BASIC TERMS UNIQUE TO HEALTH SHARING
“Contribute” or “Contribution” – The dollar amounts voluntarily transferred by a Member to Impact for continued participation in the Impact Sharing Plan. Because participation in the Impact Sharing Plan is not a contract for insurance and participation is voluntary, contributions are not a “demand for payment” for a product or service.
“Invoice” or “Statement” -- A demand for payment for medical care services rendered, submitted by a medical care provider to a Member.
“Pay” or “Payment” – The dollar amounts tendered to a medical care provider or facility by Impact and/or a Member under the Impact Sharing Plan in consideration for a medical care service rendered by the provider to a Member under the provider’s contract for service.
“Share” or “Sharing” – The joint sharing of certain medical expenses incurred by a Member that are contributed to by other Members of the Impact Sharing Community.
“Share Notice” or “Notice” – A notification of voluntary contribution amounts due under the Impact Sharing Plan, submitted by Impact to a Member. Share Notices are typically delivered monthly as a “Monthly Share Notice.”
IMPACT PROGRAM & MEMBERSHIP
Bill Approved for Sharing - An Eligible Medical Bill that meets the criteria for sharing in the Guidelines and meets the other conditions for sharing, including whether the member’s PRA has been met and other sharing limits have not been exceeded.
Cancellation Date - The month and day membership ends due to the Member’s withdrawal or administrative cancellation.
Co-Pay - The portion of a medical bill that a Member pays to a healthcare provider at each visit.
Effective Date – The date the Member’s current PRA has begun.
Eligible for Sharing - Any testing, treatment, procedure or service that meets the criteria for sharing as established in the Guidelines.
Eligible Medical Bill - An incurred medical bill that meets the criteria for sharing as established in the Guidelines, the Eligible Medical Bill may be reduced by any discounts, fees or other sources of payment.
Illegal Drugs - Drugs which are classified as Schedule 1 in Title 21 United States Code Controlled Substances Act.
Member - Any Member of the Impact Sharing Plan, including each family member participating in a Member Household.
Member Household – The related family members participating in the Impact Sharing Plan.
Membership Date – The date a Member’s participation in Impact begins. Medical bills incurred after this date may be considered for sharing among members.
Pre-Existing – Any conditions in which treatment, symptoms or diagnosis for a condition occurred within 36 months prior to membership.
Primary Member – An adult member that is the main contact for the household membership.
Primary Responsibility Amount (PRA) - The dollar amount a Household must pay toward their own Eligible Medical Bills during a 12-month period before their Eligible Medical Bills can be published and shared by the Membership. The PRA 12-month period begins on the Effective Date.
SHARE ACCOUNT ACTIVATION
Auto-Share (Recurring EFT) - a Sharing Permission enabling a Primary Member to set up recurring electronic funds transfers (EFTs) to transfer the Total Share Amount Due specified in their Monthly Share Notice.
External Account - an existing bank account that is linked to the Primary Member’s Share Account and is used to transfer via EFT the Total Share Amount Due to the Share Account each month.
Manual Share - a function that enables a Primary Member to initiate an “on-demand” EFT to transfer the Total Share Amount Due specified in their Monthly Share Notice.
Permissions - are auto-enable functions (ex. Auto-Share) that are set and managed by the Primary Member.
Share Account - the member-controlled virtual account that is linked to both your External Account and your deposit account at America’s Christian Credit Union and is used for all sharing transactions and activities.
MONTHLY SHARE NOTICE
Grace Period - the number of days between the Share Due Date and Past Due Date.
Monthly Share Amount - the sum of the Share Portion and Required Miscellaneous Portions published in the Share Notice.
Past Due Date - the day of the month that a delinquent Total Share Amount Due becomes past due.
Past Due Reminders- are Share Notice Reminders sent to members who have not paid their Share Notice and are past-due.
Payment Reminders- are Share Notice Reminders sent only to members who pay manually, instead of automatically, and only if the Total Share Amount has not yet been paid.
Previous Balance - is the sum of any past due, unpaid amounts published in the Share Notice.
Required Miscellaneous Portion – an amount set by the HCSO to fund certain described activities such as its administrative and program expenses.
Share Due Date - the day of the month by which the Total Share Amount Due must be transferred via EFT in full.
Share Notice - the written notification to a Member that details the Total Share Amount Due for the month.
Share Notice Date - similar to a statement date or invoice date, it is the day of the month that the Share Notice is published and distributed.
Share Payment (Funding) - transferring funds (Total Share Amount due) from a member’s External Account to their Share Account.
Share Portion - the portion of the Monthly Share Amount that is collected and used specifically for member-to-member sharing of eligible medical bills.
Total Share Amount Due - the sum of the Monthly Share Contribution Amount (Share Portion and Required Miscellaneous Portion), Optional Portion (auto-enabled by the Member), Service Fee and any past due amount (Previous Balance).
MEDICAL BILLS & NEEDS
Adjusted Amount – the discounted or repriced amount.
Approved for Sharing - the portion of the Adjusted Amount that is eligible for sharing as per the program guidelines
Bill Status - References the processing stage/state of a specific Need or Bill.
Charge Amount - the gross amount billed by the Medical Provider.
Explanation of Sharing (EOS) - is a notice sent to a Member detailing the eligibility status of a bill, any discounted amounts and what portion of the remaining Charge Amount has been shared by Impact members and any remaining amount that must be paid by the Member.
Member Responsibility – the portion of the Adjusted Amount calculated to be the member’s responsibility and will not be shared.
Need - is a grouping of medical bills by a medical event such as knee surgery. Individual medical bills may sometimes be referred to as a “Need."
Published Amount - the portion of the Adjusted Amount that is eligible for sharing and has been published/allocated to the members for sharing.
Received Date - the date that Impact receives the medical bill and begins processing the bill for eligibility.
Service Date - the date that the Member (patient) received services from the Medical Provider.
Shared Amount - the Published Amount that has been shared and collected in the Member’s Sharing Account.
MATCHING & SHARING
Sharing (Member-to-Member Transfers) - moving funds from a sending Member’s Share Account to a receiving Member’s Virtual Bill Account.
Available Balance - the total sum that is available for sharing a new eligible medical bill and/or Withdrawal. It is the Total Balance minus the Pending Balance minus the Restricted Balance
Debits & Sharing - The “Negative (-)” transactions debited out of the Member’s Share Account, which would be Miscellaneous Required Portion (i.e. Debits), Optional Portion, and Share Portion.
Deposits & Credits - The “Positive (+)” transactions that are credited to the Member’s Share Account, such as EFT Transfers (i.e. Deposits) and Shared Funds Received (i.e. Credits) that a Member might receive to pay their eligible medical bill.
Pending Balance - the sum of EFT(s) that have been initiated but have not yet posted to the Member’s Share Account.
Restricted Balance - the sum of funds that have been credited to the Member’s Share Account for purpose of paying an eligible medical bill.
Total Balance - the sum of the Pending Balance, Restricted Balance, and Available Balance in a Member’s Share Account.