Understanding Health Sharing Benefits: A Complete Breakdown

Health sharing plans include comprehensive coverage across 17 different benefit categories. Understanding what's included—and how each benefit works—is essential to maximizing your coverage and getting the most value from your membership.

Core Benefits Overview

1. 24/7 Virtual Care ($0 Fee)

What it is: Access to licensed doctors anytime, anywhere via phone or video.

What's covered:

• Primary care consultations
• Urgent care visits
• Behavioral health counseling
• Prescription refills
• Follow-up care

Real-world example: Your child wakes up with an ear infection at 2 AM. Instead of going to the ER, you call the virtual care line. A doctor diagnoses the infection, prescribes antibiotics, and you're done—all from home, with $0 cost.

Pro tip: Virtual care is perfect for minor illnesses, follow-ups, and after-hours concerns. It can save you hundreds in urgent care visits.

2. Primary & Specialist Care

What it is: Access to doctors for routine and specialized medical care.

Coverage details:

• 6 visits per person per year
• $35 fee per visit
• Shared up to $300 per visit
• Includes preventive care

Real-world example: You need an annual physical and a follow-up for high blood pressure. Both visits are covered under your 6 annual visits.

3. Emergency Room Coverage

What it is: Coverage for emergency department visits.

Coverage details:

• $500 member fee per incident
• Shared up to $5,000 per incident
• Covers serious injuries and acute illnesses
• Direct provider payment

Real-world example: Your child breaks an arm and needs X-rays and a cast. After the $500 fee, the remaining costs are shared by the community.

4. Hospitalization

What it is: Coverage for inpatient hospital stays.

Coverage details:

• 100% shared after Monthly Responsible Amount (MRA)
• Covers room, board, surgery, medications
• Includes emergency surgery
• Unlimited days (subject to guidelines)

Real-world example: You need an appendectomy and spend 2 days in the hospital. After your MRA, all hospital costs are covered.

5. 1,000+ Free Prescriptions

What it is: Access to over 1,000 free medications at participating pharmacies.

Coverage details:

• ~100 free at retail pharmacies
• ~900 free via mail order (shipping only)
• Covers common medications for chronic conditions
• Includes antibiotics, pain relievers, and more

Real-world example: Your blood pressure medication is on the free list. You fill it at any pharmacy with $0 cost. Your child's antibiotic is also free.

Pro tip: Check the free prescription list before enrolling to ensure your regular medications are covered.

6. In/Outpatient Surgery

What it is: Coverage for surgical procedures in hospital or surgical center settings.

Coverage details:

• 100% shared after MRA
• Includes anesthesia and facility fees
• Covers both emergency and elective surgery
• Direct provider payment

Real-world example: You need knee surgery. After your MRA, all surgical costs are covered.

7. Cancer Treatment Sharing

What it is: Specialized coverage for cancer diagnosis and treatment.

Coverage details:

• Up to $500,000 per year
• Up to $1,000,000 lifetime
• Covers chemotherapy, radiation, surgery
• Includes medications and follow-up care

Real-world example: A family member is diagnosed with breast cancer. Chemotherapy, radiation, and medications are covered up to the annual and lifetime limits.

8. Maternity Sharing

What it is: Coverage for pregnancy, delivery, and postpartum care.

Coverage details:

• Year 1: Up to $12,000 shared
• Year 2+: Up to $25,000 shared
• Covers prenatal care, delivery, hospital stay
• Includes postpartum follow-up

Real-world example: You're expecting your second child. Prenatal visits, delivery, and 2-day hospital stay are covered.

Note: Maternity coverage is available in Couple and Family plans only.

9. Chronic Maintenance Coverage

What it is: Ongoing care for chronic conditions within primary care visits.

Coverage details:

• Included in your 6 annual PCP visits
• No pre-existing condition waiting periods
• Covers diabetes, hypertension, asthma, etc.
• Medications on free prescription list

Real-world example: You have diabetes. Your quarterly checkups with your primary care doctor are covered as part of your 6 annual visits. Your insulin is on the free prescription list.

10. Imaging Services

What it is: Coverage for diagnostic imaging tests.

Coverage details:

• X-rays, MRI, CT scans
• 100% shared after MRA
• Includes ultrasounds and other imaging
• Direct provider payment

Real-world example: Your doctor orders an MRI for back pain. After your MRA, the full cost is covered.

11. Laboratory Services

What it is: Coverage for blood tests and lab work.

Coverage details:

• Discounted rates for members
• Shared according to program guidelines
• Includes routine bloodwork and specialized tests
• Direct provider payment

Real-world example: Your annual physical includes bloodwork. Lab costs are discounted and shared.

12. Vision & Hearing Discounts

What it is: Savings on eye exams, glasses, contacts, and hearing aids.

Coverage details:

• Up to 30% savings on exams
• Discounts on frames and lenses
• Hearing aid discounts
• Partner network for savings

Real-world example: You need new glasses. You get a 25% discount on frames and lenses through the partner network.

13. Durable Medical Equipment

What it is: Discounts on medical devices and equipment.

Coverage details:

• Braces, crutches, wheelchairs
• CPAP machines, oxygen equipment
• Discounted pricing through partners
• Direct ordering available

Real-world example: Your child needs a knee brace for a sports injury. You get a 20% discount through the partner network.

14. SmileShare Dental (Add-On)

What it is: Optional dental coverage available as an add-on.

Coverage details:

• 100% preventive care sharing
• Basic and major restorative coverage
• Cleanings, fillings, root canals
• Orthodontics available

Real-world example: You add SmileShare for $29/month. Your family's cleanings are 100% covered, and fillings are shared.

15. Auto/Home Insurance Savings

What it is: Discounts on auto and home insurance through partner programs.

Coverage details:

• Up to $2,000/year in savings
• Multiple insurance partners
• No enrollment required
• Easy quote process

Real-world example: You switch your auto insurance to a partner company and save $1,200/year. Your home insurance saves another $800/year.

16. Shopping & Travel Portal

What it is: Access to exclusive deals on shopping, travel, and entertainment.

Coverage details:

• ~$250 value in annual savings
• Hotel discounts, flight deals
• Shopping discounts and cashback
• Entertainment and dining deals

Real-world example: You book a family vacation and save $300 on hotel accommodations through the member portal.

17. Business Bill Negotiation

What it is: Help negotiating and reducing business expenses.

Coverage details:

• Potential savings of $30,000–$1,000,000+
• Covers internet, phone, utilities, insurance
• Professional negotiation service
• No cost to members

Real-world example: Your business saves $15,000/year on phone and internet bills through the negotiation service.

How to Maximize Your Benefits

1. Use Virtual Care First: For minor issues, always start with 24/7 virtual care ($0 cost).
2. Check the Free Prescription List: Ensure your regular medications are included.
3. Schedule Preventive Care: Use your 6 annual PCP visits for preventive care and chronic management.
4. Explore Partner Discounts: Take advantage of vision, hearing, and equipment discounts.
5. Understand Your MRA: Know your Monthly Responsible Amount to budget for specialist visits.

The Bottom Line

Health sharing plans include comprehensive coverage across 17 benefit categories—from routine care to emergency surgery. By understanding each benefit and how it works, you can maximize your coverage and get the most value from your membership.

Ready to explore health sharing? Get a free quote today.