Your DPC is there for you for all of needs that can be taken care of within the office.
Zion Health is there for the 'What If's"
Should you need to go to any Specialist, Hospital or Facility. Zion Health supports you by medical cost sharing any expenses outside of the practice that is exceed your Initial Unshared Amount.
What is an IUA?
The out of pocket amount the member has prior to cost sharing for the NEED.
All qualified medical expenses after IUA is met is shareable
with the Zion Health community at 100% and without an annual or lifetime limit.
This amount paid by the member does not need to be paid again
until symptom free for 12 months.
Members usually benefit with an IUA vs a yearly deductible
What is a NEED?
A "Need is the ALL of the medical expenses surrounding a new illness, accident or diagnosis.
How can I access care?
Members may use the
they can alternately have their providers submit expenses directly to Zion Health
Or self pay and submit to Zion Health
Are there any restrictions to sharing?
Zion Health has a pre-existing condition clause.
A pre-existing condition is any condition that existed prior to membership
in which the member had symptoms of or have received treatment for
in the 24 months preceding enrollment.
High blood pressure, high cholesterol and diabetes (type 1 & 2)
are not considered a pre-existing condition,
as long as there has not been a hospitalization for the condition
in the past 12 months and able to control through medication or diet.
All Pre-Existing Conditions are gradually eligible for sharing within the
Zion Health Medical Cost Sharing Community in the following manner:
Months 1-12: No sharing, Months 12-24: Sharing up to $25,000,
Months 24-36:Sharing up to $50,000,
After 36 Months: Sharing up to $125,000 for the pre-existing condition.
Does Zion Health Share in Alternative Medical?
Alternative Health Eligible with pre-authorization.
Maternity Needs eligible after a 60 day waiting period.
Please see Maternity Sharing Guidelines PDF for more information.
Are there any limits?
No lifetime or maximum sharing limits for most medical expenses.
Any other features?
Zion Health Assists Up To $10,000 with End Of Life/ Funeral Expenses.
Zion Health offers 3 IUA levels to choose from: $1,000, $2,500 and $5,000.
Member households choose their IUA on enrollment and
can adjust annually on their membership anniversary
Any member household that experiences 3 IUA's within a membership year - or 5 for a family,
may have any further medical expense fully shared
after only reaching a $500 threshold
to further protect the Zion Health member
Zion Health offers 2 membership types to DPC members:
Health Sharing with DPC and Zion Health DPC Connected
HealthSharing with DPC
Does not include any preventative screening
Zion Health DPC Connected
Includes preventative screenings
*Mammograms (after age 40)
*Colonoscopy (after age 50)
*1 outside visit per member
Zion Health Members pay the initial unsharable amount directly to their provider when a need occurs.
The remaining eligible medical expenses are shared with the community.
Zion Health Members enjoy a full service team that makes processing a need easy and efficiently.
Once all information is collected from the provider and member, most needs are processed within three business days..
Providers can work with our Members to suggest alternative medical treatments and not limited to the treatments that traditional insurance companies would cover.
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