1. Annual Unshared Amount (AUA): This is the amount you must pay out of pocket each year before your eligible medical bills can be shared. The AUA options typically range from $2,000 to $14,000.
2. Co-Share Amount: After meeting the AUA, you may need to pay a co-share amount, which is usually 20% of eligible medical bills, until you reach the co-share limit ($5,000 per year).
3. Ineligible Expenses: Certain treatments and conditions are not eligible for sharing, and you will need to cover these costs out of pocket. This includes some pre-existing conditions, elective procedures, and specific treatments listed in the guidelines.
4. Prescription Costs: Outpatient prescription costs are sharable only under the Enhanced program, with an annual cap of $1,000 per household. Other prescription costs may be submitted through FlexShare.
5. Routine and Preventive Care: Routine visits and preventive screenings are sharable only under the Enhanced program, and some limits apply.
These out-of-pocket costs ensure members contribute to their healthcare expenses while benefiting from the shared support of the REDEEM HealthShare community.