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GUIDELINES

Impact Health Sharing (Impact) is a not-for-profit healthcare sharing organization that facilitates sharing
medical bills with one another. Impact Health Sharing is NOT insurance and these Guidelines are not a
contract for insurance. The Guidelines do, however, outline the way in which voluntary sharing of
healthcare expenses occurs among members.

By becoming an Impact Member, you are agreeing to these Guidelines and that Impact has the legal right to facilitate sharing under these Guidelines, for your benefit and for the benefit of all members, in its reasonable discretion.

Statement of Shared Beliefs & Ethics

OUR BELIEFS, ETHICS, AND STANDARDS

Impact Health Sharing is a not-for-profit corporation that exists to create, exercise, and express practical applications of Christian faith, beliefs, and ethics. We believe in bringing together individuals and families in shared acts of common good. We believe that the expression of these things, and the right to associate in the exercise of their expression, is a fundamental right guaranteed under the United States Constitution. We welcome all people who are willing to honor and abide by our Statement of Shared Beliefs & Ethics, by which we operate. We are a community that shares a common belief that by coming together, sharing together and acting together, we provide greater opportunities for health and freedom to our neighbors and, in turn, we gain the same opportunities for ourselves and our families. As a community, we believe that it is both true and selfevident that all men are created equal and in the likeness of God. We believe that all men have been endowed, by God, with unalienable rights such as life, liberty, and the pursuit of happiness. As families and individuals, we believe we share the responsibility of ensuring that the pursuit of life, liberty, and happiness is available to all. As a community, we share a belief that contributing to one another’s medical bills express our commitment to help each other pursue a life of liberty and happiness. At the core of what we do, and how we relate to and engage with one another as a community of people, is a set of common beliefs. Our Statement of Shared Beliefs & Ethics is as follows:


 

Impact Health Sharing Program Details

Smiling couple using laptop together at home in kitchen

IMPACT HEALTH SHARING IS NOT AN INSURANCE COMPANY. HEALTH SHARING IS NOT INSURANCE OR A CONTRACT FOR INSURANCE. THE PAYMENT OF MEDICAL BILLS THROUGH IMPACT HEALTH SHARING OR OTHERWISE IS NOT GUARANTEED IN ANY WAY.

There is no transfer of risk from a Member to Impact Health Sharing or from a Member to other Members; and there is not a contract of indemnity between Impact Health Sharing and any Member or between the Members themselves.

 

Membership

  1. Qualifications
    To be eligible to participate in Impact Health Sharing, an applicant must:
    • Have abstained from the use of tobacco, or the use of vaping, or federally illegal drugs for at least the 12 months prior to applying for membership
    • Not be pregnant
    • Agree with the Statement of Beliefs and Ethics
  2. Membership Requirements
    • Members cannot use tobacco on a regular basis, vape, or use federally illegal drugs.
    • An adult child (18-25) needs to meet the same requirements in order to be on his or her parent(s) household membership and have their bills shared.
    • Medical information is provided during the application process. IF AN APPLICANT OR MEMBER FAILS TO DISCLOSE MEDICAL HISTORY OR LIFESTYLE HABITS OR CHOICES THAT MAY DISQUALIFY THEM FROM MEMBERSHIP AND THAT INFORMATION IS DISCOVERED, MEDICAL BILLS MAY NOT BE SHARED AND/OR MEMBERSHIP MAY BE CANCELLED.
    • Participation in Impact Health Sharing will be online and monthly share contributions must be made using Electronic funds transfers (EFTs). The contributions will electronically transfer from the member’s bank account to a virtual share account in order to send funds to other members. Receiving members will receive those funds in bill pay accounts, the sole purpose of which will be to pay eligible bills.
    • Body Mass Index (BMI) Assessment BMI criteria (based on weight and height) has been established that may require Applicants to pay an additional monthly amount. In order to remove this additional amount, members must provide documentation that shows they have lowered their BMI below the set criteria. You will be notified during the application process before you join if you qualify for this additional amount.
  3. Family Members
    The following family Members may be included or added to the Membership if they meet the qualifications for membership:
    • Spouse
    • Unmarried Children (Biological or Adopted) until they reach the age 26*
    • Children in full legal custody or guardianship of the Member

      *An exception is made for those who are disabled and still dependent upon and under the care of their parent(s).
  4. 65 Years of Age and Older

    Applicants who are age 65 or older must have Medicare Parts A&B, and sharing will be secondary to Medicare. There is only one PRA level available to these senior adults (see pricing calculator at ImpactHealthSharing.com). This program is available only on an individual membership basis.

  5. Non-U.S. Citizens
    Legal aliens who live full-time in the U.S. can qualify for Impact Health Sharing membership. Medical Bills incurred while not a legal resident of the U.S. are not eligible for sharing.


 

Bill Sharing

  1. Sharing Limits

    For the first 60 days of membership, Members are eligible to have up to $50,000 of their Eligible Medical Bills shared (excluding pre-existing conditions).

    Maternity sharing is limited to $150,000 per single pregnancy.

    There is an annual sharing cap of $500,000 per Member per Membership Year.

    There is no lifetime limit on sharing.

  2. Approved Treatment

    To be eligible for sharing, testing and treatment must be CMS- or FDA-approved and submitted on a CMS 1500 or a UB and IB form, and ordered by a:

    • Medical Doctor (M.D.)
    • Doctor of Osteopathy (D.O.)
    • Nurse Practitioner (N.P. or A.P.R.N.)
    • Physician’s Assistant (P.A.)
    • Doctor of Podiatric Medicine (D.P.M.) 10
    • Dentist (D.D.S. or D.M.D.)
    • Midwife
    • Optometrist

    These CMS or FDA approved tests and treatments must occur at one of the following:

    • Hospital
    • Surgery center
    • Clinic
    • Doctor’s office
    • Diagnostic facility

    Diagnosis and treatment are to be performed in the U.S. to be eligible for sharing, except in emergencies or when living abroad.

  3. Eligible for Sharing

    Medical bills related to a new condition, injury or illness are eligible for sharing, provided they are not listed in Section III. E. Not Eligible for Sharing. These bills may be subject to limitations if they are listed in Sections III. D. Limited Sharing. Eligibility for sharing cannot be determined until after medical services are received and bills are submitted for sharing.

    Bills must be received by Impact within 12 months from the date of service to be considered for sharing.

    Bills are to be submitted by the provider following standard healthcare industry submission and coding guidelines. This is necessary for bills to be considered for sharing.

  4. Limited Sharing

    Pre-Existing Medical Conditions or Related Conditions are conditions in which treatment, symptoms or diagnosis occurred within 36 months prior to membership. 

    Pre-existing conditions will not be eligible for sharing in the first year of membership.  They will be eligible in the second year up to $25,000 and in the third year up to $50,000.  After a member has been in membership for 36 months, pre-existing condtions are shared up to the annual cap.

    The pre-existing limitations do not apply to members 65 or older.

    Maternity is eligible for sharing after the mother has been a member for 12 months. Sharing is limited to $150,000 for any single pregnancy event, to include antepartum care, the cost of delivery and complications to the mother and/or child(ren) and postpartum care.

    To be eligible, delivery must be performed by a Medical Doctor, Doctor of Osteopathy, or Midwife who is properly licensed, certified and/or registered in the state of delivery.

    The newborn can be a Member from birth if a request to add them to the membership is made within 30 days of the date of birth.

    If the mother is not a Member for 12 months prior to delivery, the following are instances where maternity bills are ineligible for sharing: 

    • Medical bills incurred before the newborn’s Membership Date 
    • Unresolved maternity medical conditions of child or mother 

    Adoption Events are eligible for sharing for those who have been members for 12 months prior to the adoption, and is based on a scale per PRA:

    PRA

    Adoption Sharing Amount

    $2,500 $5,000
    $5,000 $4,500
    $7,500 $4,000
    $10,000 $3,500
     

    Prescription medications related to a new diagnosis are eligible for sharing up to six months after diagnosis. This includes prescription drugs that may be dispensed, injected or administered. Exceptions may be made in the case of medications for cancer and transplant recipients. 

    Prescription discounts are available through our wholesale direct Rx program.

    Wellness Visits/Screening tests are eligible for sharing as follows:

    • Women: Pap test—one every three years from age 21-65 Mammogram—one every year for ages 45-54, every two years starting at age 55
    • Men: PSA test—one every 10 years, starting at age 50
    • All: Colonoscopy—one every 10 years starting at age 50
    • Infants and Children: Sharing for routine well-child care is eligible until the child reaches the age of six. Well-child care is defined as recommended routine check-ups and associated lab work, excluding vaccinations and/or immunizations.

    Mental Health Care is eligible for sharing up to five visits per Member per Membership Year. Psychotropic medication is eligible for sharing.

    Therapy is limited to 50 visits per Member per Membership Year regardless of type of therapy, provided it is included in the list below:

    • Chiropractic Adjustment
    • Physical Therapy
    • Occupational Therapy
    • Speech Therapy
    • Respiratory Therapy
    • Cardiac Rehabilitation
    • Home Healthcare

    Durable Medical Equipment (DME) is eligible for sharing for a new diagnosis up to 6 months, not to include motorized locomotion equipment.

    Prostheses are eligible for sharing, one per eligible diagnosis.

    Motor Vehicle Accidents: Treatment related to injuries received while in motor vehicles is eligible for sharing, provided all legally required and industry recommended safety equipment was in use. Treatment related to motorcycle accidents is limited to $100,000 per incident. Sharing will be secondary to the vehicle insurance. Treatment will not be shared if there was abuse of alcohol or legal drugs or the use of Illegal Drugs.

    Care for Members 65 and older: Eligible medical bills for members 65 or older are eligible for sharing with no co-share amount provided the member has Medicare Parts A & B. Sharing is secondary to Medicare and is based on the difference between the Medicare-allowable charges and the actual amounts paid by Medicare. The member must submit a copy of the Medicare Explanation of Benefits and the CMS 1500, or UB and IB form.

  5. Not Eligible for Sharing

    Bills related to the following are not eligible for sharing:

    • Treatment that is in violation of the Statement of Beliefs and Ethics
    • Treatment related to current use of tobacco, nicotine, vaping or illegal drugs
    • Procedures or surgery that is not medically necessary
    • Prophylactic (treatment intended to prevent disease) and preventive surgery without personal history of diagnosis and a doctor’s recommendation 
    • Alternative or naturopathic treatment
    • Experimental treatment
    • Genetic testing not required for treatment of an existing condition 
    • Hearing aids 
    • Non-prescription (over-the-counter) drugs and medical supplies/equipment. 
    • Fertility/infertility treatment
    • Direct Primary Care costs
    • Medical marijuana
    • Routine or preventive care not listed in Section D. above
    • Sleep studies not related to a specific disease or disorder
    • Treatment related to genetic defects, hereditary diseases, or congenital conditions present before membership
    • Weight management treatment or procedures
    • Dental or vision services not related to an injury or illness
    • Treatment for members age 65 or older that is not Medicare-eligible
  6. Use of Programs

    If a Member qualifies for public assistance or private benevolence programs, they must apply for the program benefit before the bill can be considered for sharing. If the member receives assistance through the use of a program, their next three months of their monthly Share Portion will be waived.


 

Conditions of Sharing

Home-Form

 

Virtual Share Exchange

To make Healthcare Sharing convenient and efficient, Impact Health Sharing deploys a technology platform called a Virtual Share Exchange (“VSE”). The VSE enables all Impact Members to participate in the Healthcare Sharing process electronically, as well as to monitor the transactional activities of their individual share accounts and the community at large. Your Impact Membership requires that you activate your own Share Account and enable the Virtual Share Exchange to administer the sharing process on your behalf. By activating your Share Account and accepting the Virtual Share Exchange “Terms and Conditions” and Disclosures, you have given Impact Health Sharing and its Service Agents express permission to conduct financial transactions, necessary for the administration of the program, on your behalf.

  1. Share Account

    To participate in the Impact Health Sharing Community, all Members must activate a Share Account on the Virtual Share Exchange Platform. Your Share Account is a virtual account and all deposited funds are received by America’s Christian Credit Union who holds them “For the Benefit of Impact Health Sharing Members”. The Share Account will display your account balances, sharing transaction history and other relevant information, and includes your own dashboard management tools. The money in your Share Account is insured (see disclosure at ImpactHealthSharing.com) and is fully controlled by you.

    To activate your Share Account, you will be required to provide the necessary personal information to comply with US Banking Regulations. Once your information is submitted and verified, you will be required to link your Share Account to one of your External Bank Accounts, such as Bank of America or Wells Fargo. Each month, your will fund your Share Account with an EFT (electronic funds transfer) from your External Bank Account.

  2. Monthly Share Notice  

    Impact Members will receive a Monthly Share Notice through the VSE Platform to inform them and remind them of the monthly amount that they are to contribute. The monthly amount that you are to contribute (your Total Share Amount Due) is based on the Impact Sharing Plan Level that you have selected.

    The amount specified in your Monthly Share Notice is transferred through an EFT drawn off your External Bank Account. EFTs are always for the “Total Share Amount Due.” The “Total Share Amount Due” is displayed on every Monthly Share Notice and it will include the current Monthly Share Amount, any Past Due Amounts and any relevant Service Fees.

    The Total Share Amount Due may be paid manually within the VSE Platform or through Recurring EFTs that you configure within the system. You will have the ability to add, edit and delete your Recurring EFTs, as well as your linked External Bank Account at any time.

  3. Account Management

    Your Share Account is a financial account that you own and control. You will have the ability to add, edit and delete your Recurring EFT settings, as well as your linked External Bank Account at any time. You may also choose to have your medical bills “anonymously” shared among the Members, otherwise Members who share in your medical bills will be able to see with whom they are sharing.

  4. Publishing & Sharing

    Participation in the Impact Sharing Community is voluntary. This means that when you are selected to participate in a sharing event, if you object to that particular sharing event for any reason, you may withdraw and terminate your membership during the three-day publishing period (described below) rather than participate in that sharing event.

    Medical Bills that are eligible for sharing are matched, allocated and published to the Membership prior to sharing. To be compliant with regulations and safe harbor statutes, Impact Health Sharing implements a member-to-member or peer-to-peer (P2P) approach to sharing, which means that members share funds directly with one another, rather than drawing funds from a pool.

    Your medical bills will be submitted to Impact by your Medical Providers. Impact will process, all bills for eligibility per the Guidelines. Eligible bills are then submitted into the Virtual Share Exchange for sharing. Amounts Approved for Sharing are allocated to your fellow Members who have been matched to share in (contribute toward payment of) your bill.

    Members who have been matched to share your bill will be notified through a process called “publishing” as to the amount that will 20 be withdrawn from their Share Account for the payment of your bill. They will also be notified as to who will be receiving their funds, unless you choose the anonymous setting in your Share Account dashboard’s Sharing Permissions. Once the three-day publishing period has ended, the amount published to each member is transferred to a Virtual Bill Account for the payment of your bill.

    Members who have been matched and allocated to share in another Member’s medical bill may withdraw from membership prior to the expiration of the three-day Publishing Period in which case no funds will be transferred to the receiving member.

    Because a member may refuse to share in a particular medical expense for any reason or no reason, the sharing process remains entirely voluntary for every member. However, as noted above, any sharing refusal requires withdrawal from membership before the end of the three-day Publishing Period.

  5. Virtual Bill Accounts

    If you have an eligible medical bill that has been approved for sharing, the VSE will create a Virtual Bill Account for the payment of that bill. Virtual Bill Accounts are unique to a specific medical bill and are linked to your Share Account. Each Virtual Bill Account is unique to a Member of your Household, a Medical Provider and a specific bill. Amounts collected in your Virtual Bill Account(s) are restricted and are displayed as a single line item transaction in your Share Account.

  6. Provider Payments

    Virtual Bill Accounts remain open until the Amount Approved for Sharing has been fully collected and transferred to your Medical Provider as payment for your bill. While Virtual Bill Accounts are aggregated in the transactional view of your Share Account, these funds are restricted and cannot be withdrawn from your Share Account. Once all the allocated funds have been transferred from the Members who were matched to pay your medical bill, those funds are released for payment to your Medical Provider. The transfer of funds out of your Virtual Bill Account will be displayed as a single line item transaction in your Share Account.

  7. Distributed Reserves

    In order to process and pay medical bills quickly, Impact Health Sharing implements a practice called Distributed or Decentralized Reserving. Impact is NOT insurance, so we do not collect and hold medical reserves in a centralized bank account. Instead, the Monthly Share Amount is set at a level to build a small balance (or reserve) in every Member’s individual share account. These “Distributed Reserves” enable Impact Health Sharing to better manage the ebb and flow of medical usage and payments.