Keep reading to find answers to questions about your membership, how it works, or learn some important definitions.
ClearShare is a membership-based non-insurance community of individuals established for the purpose of sharing eligible healthcare expenses between Members as described in the Member Guidelines.
ClearShare was formed and approved as a nonprofit in the state of Missouri. Our 1023 non-profit 501(c)(3) tax exemption application is pending approval by the Internal Revenue Service.
No. ClearShare is not insurance. Insurance arrangements are a contract whereby one party agrees to be legally responsible for and accept another party’s risk of loss in exchange for a payment — a premium.
Medical cost sharing is an arrangement whereby members agree to share medical expenses through the act of voluntary giving. ClearShare does not assess applicants’ health risks because neither ClearShare nor its members are assuming financial liability for any other member’s risk.
Unlike insurance, the focus of ClearShare is to provide an avenue for members to help each other bear their immediate healthcare expenses. ClearShare should never be considered to be insurance. Whether you receive any amounts for medical expenses and whether or not ClearShare continues to operate, you are always personally responsible for the payment of your own medical bills.
Be sure to contact Care Coordination before procedures whenever possible to confirm eligibility. Because ClearShare is not insurance, you may be told that you are not in-network. ClearShare is an open network and will share in eligible medical expenses once a needs request is opened. Please follow these instructions or contact us for assistance when receiving care:
Accidents, ER Visits, or Hospital Services
ClearShare does not have annual or lifetime sharing limits for our members. Certain medical needs have shareable limits and are clearly stated in our Member Guidelines.
Yes, eligible medical expenses are shared no matter where they were incurred and treated. Preventative or non-emergency services are not shareable without prior written approval from ClearShare. You must have a US address for medical expenses to be shared.
ClearShare is open to anyone under the age of 65 who agrees to the Member Guidelines and abides by our Statement of Beliefs. ClearShare membership is open to people from all backgrounds, nationalities, ethnicities, and faiths.
No, ClearShare is not a substitute for insurance and does not meet the requirements of the ACA.
To cancel your membership, contact the membership administrator at email@example.com. The request must include the reason for cancellation, and the requested month in which the cancellation of the membership is to be effective. ClearShare requires a 30-day notice to cancel a membership. ClearShare does not prorate cancellations or give refunds. Cancellations become effective on the last day of your monthly billing anniversary following the timely receipt of your membership cancellation request.
If you need to make changes to your membership information (i.e. change of address, phone number, etc.), or any other membership change request, you must get in touch with ClearShare to do so.
The change request or update may take up to three business days to complete. Once a representative of ClearShare approves the requested changes, the approved changes may go into effect on the monthly membership anniversary date.
You can only switch memberships (to/from Advanced or Basic) at your 1-year renewal date or during Open Enrollment.
Members may choose to change their Annual Maximum ($1000, $2500, $5000) at your 1-year renewal date or during Open Enrollment.
The annual maximum is the amount that you will pay before the ClearShare community shares in your qualifying medical expenses. The annual maximum is also known as your personal responsibility. ClearShare has three primary levels of personal responsibility: $1000, $2500, and $5000.
All qualifying medical expenses submitted after the annual maximum is met are shareable with the ClearShare community at 100%. There is no annual or lifetime limit. You will not need to pay the annual maximum again until your new membership year begins, based on your original effective date. Additionally, you are only responsible for the annual maximum once each membership year.
Service copays are not included in the annual maximum. For members who are also part of an HSA MEC, service related costs that apply to the member’s deductible are not part of the annual maximum.
Needs that arise from conditions that existed prior to membership are only shareable if the condition was regarded as cured and did not require treatment for 12 months prior to the effective date of membership. Any illness or injury for which a person has been examined, taken medication, had a diagnostic test performed or ordered by a physician, or received medical treatment is considered a pre-membership medical condition.
High blood pressure, high cholesterol, and diabetes (types 1 and 2) will not be considered pre-membership medical conditions as long as the member has not been hospitalized for the condition in the 12 months prior to enrollment and is able to control it through medication and/or diet.
Cancer, Heart Disease, Stroke, and COPD are only shareable if the condition was regarded as cured and did not require treatment for 5 years prior to the effective date of membership.
Pre-membership medical conditions have a phase-in period wherein sharing is limited. Starting from the initial enrollment date, members have a one-year waiting period before pre-membership medical conditions are shareable. After the first year, pre-membership medical condition needs are eligible for sharing on a limited basis, with the amount increasing each membership year.
Shareable amount for pre-membership medical conditions:
After year four of membership, expenses related to pre-membership medical conditions will remain shareable at a maximum of $125,000 in a 12-month rolling period and resetting each membership year.
Voluntary contributions by members for the purpose of offsetting expenses for other members’ unshareable needs.
The maximum amount shared for eligible needs per participating member per year. ClearShare does not have annual or lifetime sharing limits for our members unless specifically stated in the Member Guidelines.
The date ClearShare receives a complete membership application.
A fund maintained by ClearShare created from the contributions of members for the exclusive purpose of reimbursing eligible needs of members.
An organization whose primary purpose is to care for the needs of the persons/members who make up the membership. A benevolent organization is not an insurance company.
Any disease or physical abnormality present at birth or that is identified or diagnosed within the first year of life.
A list of members who are being billed by payroll deduction through a company opposed to direct billing from ClearShare.
The day medical services were rendered on behalf of a participating member.
The head of the household’s spouse or unmarried child(ren) under the age of 26, who are the head of household’s dependent by birth, legal adoption, or marriage, and who are participating under the same combined membership. Unmarried children under 26 years of age may participate in the membership as a dependent.
The date a person’s membership begins. ClearShare members also have the effective date as the billing due date.
A medical need that qualifies for sharing via the contributions of ClearShare members.
Correspondence that is delivered to the participating members and their providers once medical needs have been processed, are pending, or have been rejected. The Sharing Summary will state their member responsibility amount as well as any amounts shared by the Benevolent Fund on the member’s behalf.
A membership-based, non-insurance arrangement established for the purpose of sharing legitimate healthcare expenses between members.
A contributor, and contributor’s dependents, if applicable, who has/have not submitted monthly contributions in the manner established by the Member Guidelines. An inactive member is not eligible for sharing.
An individual who has successfully completed a prescribed program of study in a variety of health fields and who has obtained a license or certificate indicating his or her competence to practice in that field (MD, DO, ND, NP, PT, PA, Chiropractor, etc.)
The maximum amount shared for eligible needs over the course of an individual members’ lifetime of membership.
A need request that must be submitted once a member becomes pregnant within 30 days of confirmation of pregnancy from a licensed medical professional.
The maximum dollar amount (limit) that can be shared for any one need. Certain medical needs have a maximum shareable amount as described in the Guidelines.
A service, procedure, or medication necessary to rest or to maintain physical function and that is provided in the most cost-effective setting consistent with the member’s condition. The fact that a provider may prescribe, administer, or recommend services or care does not make it medically necessary.
This applies even if it is not listed as a membership limitation, or in the Member Guidelines. To help determine medical necessity, ClearShare may request medical records and information from licensed medical professionals.
This term applies to the collective body of all active, participating members of ClearShare.
Members have 30 days from the membership cancellation date to reactivate membership in order to qualify for continuous membership. For example, employers who terminate employee memberships.
A specified medical condition for which medical needs arising from or associated with the condition are ineligible for reimbursement from the Benevolent Fund. An associated condition is one that is caused directly and primarily by the medical condition that is specifically ineligible.
The membership limitation will be issued during the application process and may be subject to medical record review. Membership limitations (excluding cancer) do not apply to office visits/urgent care.
When a membership has been or will be canceled due to the submission of a Membership Cancellation Request Form, a violation of the ClearShare’s Statement of Beliefs, or non-receipt of a voluntary monthly contribution or annual membership fee for more than 10 days past the date such payment was due. Such cancellation of membership is referred to as membership withdrawal.
Monetary contribution given voluntarily and placed in the care of ClearShare by a member to maintain active membership and to be disbursed for the eligible needs of its members in accordance with the Member Guidelines.
A request that is required to process medical needs for accidents, injuries, or medical conditions that result in medical costs. Need requests can be submitted to ClearShare. The need request must be submitted to ClearShare within six (6) months of the need to be eligible for sharing.
A non-network, licensed medical professional or facility as determined by ClearShare.
Sick visits, wellness visits, specialists, and urgent care are generally considered to be office visits. The medical bill must include an office visit CPT code for the need to qualify as an office visit. Qualifications for sharing eligibility include exclusion of prior medical conditions and meeting your annual maximum.
Any illness or accident for which a person has been examined, taken medication, has a diagnostic test performed or ordered by a physician, or received medical treatment for 12 months prior to the effective date. For information on sharing for pre-membership conditions, see the section titled “Pre-Membership Medical Conditions”.
If shareable needs are ever significantly greater than shares available in any given month, ClearShare may prorate the needs amount requested for medical expenses. This involves an across-the-board percentage reduction of needs payments but does not necessarily mean that all member needs will not be met in that month.
The amount of the need request that remains after the member’s annual maximum has been satisfied and falls within the guidelines for sharing within the membership.
Medical needs that do not fall within the definition of eligible needs but are not a violation of the member requirements and may be eligible for Additional Giving (ie: a prior medical condition).
The general cost of medical services in a geographic area, as determined by ClearShare, based on what providers in the area usually charge for the same or a similar medical service.
A medical expense incurred by a member that is not shareable for one or more of the following reasons: a member’s violation of ClearShare’s Statement of Beliefs, non-current membership status, or any other condition or requirement that is excluded by the Member Guidelines.