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Program Sharing Details for the
Healthy Life EasyShare Programs
I. General Sharing Requirements,
Restrictions, Limitations & Maximums
Total eligible needs for sharing among the Members are limited as set forth in this section, or elsewhere
in these Guidelines, and as may be indicated in writing to the individual Sharin... | null | null | null | null | null | null | null | null | null | null | null | null | null |
null | Office Visit fee billed for physician services from that visit, such as testing, screening,
imaging, and procedures, may be sharable if applicable, subject to requirements and limitations. (If
multiple visits are required for an immunization that is eligible for sharing, the Member Consultation Fee
will apply to the in... | null | null | null | null | null | null | null | null | null | null | null | null |
null | null | EasyShare25 member is $250,000.
vi. Per Medical Incident Sharing Limits.
There is a limit on the total amount of medical expenses that may be shared for each Member in
connection with any Medical Incident (as defined herein), inclusive of all inpatient and outpatient Facility
and Professional expenses related to that M... | null | null | null | null | null | null | null | null | null | null | null |
null | null | null | ss results in an in-patient hospital stay.
Inpatient and outpatient hospital and surgery have a 90-day waiting period for the EasyShare Programs.
All outpatient CT Scan, MRI, and X-Ray imaging for the EasyShare Programs have a 90-day waiting
period and are sharable for up to two imaging series per year in each category... | null | null | null | null | null | null | null | null | null | null |
null | null | null | null | 00 for
EasyShare25) for all services combined. The table above represents the amounts shared for
particular incidents and any limitations specifically related to such incidents. The program shares the
actual charges of room and board up to the maximum listed in the chart above per day. In addition,
for surgical procedu... | null | null | null | null | null | null | null | null | null |
null | null | null | null | null | rred for medical costs must exceed the
Annual Non-Sharable Amount established for your Program to be eligible for sharing (See Section 5.02
for details). Medical expenses must be submitted for sharing in the manner and form specified by
Universal HealthShare. This includes the standard industry billing forms (HCFA 1500... | null | null | null | null | null | null | null | null |
null | null | null | null | null | null | y is sharable when prescribed due to symptoms for a condition not evident prior
to your membership. Routine or screening colonoscopies are not sharable.
(h) Cosmetic Surgery.
Cosmetic Surgery, including breast reduction or enhancement operations and any other elective cosmetic
surgery or procedures done primarily to al... | null | null | null | null | null | null | null |
null | null | null | null | null | null | null | 2-D screening mammograms can be shared, not 3-D or
other similar types of mammograms.
(t) MRIs.
For MRIs in a non-hospital environment EasyShare limits sharing to a fixed amount of $400 per
visit/series with the member responsible for any amount above that limit. All outpatient MRI imaging have
a 90-day waiting period... | null | null | null | null | null | null |
null | null | null | null | null | null | null | null | RxSimpleShare Prescription Drug Program is included in the Healthy Life EasyShare Programs.
RxSimpleShare allows for the purchase of many common prescriptions for a $5 co-share. See section IX
for details. Other prescription drugs are only eligible for sharing when provided by a Hospital as part of
inpatient treatment ... | null | null | null | null | null |
null | null | null | null | null | null | null | null | null | ired.
(f) Carpal Tunnel Syndrome.
Carpal Tunnel Syndrome is generally sharable, but during the first 36 months membership, a
Confirmation of No Prior Existence of Condition statement may be required.
(g) Complications Arising from Maternity.
Medical expenses for complications to the member are considered part of the ma... | null | null | null | null |
null | null | null | null | null | null | null | null | null | null | ncluded in a
membership since the adoption, and the adopting parents were unaware of the condition at the
time the adoption was finalized.
(m) Heart Conditions.
Heart Conditions are sharable unless related to a heart condition you had prior to becoming a member,
and it does not come within the exceptions described in S... | null | null | null |
null | null | null | null | null | null | null | null | null | null | null | at results in a ruptured fallopian tube, expenses eligible for
sharing include surgery, post-operative recovery of the member, follow-up care, and treatment of
any complications.
In the case of an ectopic pregnancy, expenses eligible for sharing will be subject to the applicable per-
Medical Incident limit, inclusive o... | null | null |
null | null | null | null | null | null | null | null | null | null | null | null | ds for injuries caused by or incurred in a Motor Vehicle accident in which you were an operator or
passenger of an on-road or off-road Motor Vehicles (including cars, trucks, motorcycles, tractors, farm UHFR093021E100121 Page 114
implements, construction equipment, go-karts, four-wheel or six-wheel ATVs, golf carts, pe... | null |
null | null | null | null | null | null | null | null | null | null | null | null | null | tional Member by remitting a monthly amount set, and revised from time to time, by Universal
HealthShare. Certain expenses associated with that customized treatment plan may be eligible for
sharing based upon review and case by case determination by Universal HealthShare, to include, but not
be limited to, smoking cess... |
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