A condition is considered pre-existing for a member or dependent if symptoms or treatment have occurred within the 12 months prior to joining the Medical Cost Share. See the Membership Guidelines for a detailed description of what will be considered a pre-existing condition. Controlled diabetes, hypertension, high cholesterol, seasonal allergies, and intermittent asthma will not be considered pre-existing when reported prior to the membership effective date.

Conditions beginning after a member’s effective date will be shared after paying their $2,000 initial member responsibility than 20% with a maximum out-of-pocket of $4,000^ per year. See the Membership Guidelines for sharing rules.

Additional Sharing Restrictions

See Member Guidelines for detailed shareable restrictions.

Pre-existing conditions become eligible for sharing based on members’ tenure with the plan, as indicated by the following graduated sharing schedule:

Time After Membership - Effective Date.                                Shareable

First 12 months                                                                   Not shareable

Months 13-24                                                                     Shareable to $25,000

Months 25-36                                                                     Shareable to $50,000

Month 37 and after                                                             Shareable to $125,000