Zion HealthShare | Condensed Guidelines Updates

Membership
Guidelines Updates
Condensed Version January 2024

Zion HealthShare Members,

This correspondence highlights the changes to the Member Guidelines that will be implemented
on January 1, 2024. It is recommended that you read the complete Member Guidelines , when they
are made available, for a comprehensive understanding. The following serves as a starting point
for your reference:
• Changes to Member Guidelines effective January 1, 2024:
o Please review the complete document for a thorough understanding.
o This condensed version provides an overview of the modifications.
o Please note that “additional clarification” refers to any major changes to word
choice and definition.
It is important to note that the condensed version is not a substitute for reading the entire
Member Guidelines. Should you have any questions please contact Member Care a t 888-920-9466
or member@zionhealthshare.org.

Members and Membership (previously known as Membership Requirements)

Find/Replace all “dependents” to child(ren).

Spouse/Domestic Partner (New Guideline - under Members and Membership)

New category/definition added.

Child(ren) (previously known as Dependents)

Clarification to definition of a child dependent.

Tobacco Users
Defining when the surcharge may be removed.

Maximum Shareable Amounts

Clarification.

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Appeals
Clarification to process and email to which appeals should be submitted.

Multiple Sharing Requests in a 12-Month Period

Clarification to when the rolling 12-month period begins.

Aging Out at 65 (New Guideline – under Submission of Sharing Requests)

New Guideline defining age out at 65.

Medical Records Addendums (New Guideline – under Submission of Sharing Requests)

New Guideline defining the requirements of Medical Record Addendums.

Definition of Pre-Membership Medical Conditions

Clarification to what a Pre-Membership is defined as by Zion HealthShare.

Medical Expenses Eligible for Sharing

Arthritis Treatment
Additional clarification.

Cataract Surgery
Additional clarification to age-related cataracts and the requirements.

Contraception
Adding additional examples of contraceptives not considered shareable.

Degenerative Conditions (New Guideline – under Eligible for Sharing)

New Guideline defining Degenerative Conditions.

Home Healthcare
Clarification on sharing limit.

International Medical Treatment

Clarification on guideline requirements.

Joint Replacement Treatment

Clarification to Guideline.

Nutritionists
Additional clarification to shareable visits.

Osteoporosis (New Guideline – under Eligible for Sharing)

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New Guideline defining Osteoporosis.

Suicide & Attempted Suicide

Clarification to Guideline.

Medical Expenses Ineligible for Sharing

ADHD & SPD Treatment (previously ADHD, ADHS, & SPD Treatment)
Removing ADHS.

Dental
Adding an example of accident or injury.

Genetic Screening
Clarification to Guideline.

Injuries Obtained from Certain Acts

Clarification to Guideline.

Fees & Interest (previously Late Fees & Interest)

Clarification with credit card transaction fees.

Medically Stable Conditions

Clarification to Guideline.

Vision
Additional clarification about Lasik, PRK, and/or other surgical or non -surgical visual
acuity procedures.

Preventive Services

Annual Provider Visit

Clarification to what is considered shareable at the annual provider visit (e.g. cervical
cancer screenings, prostate exams, services provided at the APV, etc.)

Colorectal Cancer Screenings (previously Colonoscopies)

Additional guideline to include home colorectal cancer screening testing.

Mammograms
Clarification to additional ultrasounds.

Maternity Sharing Requests

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Maternity General
Clarification to the timeline for submitting sharing request and submittal of itemized
statements and bills.

Maternity - Waiting Period

Clarification to when conception can occur for the request to be shareable.

Maternity – What is Shareable

Additional guidelines under Delivery for what is considered shareable.

Maternity – What is Unshareable

Additional clarification for what is considered unshareable.

Maternity - Maternity IUA Payment

Simplifying guideline.

Maternity – Separate Sharing Requests

Additional clarification.

End Of Life Assistance

End of Life Assistance

Clarification to the financial assistance provided.

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