Preexisting Medical Conditions
Pre-existing medical conditions are those where known signs, symptoms, testing, treatment, diagnosis, or use of medication occurred within 36 months prior to the member’s start date. REDEEM™ HealthShare Ministry does share in pre-existing conditions, but there are specific guidelines and limitations:
1. Waiting Period:
There is a three-year waiting period from the start of membership for sharing bills related to pre-existing conditions.
After this waiting period, up to $125,000 per year per member will be shared for pre-existing conditions. This limit increases to $500,000 in the sixth year of membership.
2. FlexShare Option:
Pre-existing conditions can also be submitted for sharing under the FlexShare program after an initial six-month waiting period for FlexShare has elapsed.
3. Specific Conditions:
- Heart and Cancer Conditions: Bills for pre-existing heart and cancer conditions are subject to a five-year waiting period from the time of membership. After this period, the standard sharing limits apply.
- Type 1 Diabetes: Bills for pre-existing Type 1 diabetes are not eligible for sharing.
- High Blood Pressure: Bills for pre-existing high blood pressure can be shared if the member has not received hospital treatment for this condition in the last 5 years and it is controlled through medication or diet.
- Elevated Cholesterol: Elevated cholesterol alone is not considered a pre-existing condition, even if a statin is prescribed. However, if the statin is prescribed for a pre-existing condition such as arteriosclerosis, it will be considered pre-existing.
4. Seniors (65+):
- Seniors with Medicare A&B: Pre-existing conditions do not apply.
- Seniors with Enhanced Membership (no Medicare A&B): Pre-existing conditions still apply.
By understanding these guidelines, members can better navigate their healthcare sharing options within REDEEM HealthShare Ministry.