable Shareable Shareable
Therapy, including but not limited to Eye, Occupational, Physical, & Speech Shareable Not Shareable Shareable up to 45 sessions if ordered by MD, ARNP, or PA and performed by licensed therapist