How Does Medical Cost Sharing Work

What Happens When I Get Sick or Injured?

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:

  • No waiting in a long line.
  • No copay, even if your yearly responsibility has not yet been met.
  • No exposure to other sick people as is the case at medical facilities. Please follow the advice given by the board-certified physician.

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. Where an MCS TeleMedicine physician instructs you to see a local healthcare professional, you, as the member, should find this medical professional inside our provided doctor network. We use PHCS. This is the largest PPO network in the United States. Once at the local doctor’s office, you, as the member, should present your medical card to your medical provider. He or she should be familiar with this network.

3. The medical provider will send the bill to the PHCS/Multiplan network contracted with the Medical Cost Sharing plan. This is done electronically. Their team of experts will then negotiate the lowest cost on your behalf and validate the cost with the provider. Due to no copay, patients leave the medical provider’s office without any out of pocket expenses at the time. Please take note that although you have this benefit, you, as the patient, are ultimately responsible for expenses incurred that are not reimbursed 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.

What Happens When I Need Hospitalization/Surgery?

Reimbursement for any medical condition depends on a member fulfilling their entire yearly responsibility, and it is not part of a pre-existing condition. 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 surgery requests, except for medical emergency surgery, must be submitted to MCS/PHCS staff in advance. Our third-party company has credible, positive statistics regarding the success rates for different surgeries performed at hospitals throughout the country. Because we wish to give you the best chance of success, you will be directed to the best hospital in your particular area regarding the type of surgery needed.

Our Plans Cover the Following

A partial list of procedures shared by the Medical Cost Sharing program after meeting personal responsibility for a year (and are not part of a pre-existing condition):

  • Inpatient hospital care
  • Outpatient hospital care
  • Medical testing
  • Maternity – only covered after 18 months’ continuous coverage
  • Physical therapy, occupational therapy, and a chiropractor – we cover up to $250, per year, of your combined benefits. Please note there is also a $50 copay for these services. For pre-existing conditions, please see Item #2 in What Does MCS Medical Cost Sharing Not Cover.
  • Visits to the doctor’s office
  • MRI and CT scans
  • Ultrasound services
  • Flu shots and immunizations

Please note, effective 04/30/2018, all preventative and wellness care is not 100% covered by MCS. It is a shared expense and will now go toward your personal responsibility.

What Does MCS Medical Cost Sharing Not Cover?

A partial list of procedures not covered by our Medical Cost Sharing program includes:

  • All medical expenses not yet met by your personal responsibility
  • Pre-existing conditions are not included for the first 36-months of participation, and will be re-evaluated after 36-months
  • Any cosmetic procedures, including refractive eye surgery, e.g. Lasik
  • Illnesses due to the use of tobacco
  • Abortion and sex reassignment surgery
  • Injuries or conditions caused by or associated with, the use of alcohol or drugs
  • Procedures not in line with Biblical teachings
  • Any injuries or conditions associated with dangerous occupations, hobbies, or activities. These include, amongst many others, car racing, a motorcycle stuntman, hazardous waste hauling, etc.

Pre-Existing Conditions

A pre-existing condition refers to any condition you had prior to requesting Medical Cost Sharing Membership. Reimbursement with regards to pre-existing conditions only takes effect after you have been a member for 36 continuous months. Reimbursement for any medical condition is dependent upon a member fulfilling their yearly personal responsibility. Please take note that tobacco-related illnesses, non-Christian activities, and dangerous occupation, sport, or activity etc. are not, and will never be, considered or covered as a shareable expense.

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