1. All Medical Cost Sharing members are automatically enrolled in the TeleMedicine program. Unless you have a medical emergency, please seek the advice of the 24-hour on-call physician before taking another course of action. The advantages of the TeleMedicine benefit include:
The on-call physician can give you a valid medical prescription in most states. Please contact our TeleMedicine doctors at our Members Portal.
In the event of a life-threatening condition, please go to the emergency room IMMEDIATELY.
The following is applicable with immediate effect: Due to emergency rooms being misused as a primary care physician, ER visits are no longer eligible for sharing. The exception to this rule is in a life-threatening condition. In case of a life-threatening situation, the personal responsibility regarding the emergency room is $1000.00. This is in addition to your annual plan responsibility.
2. When a HealthAdvocate TeleMedicine (MeMD) physician instructs you to see a local healthcare professional, you, as the member, will find the provider of your choice (With the exception of Specialists, which require prior authorization).
3. The medical provider will mail the claim to MCS. Please take note that you, as the patient, are ultimately responsible for expenses incurred that are not shared through our health-sharing ministry.
4. After your personal responsibility is met and the medical necessity verified by Medical Cost Sharing staff, your payment, which is shared by other members, is sent directly to the medical professional you used. This will be in your name.
We recommend all members save at least $1,000.00 to cover any out-of-pocket expenses.
All surgery requests, except for medical emergency surgery, must be submitted to MCS staff in advance. Conditions such as a tobacco-related illness, non-Christian activities, or those sustained due to dangerous occupations or sports will NEVER be covered as a shareable expense.
All services requiring notification, as noted on the Schedule of Shared Services, are to be certified in advance by the prior authorization department, except for emergencies. Please always refer to your member guide for proper information or call our customer service number.
Included, but not limited to:
Please note, effective 04/30/2018, all preventative and wellness care is not 100% covered by MCS. The total combined maximum shared amount allowed for preventative care is $1000 per covered person, per plan year, and will go toward personal responsibility.
A partial list, but not limited to, what is not covered:
“What is a pre-existing condition?”
A pre-existing condition refers to any condition you had prior to requesting Medical Cost Sharing Membership.
MCS is happy to announce an upgrade to what was the graded benefit plan.
We have eliminated the pre-existing grading benefits of $15,000 first year, $30,000 second year, and $45,000 third year. To best serve our membership in general, we have adopted a new policy. We are introducing the new pre-existing condition program that becomes effective on 08/01/2020.
The new program works as follows. Under the new unlimited plan, the caps have been removed. We will now, from dollar one, run claims on pre-existing conditions for any amount. Even if it is for multiple issues or for multiple occurrences. Whatever the discounted amount turns out to be, it will be the members responsibility, but the annual caps have been removed.
Our Team feels this will be a tremendous asset and benefit to our members with pre-existing conditions. The savings under our Reference-Based Pricing is generally in the 75% range. Eliminating the caps should address concerns about larger claims. This will assist both the member and the provider in determining the amount owed to the provider.