Liberty HealthShare's Sharing Guidelines document helps us to steward the resources of all our members while ensuring that each member has the full opportunity to understand and be aware of the standards by which sharing is determined. It is essential that you take the time to review and understand our Sharing Guidelines as often as you need to. Doing so will ensure that your expectations are appropriate. The Sharing Guidelines exist for ALL of us so that we all understand the role medical cost sharing may play in our individual healthcare decisions. They serve as a transparent document that each of us agrees to - a document that assists us all in maintaining the freedom to make our own healthcare decisions.
Every year, Liberty Healthshare members vote on changes to be made to our Sharing Guidelines. The Board of Directors also consults with administrative entities of LHS and often times clarifying language is added to our existing Sharing Guidelines. These guidelines include critical information directly related to eligible and ineligible medical costs and other policies regarding your sharing membership. As such, the following changes went into effect on April 1, 2016, following the annual member vote and accompanying board meeting.
Members voted affirmatively to adjust the Sharing Guidelines. Below are the changes that can be found in our Sharing Guidelines in Section IV, Member Medical Expenses, subsection C Sharing Limits.
10) Occupational or Work Related Injuries. Expenses arising from the care and treatment of an injury or illness that is occupational, or that arises from work for wage or profit, including self-employment, are not eligible for sharing. However, such expenses will be considered for sharing if:
- the State in which the injuries occurred has no Worker’s Compensation laws or requirement.
- the State laws proscribing participation in the Worker’s Compensation system of that State do not permit the business owner and/or enterprise from participation in Worker's Compensation. Documentation of such exemption may be required.
- the business owner personally has an objection to his or her own participation in insurance based on religious conscience. Such a statement must be submitted in writing by the business owner and verified by Liberty HealthShareSM .
If you are a current member AND a business owner in a state that offers Worker's Compensation for business owners, you will need to secure such coverage beginning no later than July 1, 2016.
15) Pre-Existing Condition Review. Medical expenses incurred within the first 90 days of membership may be subject to a pre-existing condition review, including, but not limited to, request for medical notes/records, hospital charts, surgical records or other relevant medical history information. Failure to fully disclose pre-existing condition information at the time of enrollment is a violation of our shared trust between members and may subject the member to termination of membership.
Two changes have been made to our guidelines describing the kinds of bills we share in Section IV, Member Medical Expenses, subsection A, Medical Expenses Eligible for Sharing #10 and #11.
10) Prosthetics, and their replacement, if medically necessary.
11) 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 residing outside the United States. Eligibility of such charges is subject to all other provisions of the Guidelines. Medical billing is requested to be submitted in English and converted to U.S. currency.
Our Member Services and Bill Processing departments receive numerous emails and phone calls from both members and their healthcare providers seeking clarification of our guidelines. It is critical that you, the member, understand our Sharing Guidelines. Please take the time to read this important document.
The guidelines can always be found under RESOURCES on our web page.
If you have any questions, please contact Member Services at 1-855-585-4237.
*PLEASE NOTE: AS THE GUIDELINES UNDERGO REVIEW AND CHANGES FOLLOWING EACH YEAR'S MEMBER VOTE, THIS INFORMATION MAY NOT BE THE MOST CURRENT. BE SURE TO REVIEW THE SHARING GUIDELINES LINKED ON THE LIBERTY HEALTHSHARE WEBPAGE TO OBTAIN THE MOST CURRENT INFORMATION.