esy_shr.josn

{"question": "What are the General Sharing Requirements, Restrictions, Limitations & Maximums for the Healthy Life EasyShare Programs?", "answer": "The General Sharing Requirements, Restrictions, Limitations & Maximums for the Healthy Life EasyShare Programs define the rules and limits for sharing medical expenses among members."}
{"question": "How long must a member be continuously enrolled before Maternity medical expenses become eligible for sharing?", "answer": "A member must be continuously enrolled for at least twelve (12) months prior to conception for Maternity medical expenses to become eligible for sharing."}
{"question": "What is the waiting period for Cologuard testing expenses to be eligible for sharing?", "answer": "There is a 180-day waiting period before Cologuard testing expenses may be eligible for sharing."}
{"question": "How long is the waiting period for Preventive Care expenses, including an Annual Routine Physical or Well Child Exam, to become eligible for sharing?", "answer": "There is a 30-day waiting period before Preventive Care expenses, including an Annual Routine Physical or Well Child Exam, may become eligible for sharing."}
{"question": "What types of medical expenses do not have a waiting period for sharing eligibility?", "answer": "Telemedicine, Primary Care, Urgent Care, and Specialty Care visits, as well as diagnostic testing, in-office procedures, and laceration repair during the visit, do not have a waiting period for sharing eligibility."}
{"question": "What are the consultation fees for Telemedicine visits in the EasyShare Programs?", "answer": "The consultation fee for Telemedicine visits is $0 for both EasyShare50 and EasyShare25 members."}
{"question": "How much is the consultation fee for Primary Care Physician Visits in the EasyShare50 program?", "answer": "The consultation fee for Primary Care Physician Visits is $25 for EasyShare50 members."}
{"question": "Is there an annual Non-Sharable Amount for medical expenses in the EasyShare Programs?", "answer": "No, there is no annual Non-Sharable Amount for medical expenses in the EasyShare Programs; it is $0."}
{"question": "How much is the consultation fee for Pediatric Visits in the EasyShare25 program?", "answer": "The consultation fee for Pediatric Visits is $40 for EasyShare25 members."}
{"question": "Are there limits to the sharing of outpatient CT Scan, MRI, and X-Ray imaging in the EasyShare Programs?", "answer": "Yes, there is a 90-day waiting period for outpatient CT Scan, MRI, and X-Ray imaging, and sharing is limited to two imaging series per year in each category, subject to certain cost limits."}The
{"question": "How much is the maximum sharing limit for inpatient hospitalization in the EasyShare50 program for a Medical Incident?", "answer": "The maximum sharing limit for inpatient hospitalization in the EasyShare50 program for a Medical Incident is up to $3,000 per day for room and board."}
{"question": "What is the maximum sharing limit for Emergency Room visits in the EasyShare25 program for a Medical Incident?", "answer": "The maximum sharing limit for Emergency Room visits in the EasyShare25 program for a Medical Incident is up to $1,000 per incident."}
{"question": "What is the Annual Sharing Limit for routine annual physicals, well-child exams, and preventive care in the EasyShare50 program?", "answer": "The Annual Sharing Limit for routine annual physicals, well-child exams, and preventive care in the EasyShare50 program is $500 maximum per member per year."}
{"question": "What is the maximum amount of lifetime sharing available for EasyShare50 members?", "answer": "The maximum amount of lifetime sharing available for EasyShare50 members is $500,000."}
{"question": "How many visits/incidents of Inpatient Hospitalization are eligible for sharing in the EasyShare25 program for a Medical Incident?", "answer": "Up to 10 days of Inpatient Hospitalization are eligible for sharing in the EasyShare25 program for a Medical Incident."}
{"question": "What is the per Medical Incident sharing limit for Inpatient and Outpatient Surgery in the EasyShare50 program?", "answer": "The per Medical Incident sharing limit for Inpatient and Outpatient Surgery in the EasyShare50 program is up to $3,000 per incident."}
{"question": "How much is the Consultation Fee for Specialty Physician Visits in the EasyShare Programs?", "answer": "The Consultation Fee for Specialty Physician Visits is $50 for EasyShare50 members and $75 for EasyShare25 members."}
{"question": "What is the maximum sharing limit for Ambulance services in the EasyShare Programs?", "answer": "The maximum sharing limit for Ambulance services in the EasyShare Programs is up to $500 per incident."}
{"question": "How many incidents of Ambulance services are eligible for sharing per year in the EasyShare Programs?", "answer": "Up to 2 incidents of Ambulance services are eligible for sharing per year in the EasyShare Programs."}
{"question": "What is the sharing limit for CT Scan imaging series in the EasyShare Programs?", "answer": "The sharing limit for CT Scan imaging series is up to $400 per imaging series."}
{"question": "How many imaging series of MRI are eligible for sharing per year in the EasyShare Programs?", "answer": "Up to 2 imaging series of MRI are eligible for sharing per year in the EasyShare Programs."}
{"question": "What is the sharing limit for X-Ray imaging series in the EasyShare Programs?", "answer": "The sharing limit for X-Ray imaging series is up to $250 per imaging series."}
{"question": "Are Emergency Room and Ambulance expenses subject to a waiting period in the EasyShare Programs?", "answer": "Yes, Emergency Room and Ambulance expenses are subject to a 90-day waiting period in the EasyShare Programs."}
{"question": "What types of medical conditions are eligible for Emergency Room and Ambulance cost sharing in the EasyShare Programs?", "answer": "Emergency Room and Ambulance cost sharing is only available for medical conditions that are life-threatening or could seriously jeopardize the health of the individual and result in an in-patient hospital stay."}
{"question": "How many incidents of Emergency Room and Ambulance cost sharing are allowed per year in the EasyShare Programs?", "answer": "A maximum of 2 incidents of Emergency Room and Ambulance cost sharing are allowed per year in the EasyShare Programs."}
{"question": "What is the waiting period for inpatient and outpatient hospital and surgery expenses in the EasyShare Programs?", "answer": "Inpatient and outpatient hospital and surgery expenses have a 90-day waiting period in the EasyShare Programs."}
{"question": "What is the maximum annual sharing limit for EasyShare25 members?", "answer": "The maximum annual sharing limit for EasyShare25 members is $25,000."}
{"question": "How much is the consultation fee for Urgent Care Physician Visits in the EasyShare Programs?", "answer": "The consultation fee for Urgent Care Physician Visits is $75 for both EasyShare50 and EasyShare25 members."}
{"question": "What is the Annual Sharing Limit for routine annual physicals, well-child exams, and preventive care in the EasyShare25 program?", "answer": "The Annual Sharing Limit for routine annual physicals, well-child exams, and preventive care in the EasyShare25 program is $500 maximum per member per year."}
{"question": "How many visits/incidents of Inpatient Hospitalization are eligible for sharing in the EasyShare50 program for a Medical Incident?", "answer": "Up to 10 days of Inpatient Hospitalization are eligible for sharing in the EasyShare50 program for a Medical Incident."}
{"question": "What is the maximum per-incident sharing limit for Inpatient and Outpatient Surgery in the EasyShare25 program?", "answer": "The maximum per-incident sharing limit for Inpatient and Outpatient Surgery in the EasyShare25 program is up to $2,500 per incident."}
{"question": "What is the maximum lifetime sharing limit for EasyShare25 members?", "answer": "The maximum lifetime sharing limit for EasyShare25 members is $250,000."}
{"question": "How many incidents of Ambulance services are eligible for sharing per year in the EasyShare25 program?", "answer": "Up to 2 incidents of Ambulance services are eligible for sharing per year in the EasyShare25 program."}
{"question": "Are inpatient and outpatient hospital and surgery expenses subject to a waiting period in the EasyShare Programs?", "answer": "Yes, inpatient and outpatient hospital and surgery expenses have a 90-day waiting period in the EasyShare Programs."}
{"question": "How many incidents of CT Scan imaging series are eligible for sharing per year in the EasyShare25 program?", "answer": "Up to 2 incidents of CT Scan imaging series are eligible for sharing per year in the EasyShare25 program."}
{"question": "What is the per Medical Incident sharing limit for Emergency Room visits in the EasyShare50 program?", "answer": "The per Medical Incident sharing limit for Emergency Room visits in the EasyShare50 program is up to $1,000 per incident."}
{"question": "How many incidents of MRI imaging series are eligible for sharing per year in the EasyShare25 program?", "answer": "Up to 2 incidents of MRI imaging series are eligible for sharing per year in the EasyShare25 program."}
{"question": "How much is the maximum sharing limit for X-Ray imaging series in the EasyShare25 program?", "answer": "The maximum sharing limit for X-Ray imaging series in the EasyShare25 program is up to $250 per imaging series."}
{"question": "Is there a consultation fee for Preventive Care visits in the EasyShare Programs?", "answer": "No, there is no consultation fee for Preventive Care visits in the EasyShare Programs."}
{"question": "What are the sharing limits for Room and Board and procedures in the EasyShare Programs?", "answer": "The sharing limits for Room and Board and procedures are up to the maximum per-day or per-incident limit, inclusive of any other eligible, sharable medical expenses incurred on that day."}
{"question": "How much is the maximum sharing limit for Inpatient and Outpatient Surgery in the EasyShare50 program for a Medical Incident?", "answer": "The maximum sharing limit for Inpatient and Outpatient Surgery in the EasyShare50 program for a Medical Incident is up to $3,000 per incident."}
{"question": "What are the sharing limits for Emergency Room and Ambulance expenses in the EasyShare Programs?", "answer": "The sharing limits for Emergency Room and Ambulance expenses in the EasyShare Programs are up to $1,000 per incident, subject to the 90-day waiting period."}
{"question": "What is the per Medical Incident sharing limit for Ambulance services in the EasyShare50 program?", "answer": "The per Medical Incident sharing limit for Ambulance services in the EasyShare50 program is up to $500 per incident."}
{"question": "What is the maximum annual sharing limit for EasyShare50 members?", "answer": "The maximum annual sharing limit for EasyShare50 members is $50,000."}
{"question": "How many incidents of Inpatient and Outpatient Surgery are eligible for sharing per year in the EasyShare25 program for a Medical Incident?", "answer": "Up to 2 incidents of Inpatient and Outpatient Surgery are eligible for sharing per year in the EasyShare25 program for a Medical Incident."}
{"question": "What is the sharing limit for CT Scan imaging series in the EasyShare50 program?", "answer": "The sharing limit for CT Scan imaging series in the EasyShare50 program is up to $400 per imaging series."}
{"question": "How many incidents of MRI imaging series are eligible for sharing per year in the EasyShare50 program?", "answer": "Up to 2 incidents of MRI imaging series are eligible for sharing per year in the EasyShare50 program."}
{"question": "Is there a consultation fee for Routine Annual Physicals and Well Child Exams in the EasyShare Programs?", "answer": "Yes, there is a consultation fee of $25 for Routine Annual Physicals and Well Child Exams for EasyShare50 members and $40 for EasyShare25 members."}
{"question": "What are the Lifetime Sharing Limits for EasyShare50 and EasyShare25 members?", "answer": "The Lifetime Sharing Limit for EasyShare50 members is $500,000, and for EasyShare25 members, it is $250,000."}
{"question": "What is the per Medical Incident sharing limit for X-Ray imaging series in the EasyShare50 program?", "answer": "The per Medical Incident sharing limit for X-Ray imaging series in the EasyShare50 program is up to $250 per imaging series."}
{"question": "What types of medical expenses have a 90-day waiting period in the EasyShare Programs?", "answer": "Inpatient and outpatient hospital and surgery expenses, as well as outpatient CT Scan, MRI, and X-Ray imaging, have a 90-day waiting period in the EasyShare Programs."}
{"question": "How does the EasyShare Programs handle outpatient CT Scan, MRI, and X-Ray imaging costs that exceed the sharing limit?", "answer": "If outpatient CT Scan, MRI, or X-Ray imaging costs exceed the sharing limit, the member is responsible for any amount above that limit."}
{"question": "What are the annual sharing limits for the EasyShare Programs for routine annual physicals, well-child exams, and preventive care?", "answer": "The annual sharing limit for routine annual physicals, well-child exams, and preventive care is $500 maximum per member per year for both EasyShare50 and EasyShare25."}
{"question": "What are the per Medical Incident sharing limits for Emergency Room visits in the EasyShare25 program?", "answer": "The per Medical Incident sharing limit for Emergency Room visits in the EasyShare25 program is up to $1,000 per incident."}
{"question": "How many incidents of Inpatient Hospitalization are eligible for sharing in the EasyShare25 program for a Medical Incident?", "answer": "Up to 10 days of Inpatient Hospitalization are eligible for sharing in the EasyShare25 program for a Medical Incident."}
{"question": "What is the sharing limit for Inpatient and Outpatient Surgery in the EasyShare25 program for a Medical Incident?", "answer": "The sharing limit for Inpatient and Outpatient Surgery in the EasyShare25 program for a Medical Incident is up to $2,500 per incident."}
{"question": "Is there a waiting period for inpatient and outThepatient hospital and surgery expenses in the EasyShare Programs?", "answer": "Yes, inpatient and outpatient hospital and surgery expenses have a 90-day waiting period in the EasyShare Programs."}
{"question": "How does the EasyShare Programs handle expenses for inpatient and outpatient hospital and surgery procedures that exceed the sharing limit?", "answer": "If expenses for inpatient and outpatient hospital and surgery procedures exceed the sharing limit, the member is responsible for any amount above that limit."}
{"question": "What is the maximum per Medical Incident sharing limit for Ambulance services in the EasyShare25 program?", "answer": "The maximum per Medical Incident sharing limit for Ambulance services in the EasyShare25 program is up to $500 per incident."}
{"question": "What is the maximum annual sharing limit for EasyShare25 members?", "answer": "The maximum annual sharing limit for EasyShare25 members is $25,000."}
{"question": "What are the maximum annual visits or incidents eligible for sharing for an Annual Routine Physical or Well Child Exam?", "answer": "One visit per Program Year is eligible for sharing for an Annual Routine Physical or Well Child Exam."}
{"question": "How many combined visits for Primary Care and Pediatrics are eligible for sharing per Program Year?", "answer": "Four visits in total for any combination of Primary Care and Pediatrics are eligible for sharing, and the Annual Physical or Well Child Exam does not count towards this limit."}
{"question": "How many Urgent Care visits are eligible for sharing per Program Year?", "answer": "Two Urgent Care visits are eligible for sharing per Program Year."}
{"question": "What is the sharing limit for Specialty Care visits per Program Year?", "answer": "Two Specialty Care visits are eligible for sharing per Program Year."}
{"question": "How many days of Inpatient Hospital Care are eligible for sharing per Program Year?", "answer": "Up to 10 days of Inpatient Hospital Care are eligible for sharing per Program Year."}
{"question": "How many surgical procedures (Inpatient or Outpatient) are eligible for sharing per Program Year?", "answer": "Two surgical procedures (Inpatient or Outpatient) are eligible for sharing per Program Year."}
{"question": "What is the sharing limit for Emergency Room visits per Program Year?", "answer": "Two Emergency Room visits are eligible for sharing per Program Year."}
{"question": "How many incidents of Ambulance transportation are eligible for sharing per Program Year?", "answer": "Two incidents of Ambulance transportation are eligible for sharing per Program Year."}
{"question": "How many visits or series of CT Scan imaging are eligible for sharing per Program Year?", "answer": "Two visits or series of CT Scan imaging are eligible for sharing per Program Year."}
{"question": "How many visits or series of MRI imaging are eligible for sharing per Program Year?", "answer": "Two visits or series of MRI imaging are eligible for sharing per Program Year."}
{"question": "How many visits or series of X-Ray imaging are eligible for sharing per Program Year?", "answer": "Two visits or series of X-Ray imaging are eligible for sharing per Program Year."}
{"question": "What is the per-incident sharing limit for Hospitalization Room & Board in the EasyShare50 program?", "answer": "The per-incident sharing limit for Hospitalization Room & Board in the EasyShare50 program is $3,000."}
{"question": "How many days of Inpatient or Outpatient Surgical Procedures are eligible for sharing per Program Year in the EasyShare25 program?", "answer": "Up to two Inpatient or Outpatient Surgical Procedures are eligible for sharing per Program Year in the EasyShare25 program."}
{"question": "What is the per-incident sharing limit for Emergency Room visits in the EasyShare50 program?", "answer": "The per-incident sharing limit for Emergency Room visits in the EasyShare50 program is $1,000."}
{"question": "How much is the per-incident sharing limit for Ambulance services in the EasyShare50 program?", "answer": "The per-incident sharing limit for Ambulance services in the EasyShare50 program is $500."}
{"question": "What is the per-incident sharing limit for CT Scan imaging in the EasyShare Programs?", "answer": "The per-incident sharing limit for CT Scan imaging in the EasyShare Programs is $400."}
{"question": "How many visits or series of MRI imaging are eligible for sharing per Program Year in the EasyShare50 program?", "answer": "Up to two visits or series of MRI imaging are eligible for sharing per Program Year in the EasyShare50 program."}
{"question": "What is the per-incident sharing limit for X-Ray imaging series in the EasyShare Programs?", "answer": "The per-incident sharing limit for X-Ray imaging series in the EasyShare Programs is $250."}
{"question": "What is the maximum annual per member amount shared for all services combined in the EasyShare50 program?", "answer": "The maximum annual per member amount shared for all services combined in the EasyShare50 program is $50,000."}
{"question": "How many incidents of Emergency Room cost sharing are allowed per year in the EasyShare Programs?", "answer": "A maximum of two incidents of Emergency Room cost sharing are allowed per year in the EasyShare Programs."}
{"question": "What conditions must be met for Emergency Room and Ambulance cost sharing in the EasyShare Programs?", "answer": "Emergency Room and Ambulance cost sharing is only available for medical conditions that are life-threatening or could seriously jeopardize the health of the individual and result in an in-patient hospital stay."}
{"question": "How long is the waiting period for outpatient CT Scan, MRI, and X-Ray imaging to become eligible for sharing in the EasyShare Programs?", "answer": "Outpatient CT Scan, MRI, and X-Ray imaging have a 90-day waiting period before becoming eligible for sharing."}
{"question": "What is the sharing limit for CT Scan imaging series in a non-hospital environment in the EasyShare Programs?", "answer": "The sharing limit for CT Scan imaging series in a non-hospital environment in the EasyShare Programs is not more than $400."}
{"question": "How long is the waiting period for inpatient and outpatient hospital and surgery expenses to become eligible for sharing in the EasyShare Programs?", "answer": "Inpatient and outpatient hospital and surgery expenses have a 90-day waiting period before becoming eligible for sharing."}
{"question": "How much is the per-incident sharing limit for Hospitalization Room & Board in the EasyShare25 program?", "answer": "The per-incident sharing limit for Hospitalization Room & Board in the EasyShare25 program is $2,500."}
{"question": "Is there a separate sharable amount for individual surgical procedures in the EasyShare25 program?", "answer": "Yes, there is a separate sharable amount for individual surgical procedures in the EasyShare25 program, which is up to $2,500 per procedure for up to two surgical procedures per program year."}
{"question": "What is the per-incident sharing limit for Emergency Room visits in the EasyShare25 program?", "answer": "The per-incident sharing limit for Emergency Room visits in the EasyShare25 program is $1,000."}
{"question": "How much is the per-incident sharing limit for Ambulance services in the EasyShare25 program?", "answer": "The per-incident sharing limit for Ambulance services in the EasyShare25 program is $500."}
{"question": "What is the maximum annual per member amount shared for all services combined in the EasyShare25 program?", "answer": "The maximum annual per member amount shared for all services combined in the EasyShare25 program is $25,000."}
{"question": "How many incidents of Inpatient or Outpatient Surgical Procedures are eligible for sharing per Program Year in the EasyShare50 program?", "answer": "Up to two Inpatient or Outpatient Surgical Procedures are eligible for sharing per Program Year in the EasyShare50 program."}
{"question": "What is the sharing limit for X-Ray imaging series in a non-hospital environment in the EasyShare Programs?", "answer": "The sharing limit for X-Ray imaging series in a non-hospital environment in the EasyShare Programs is not more than $250."}
{"question": "What is the Annual Non-Sharable Amount established for your Program, and why is it important for sharing eligibility?", "answer": "The Annual Non-Sharable Amount is the threshold that medical expenses must exceed to be eligible for sharing. It is important because medical expenses must surpass this amount to be considered for sharing."}
{"question": "Are medical expenses shared on a per-person basis or a per-Medical Incident basis in the EasyShare Programs?", "answer": "Medical expenses in the EasyShare Programs are shared on a per-Medical Incident basis."}
{"question": "What is considered a Medical Incident in the EasyShare Programs?", "answer": "A Medical Incident in the EasyShare Programs is a medically diagnosed condition and all medical treatment(s) received and medical expenses incurred relating to such diagnosis."}
{"question": "Are all types of medical expenses eligible for sharing in the EasyShare Programs?", "answer": "No, not all types of medical expenses are eligible for sharing in the EasyShare Programs. Eligibility is subject to specific guidelines and limitations."}
{"question": "What is the definition of an Emergency medical condition for Emergency Room cost sharing in the EasyShare Programs?", "answer": "An Emergency medical condition in the EasyShare Programs is a condition with symptoms of sufficient severity that the absence of immediate medical attention would reasonably be expected to result in death or serious jeopardy to the health of the individual (or, with respect to a pregnant woman, the woman's unborn child) involving serious impairment to bodily functions or serious dysfunction of any bodily organ or part."}
{"question": "Is Emergency Room cost sharing available for non-Emergency situations in the EasyShare Programs?", "answer": "No, Emergency Room cost sharing in the EasyShare Programs is intended for Emergency treatment only. Expenses incurred for non-Emergency situations will not be shared."}
{"question": "How long is the waiting period for outpatient CT Scan, MRI, and X-Ray imaging to become eligible for sharing in the EasyShare Programs?", "answer": "Outpatient CT Scan, MRI, and X-Ray imaging have a 90-day waiting period before becoming eligible for sharing."}
{"question": "What are the requirements for sharing CT Scan and MRI imaging in a non-hospital environment in the EasyShare Programs?", "answer": "Sharing of CT Scan and MRI imaging in a non-hospital environment in the EasyShare Programs requires a physician prescription and must be procured at a free-standing in-network diagnostic center unless received as an admitted patient."}
{"question": "How much is the sharing limit for CT Scan imaging in a non-hospital environment in the EasyShare Programs?", "answer": "The sharing limit for CT Scan imaging in a non-hospital environment in the EasyShare Programs is not more than $400."}
{"question": "How much is the sharing limit for MRI imaging in the EasyShare Programs?", "answer": "The sharing limit for MRI imaging in the EasyShare Programs is not more than $400."}
{"question": "How much is the sharing limit for X-Ray imaging series in a non-hospital environment in the EasyShare Programs?", "answer": "The sharing limit for X-Ray imaging series in a non-hospital environment in the EasyShare Programs is not more than $250."}
{"question": "Are sharing percentages applicable to the EasyShare Programs?", "answer": "No, sharing percentages are not applicable to the EasyShare Programs. Sharing amounts and limits are specified in the guidelines."}
{"question": "How are medical costs shared in the EasyShare Programs?", "answer": "Medical costs in the EasyShare Programs are shared on a per-person per-Medical Incident basis for medically necessary expenses provided by licensed Physicians, Hospitals, or other licensed medical Facilities, or approved Practitioners."}
{"question": "What is the definition of a Medical Incident in the EasyShare Programs?", "answer": "A Medical Incident in the EasyShare Programs refers to a medically diagnosed condition and all medical treatment(s) received and medical expenses incurred relating to such diagnosis."}
{"question": "What types of medical expenses are eligible for sharing in the EasyShare Programs?", "answer": "Eligible medical expenses for sharing in the EasyShare Programs include physician and hospital services, emergency medical care, medical testing, x-rays, emergency medical transportation, and prescription medications provided by a Hospital during an admission, unless otherwise limited or excluded by the guidelines."}
{"question": "What is the threshold that medical expenses must surpass to be eligible for sharing in the EasyShare Programs?", "answer": "Medical expenses must exceed the Annual Non-Sharable Amount established for your Program to be eligible for sharing."}
{"question": "How should medical expenses be submitted for sharing in the EasyShare Programs?", "answer": "Medical expenses must be submitted for sharing in the manner and form specified by Universal HealthShare, including the use of standard industry billing forms (HCFA 1500 and/or UB 92) and relevant/required medical records."}
{"question": "What is the purpose of the following sections in the guidelines: 'Sharing for Facilities, Providers & Services' and 'Members share costs as addressed below'?", "answer": "These sections provide information about which health care facilities, providers, and services are generally eligible for sharing and the specific sharing details associated with them."}
{"question": "What is the criterion for sharing Ambulance transportation costs in the EasyShare Programs?", "answer": "Ambulance transportation costs are sharable when the transportation is medically necessary for a medical condition with symptoms of sufficient severity that the absence of immediate medical attention would reasonably be expected to result in death or serious jeopardy to the health of the individual (or, with respect to a pregnant woman, the woman's unborn child) involving serious impairment to bodily functions or serious dysfunction of any bodily organ or part."}
{"question": "What is the maximum number of visits or incidents eligible for sharing for an Annual Routine Physical or Well Child Exam per Program Year?", "answer": "One visit per Program Year is eligible for sharing for an Annual Routine Physical or Well Child Exam."}
{"question": "How many combined visits for Primary Care and Pediatrics are eligible for sharing per Program Year?", "answer": "Four visits in total for any combination of Primary Care and Pediatrics are eligible for sharing, and the Annual Physical or Well Child Exam does not count towards this limit."}
{"question": "What is the maximum number of Urgent Care visits eligible for sharing per Program Year?", "answer": "Two Urgent Care visits are eligible for sharing per Program Year."}
{"question": "What is the sharing limit for Specialty Care visits per Program Year?", "answer": "Two Specialty Care visits are eligible for sharing per Program Year."}
{"question": "How many days of Inpatient Hospital Care are eligible for sharing per Program Year?", "answer": "Up to 10 days of Inpatient Hospital Care are eligible for sharing per Program Year."}
{"question": "How many surgical procedures (Inpatient or Outpatient) are eligible for sharing per Program Year?", "answer": "Two surgical procedures (Inpatient or Outpatient) are eligible for sharing per Program Year."}
{"question": "What is the sharing limit for Emergency Room visits per Program Year?", "answer": "Two Emergency Room visits are eligible for sharing per Program Year."}
{"question": "How many incidents of Ambulance transportation are eligible for sharing per Program Year?", "answer": "Two incidents of Ambulance transportation are eligible for sharing per Program Year."}
{"question": "How many visits or series of CT Scan imaging are eligible for sharing per Program Year?", "answer": "Two visits or series of CT Scan imaging are eligible for sharing per Program Year."}
{"question": "How many visits or series of MRI imaging are eligible for sharing per Program Year?", "answer": "Two visits or series of MRI imaging are eligible for sharing per Program Year."}
{"question": "How many visits or series of X-Ray imaging are eligible for sharing per Program Year?", "answer": "Two visits or series of X-Ray imaging are eligible for sharing per Program Year."}
{"question": "What is the per-incident sharing limit for Hospitalization Room & Board in the EasyShare50 program?", "answer": "The per-incident sharing limit for Hospitalization Room & Board in the EasyShare50 program is $3,000."}
{"question": "How many days of Inpatient or Outpatient Surgical Procedures are eligible for sharing per Program Year in the EasyShare25 program?", "answer": "Up to two Inpatient or Outpatient Surgical Procedures are eligible for sharing per Program Year in the EasyShare25 program."}
{"question": "What is the per-incident sharing limit for Emergency Room visits in the EasyShare50 program?", "answer": "The per-incident sharing limit for Emergency Room visits in the EasyShare50 program is $1,000."}
{"question": "How much is the per-incident sharing limit for Ambulance services in the EasyShare50 program?", "answer": "The per-incident sharing limit for Ambulance services in the EasyShare50 program is $500."}
{"question": "What is the per-incident sharing limit for CT Scan imaging in the EasyShare Programs?", "answer": "The per-incident sharing limit for CT Scan imaging in the EasyShare Programs is $400."}
{"question": "How many visits or series of MRI imaging are eligible for sharing per Program Year in the EasyShare50 program?", "answer": "Up to two visits or series of MRI imaging are eligible for sharing per Program Year in the EasyShare50 program."}
{"question": "What is the per-incident sharing limit for X-Ray imaging series in the EasyShare Programs?", "answer": "The per-incident sharing limit for X-Ray imaging series in the EasyShare Programs is $250."}
{"question": "What is the maximum annual per member amount shared for all services combined in the EasyShare50 program?", "answer": "The maximum annual per member amount shared for all services combined in the EasyShare50 program is $50,000."}
{"question": "How many incidents of Emergency Room cost sharing are allowed per year in the EasyShare Programs?", "answer": "A maximum of two incidents of Emergency Room cost sharing are allowed per year in the EasyShare Programs."}
{"question": "What conditions must be met for Emergency Room and Ambulance cost sharing in the EasyShare Programs?", "answer": "Emergency Room and Ambulance cost sharing is only available for medical conditions that are life-threatening or could seriously jeopardize the health of the individual and result in an in-patient hospital stay."}
{"question": "How long is the waiting period for outpatient CT Scan, MRI, and X-Ray imaging to become eligible for sharing in the EasyShare Programs?", "answer": "Outpatient CT Scan, MRI, and X-Ray imaging have a 90-day waiting period before becoming eligible for sharing."}
{"question": "What is the sharing limit for CT Scan imaging series in a non-hospital environment in the EasyShare Programs?", "answer": "The sharing limit for CT Scan imaging series in a non-hospital environment in the EasyShare Programs is not more than $400."}
{"question": "How long is the waiting period for inpatient and outpatient hospital and surgery expenses to become eligible for sharing in the EasyShare Programs?", "answer": "Inpatient and outpatient hospital and surgery expenses have a 90-day waiting period before becoming eligible for sharing."}
{"question": "How much is the per-incident sharing limit for Hospitalization Room & Board in the EasyShare25 program?", "answer": "The per-incident sharing limit for Hospitalization Room & Board in the EasyShare25 program is $2,500."}
{"question": "Is there a separate sharable amount for individual surgical procedures in the EasyShare25 program?", "answer": "Yes, there is a separate sharable amount for individual surgical procedures in the EasyShare25 program, which is up to $2,500 per procedure for up to two surgical procedures per program year."}
{"question": "What is the per-incident sharing limit for Emergency Room visits in the EasyShare25 program?", "answer": "The per-incident sharing limit for Emergency Room visits in the EasyShare25 program is $1,000."}
{"question": "How much is the per-incident sharing limit for Ambulance services in the EasyShare25 program?", "answer": "The per-incident sharing limit for Ambulance services in the EasyShare25 program is $500."}
{"question": "What is the maximum annual per member amount shared for all services combined in the EasyShare25 program?", "answer": "The maximum annual per member amount shared for all services combined in the EasyShare25 program is $25,000."}
{"question": "How many incidents of Inpatient or Outpatient Surgical Procedures are eligible for sharing per Program Year in the EasyShare50 program?", "answer": "Up to two Inpatient or Outpatient Surgical Procedures are eligible for sharing per Program Year in the EasyShare50 program."}
{"question": "What is the sharing limit for X-Ray imaging series in a non-hospital environment in the EasyShare Programs?", "answer": "The sharing limit for X-Ray imaging series in a non-hospital environment in the EasyShare Programs is not more than $250."}
{"question": "What is the Annual Non-Sharable Amount established for your Program, and why is it important for sharing eligibility?", "answer": "The Annual Non-Sharable Amount is the threshold that medical expenses must exceed to be eligible for sharing. It is important because medical expenses must surpass this amount to be considered for sharing."}
{"question": "Are medical expenses shared on a per-person basis or a per-Medical Incident basis in the EasyShare Programs?", "answer": "Medical expenses in the EasyShare Programs are shared on a per-Medical Incident basis."}
{"question": "What is considered a Medical Incident in the EasyShare Programs?", "answer": "A Medical Incident in the EasyShare Programs is a medically diagnosed condition and all medical treatment(s) received and medical expenses incurred relating to such diagnosis."}
{"question": "Are all types of medical expenses eligible for sharing in the EasyShare Programs?", "answer": "No, not all types of medical expenses are eligible for sharing in the EasyShare Programs. Eligibility is subject to specific guidelines and limitations."}
{"question": "What is the definition of an Emergency medical condition for Emergency Room cost sharing in the EasyShare Programs?", "answer": "An Emergency medical condition in the EasyShare Programs is a condition with symptoms of sufficient severity that the absence of immediate medical attention would reasonably be expected to result in death or serious jeopardy to the health of the individual (or, with respect to a pregnant woman, the woman's unborn child) involving serious impairment to bodily functions or serious dysfunction of any bodily organ or part."}
{"question": "Is Emergency Room cost sharing available for non-Emergency situations in the EasyShare Programs?", "answer": "No, Emergency Room cost sharing in the EasyShare Programs is intended for Emergency treatment only. Expenses incurred for non-Emergency situations will not be shared."}
{"question": "How long is the waiting period for outpatient CT Scan, MRI, and X-Ray imaging to become eligible for sharing in the EasyShare Programs?", "answer": "Outpatient CT Scan, MRI, and X-Ray imaging have a 90-day waiting period before becoming eligible for sharing."}
{"question": "What are the requirements for sharing CT Scan and MRI imaging in a non-hospital environment in the EasyShare Programs?", "answer": "Sharing of CT Scan and MRI imaging in a non-hospital environment in the EasyShare Programs requires a physician prescription and must be procured at a free-standing in-network diagnostic center unless received as an admitted patient."}
{"question": "How much is the sharing limit for CT Scan imaging in a non-hospital environment in the EasyShare Programs?", "answer": "The sharing limit for CT Scan imaging in a non-hospital environment in the EasyShare Programs is not more than $400."}
{"question": "How much is the sharing limit for MRI imaging in the EasyShare Programs?", "answer": "The sharing limit for MRI imaging in the EasyShare Programs is not more than $400."}
{"question": "How much is the sharing limit for X-Ray imaging series in a non-hospital environment in the EasyShare Programs?", "answer": "The sharing limit for X-Ray imaging series in a non-hospital environment in the EasyShare Programs is not more than $250."}
{"question": "Are sharing percentages applicable to the EasyShare Programs?", "answer": "No, sharing percentages are not applicable to the EasyShare Programs. Sharing amounts and limits are specified in the guidelines."}
{"question": "How are medical costs shared in the EasyShare Programs?", "answer": "Medical costs in the EasyShare Programs are shared on a per-person per-Medical Incident basis for medically necessary expenses provided by licensed Physicians, Hospitals, or other licensed medical Facilities, or approved Practitioners."}
{"question": "What is the definition of a Medical Incident in the EasyShare Programs?", "answer": "A Medical Incident in the EasyShare Programs refers to a medically diagnosed condition and all medical treatment(s) received and medical expenses incurred relating to such diagnosis."}
{"question": "What types of medical expenses are eligible for sharing in the EasyShare Programs?", "answer": "Eligible medical expenses for sharing in the EasyShare Programs include physician and hospital services, emergency medical care, medical testing, x-rays, emergency medical transportation, and prescription medications provided by a Hospital during an admission, unless otherwise limited or excluded by the guidelines."}
{"question": "What is the threshold that medical expenses must surpass to be eligible for sharing in the EasyShare Programs?", "answer": "Medical expenses must exceed the Annual Non-Sharable Amount established for your Program to be eligible for sharing."}
{"question": "How should medical expenses be submitted for sharing in the EasyShare Programs?", "answer": "Medical expenses must be submitted for sharing in the manner and form specified by Universal HealthShare, including the use of standard industry billing forms (HCFA 1500 and/or UB 92) and relevant/required medical records."}
{"question": "What is the purpose of the following sections in the guidelines: 'Sharing for Facilities, Providers & Services' and 'Members share costs as addressed below'?", "answer": "These sections provide information about which health care facilities, providers, and services are generally eligible for sharing and the specific sharing details associated with them."}
{"question": "What is the criterion for sharing Ambulance transportation costs in the EasyShare Programs?", "answer": "Ambulance transportation costs are sharable when the transportation is medically necessary for a medical condition with symptoms of sufficient severity that the absence of immediate medical attention would reasonably be expected to result in death or serious jeopardy to the health of the individual (or, with respect to a pregnant woman, the woman's unborn child) involving serious impairment to bodily functions or serious dysfunction of any bodily organ or part."}
{"question": "What is Hyperbaric Oxygen Therapy?", "answer": "N/A"}
{"question": "What is Infusion Therapy?", "answer": "N/A"}
{"question": "How often are mammograms eligible for sharing for Members up to age forty-nine (49)?", "answer": "Once every two years."}
{"question": "How often are mammograms eligible for sharing for Members fifty (50) years of age and older?", "answer": "Once every year."}
{"question": "What types of mammograms can be shared?", "answer": "Only charges for conventional 2-D screening mammograms can be shared, not 3-D or other similar types."}
{"question": "What are the sharing limitations for MRIs in a non-hospital environment?", "answer": "EasyShare limits sharing to a fixed amount of $400 per visit/series with the member responsible for any amount above that limit."}
{"question": "What are the requirements for sharing outpatient MRI imaging?", "answer": "All outpatient MRI imaging has a 90-day waiting period, is sharable only with a physician prescription, and must be procured at a free-standing in-network diagnostic center unless received as an admitted patient."}
{"question": "Are Naturopathic and/or Alternative Treatments eligible for sharing?", "answer": "N/A"}
{"question": "Is Occupational Therapy eligible for sharing?", "answer": "N/A"}
{"question": "How are expenses incurred in connection with organ or tissue transplant treated?", "answer": "They are treated like any other hospitalization and surgical procedure and are subject to the same sharing limitations."}
{"question": "Is Physical Therapy eligible for sharing?", "answer": "N/A"}
{"question": "Which physician services are eligible for immediate sharing?", "answer": "Primary Care, Specialty Care, Pediatric, and Urgent Care office visit physician charges, as well as Preventive Services."}
{"question": "Is there a waiting period for office visits eligible for immediate sharing?", "answer": "The 90-day waiting period does not apply to these office visits."}
{"question": "What fee must be paid for each visit under the EasyShare Program?", "answer": "You must pay a Consultation Fee for each visit; this fee will be due at the time of your visit."}
{"question": "Which charges are eligible for sharing under the physician services category?", "answer": "Charges other than the actual 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."}
{"question": "What happens if imaging is done both without and with a contrast agent?", "answer": "That is considered two separate imaging series, and the Member Consultation Fee must be paid for both."}
{"question": "What happens if imaging is done on two different body parts (e.g., head and leg)?", "answer": "That is considered two separate imaging series, and the Member Consultation Fee must be paid for both."}
{"question": "Is Plastic Surgery for Disfiguration eligible for sharing?", "answer": "Medical care and treatment provided for disfiguration caused by amputation, mastectomy, disease, or accident, including reconstructive mammoplasty or a similar procedure performed by a general surgeon, is eligible for sharing. Any other plastic surgery or cosmetic care or treatment is ineligible for sharing, including but not limited to, pharmacological regimens; nutritional procedures or treatments; cosmetic surgery; salabrasion, chemosurgery, and other such skin abrasion procedures associated with the removal or revision of scars, tattoos, or actinic changes."}
{"question": "Is there a Prescription Drug Program included in the Healthy Life EasyShare Programs?", "answer": "Yes, the RxSimpleShare Prescription TheDrug Program is included."}
{"question": "What is the co-share for many common prescriptions under RxSimpleShare?", "answer": "$5 co-share."}
{"question": "When are other prescription drugs eligible for sharing?", "answer": "Other prescription drugs are only eligible for sharing when provided by a Hospital as part of inpatient treatment or provided by a Facility during an outpatient surgical procedure."}
{"question": "How often are PSA tests eligible for sharing up to age forty-nine (49)?", "answer": "PSA tests are eligible for sharing once every two years up to and including age forty-nine (49)."}
{"question": "How often are PSA tests eligible for sharing for members fifty (50) years of age and older?", "answer": "PSA tests are eligible for sharing for members fifty (50) years of age and older once each year."}
{"question": "Is Respiratory Therapy eligible for sharing?", "answer": "N/A"}
{"question": "Is Speech Therapy/Speech Pathology eligible for sharing?", "answer": "N/A"}
{"question": "Is Vision Therapy eligible for sharing?", "answer": "N/A"}
{"question": "Are Well Baby Visits eligible for sharing?", "answer": "Yes, well baby visits, including immunizations, are eligible for sharing within the first year of birth."}
{"question": "What is the eligibility for Well Child Exam?", "answer": "Refer to Annual Routine Physical Exam, above."}
{"question": "What are the sharing limitations for X-Rays in a non-hospital environment?", "answer": "EasyShare limits sharing to a fixed amount of $250 per visit/series, with the member responsible for any amount above that limit."}
{"question": "What are the requirements for sharing outpatient X-Ray imaging?", "answer": "All outpatient X-Ray imaging has a 90-day waiting period, is sharable only with a physician prescription, and must be procured at a free-standing in-network diagnostic center unless received as an admitted patient."}
{"question": "Are expenses for most types of physical conditions resulting from Illness or Injury generally sharable?", "answer": "Yes, expenses for most types of physical conditions resulting from Illness or Injury are generally sharable, subject to all applicable conditions and limitations set forth elsewhere in these Guidelines."}
{"question": "Are there special provisions for certain conditions?", "answer": "Yes, special provisions apply for certain conditions, as explained below."}
{"question": "Under what circumstances are services, supplies, care, or treatment in connection with an abortion sharable?", "answer": "Services, supplies, care, or treatment in connection with an abortion may only be sharable if (a) the physical life of the mother is endangered by the continued Pregnancy, and treatment via a cesarean section has been determined by a neonatologist to be inadvisable, or (b) the Pregnancy was the result of a rape or incest for which a police report was filed."}
{"question": "Is Asthma generally sharable?", "answer": "Yes, asthma is generally sharable, but during the first 36 months of membership, a Confirmation of No Prior Existence of Condition statement may be required."}
{"question": "Are Back Problems generally sharable?", "answer": "Yes, back problems are generally sharable, but during the first 36 months of membership, a Confirmation of No Prior Existence of Condition statement may be required."}
{"question": "Are Bunions generally sharable?", "answer": "Yes, bunions are generally sharable, but during the first 36 months of membership, a Confirmation of No Prior Existence of Condition statement may be required."}
{"question": "Is Cancer generally sharable?", "answer": "Yes, cancer is generally sharable, but limitations may apply if it is related to cancer of a type you had prior to becoming a Member (see Section 4.05(n)) and during the first 60 months of membership, a Confirmation of No Prior Existence of Condition statement may be required."}
{"question": "Is Carpal Tunnel Syndrome generally sharable?", "answer": "Yes, Carpal Tunnel Syndrome is generally sharable, but during the first 36 months of membership, a Confirmation of No Prior Existence of Condition statement may be required."}
{"question": "What happens to medical expenses for complications arising from maternity?", "answer": "Medical expenses for complications to the member are considered part of the maternity need."}
{"question": "Are complications arising from sharable medical procedures eligible for sharing?", "answer": "Yes, if complications arise from a medical procedure that is sharable, expenses for treating the complications are sharable unless the complication itself is not sharable under these Guidelines."}
{"question": "Are expenses for dental care generally sharable?", "answer": "No, expenses for dental care are generally not sharable."}
{"question": "What are the exceptions for dental care expenses?", "answer": "Expenses for the treatment of natural teeth and caps (but not dentures or partial plates) that are broken/injured in an accident (but not an accident that occurs in the course of receiving dental care, when eating, or in certain motor vehicle accidents) are sharable."}
{"question": "What routine dental work is not sharable?", "answer": "Routine dental work such as check-ups, cleanings (including deep cleanings), fillings, crowns, root canals, implants, removal of wisdom or infected teeth, dentures, bridges, anesthesia for routine dental care, or treatment of periodontal disease is generally not sharable, except when these routine treatments are necessarily a part of surgery on the bones or other non-routine treatments."}
{"question": "How is diabetes treated under the sharing program?", "answer": "Diabetes is sharable, unless it is related to diabetes you had prior to becoming a member and it does not come within the exception described in Section VII.C.2. During the first 36 months of membership, a Confirmation of No Prior Existence of Condition statement may be required."}
{"question": "Are Foot Disorders generally sharable?", "answer": "Yes, Foot Disorders are generally sharable, but during the first 36 months of membership, a Confirmation of No Prior Existence of Condition statement may be required."}
{"question": "Under what conditions are Genetic Defects sharable?", "answer": "Genetic Defects are sharable when at least one of the following is true: (i) Neither the condition nor a symptom of the condition was discovered until after the then-current and continuously maintained membership had begun; (ii) The condition has not required treatment or produced harmful symptoms and has not deteriorated for at least five years; (iii) The condition exists in a person who has been included in a membership from birth, and the member was included in a membership prior to the pregnancy; or (iv) If the condition exists in a person who was adopted, the person has been included in a membership since the adoption, and the adopting parents were unaware of the condition at the time the adoption was finalized."}
{"question": "Are Heart Conditions generally sharable?", "answer": "Yes, 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 Section VII. During the first 36 months of membership, a Confirmation of No Prior Existence of Condition statement may be required."}
{"question": "What are Hemorrhoids?", "answer": "Hemorrhoids are generally sharable, but during the first 36 months of membership, a Confirmation of No Prior Existence of Condition statement may be required."}
{"question": "How are Hereditary Diseases treated under the sharing guidelines?", "answer": "Hereditary Diseases are sharable under the same conditions as Genetic Defects."}
{"question": "Are Hernias sharable under the sharing guidelines?", "answer": "A Hernia is generally sharable, but during the first 36 months of membership, a Confirmation of No Prior Existence of Condition statement may be required."}
{"question": "What conditions need to be met for High Blood Pressure to be sharable?", "answer": "High Blood Pressure is sharable as long as you have not been treated in a hospital for it in the past four years and can control it through medication or diet."}
{"question": "Are Maternity expenses eligible for sharing?", "answer": "Yes, for members with at least twelve months of continuous membership before conception, Maternity expenses are eligible for sharing with certain limits."}
{"question": "What is the maximum limit for Maternity expenses related to complications during delivery?", "answer": "The limit for Maternity expenses related to complications during delivery is up to $50,000 or the Program's Annual Sharing Limit per pregnancy."}
{"question": "Are expenses related to ectopic pregnancies eligible for sharing?", "answer": "Yes, expenses related to ectopic pregnancies are eligible for sharing, subject to applicable limits."}
{"question": "What type of pregnancy expenses are subject to the Annual Non-Sharable Medical Amount?", "answer": "Expenses related to normal deliveries or non-medically necessary cesarean sections are subject to the Annual Non-Sharable Medical Amount."}
{"question": "Are pre-natal care visits sharable?", "answer": "Yes, standard pre-natal care visits are generally sharable, subject to applicable visit limits."}
{"question": "What are the conditions for sharing Prostate Conditions?", "answer": "Prostate Conditions are generally sharable, but a Confirmation of No Prior Existence of Condition statement may be required during the first 36 months of membership."}
{"question": "Which STDs are eligible for sharing?", "answer": "HIV, AIDS, or other STDs contracted due to the actions of others (e.g., blood transfusions or medical procedures) are sharable."}
{"question": "Under what circumstances are STDs not sharable?", "answer": "STDs contracted through irresponsible behavior, such as sharing hypodermic needles for legal or illegal drugs, are not sharable."}
{"question": "What is the condition for sharing Sleep Apnea expenses?", "answer": "Sleep Apnea is generally sharable, but during the first 36 months of membership, a Confirmation of No Prior Existence of Condition statement may be required."}
{"question": "How are injuries caused by Motor Vehicle Accidents handled under the sharing guidelines?", "answer": "Most needs for motor vehicle-related injuries are sharable, but there are exceptions, and they must first be submitted to any responsible party for the accident."}
{"question": "Are injuries from Motor Vehicle Accidents sharable if you were not the Operator or Passenger?", "answer": "Yes, injuries from Motor Vehicle Accidents are sharable if you were not the Operator or Passenger, and the costs are not the responsibility of any insurance carrier or liable party."}
{"question": "What conditions must be met for injuries from Motor Vehicle Accidents to be sharable if you were an Operator or Passenger?", "answer": "Several conditions must be met, including valid insurance, no reckless driving, and no impairment due to alcohol or drugs."}
{"question": "Are expenses related to accidents involving three-wheel vehicles or snowmobiles sharable?", "answer": "Expenses related to accidents involving three-wheel vehicles or snowmobiles in which you were an operator or passenger are not sharable."}
{"question": "Are occupational or work-related injuries eligible for sharing?", "answer": "Expenses arising from occupational or work-related injuries are generally not eligible for sharing, except under certain conditions."}
{"question": "What are the conditions for occupational or work-related injuries to be considered for sharing?", "answer": "They may be considered for sharing if the state has no Worker's Compensation laws or the business owner is not allowed to participate in Workers Compensation."}
{"question": "What are Conditional Member Expenses?", "answer": "Conditional Member Expenses are related to pre-existing conditions that can be managed through lifestyle changes and are accepted into the membership based on a treatment plan."}
{"question": "Who monitors and encourages Conditional Members' progress toward health goals?", "answer": "Conditional Members are assigned a health coach to monitor and encourage their personal progress toward health goals."}
{"question": "What expenses are eligible for sharing for Conditional Members?", "answer": "Certain expenses associated with the customized treatment plan may be eligible for sharing, such as smoking cessation, weight loss, or dietary control."}
{"question": "Can the pre-existing condition guidelines be altered for Conditional Members?", "answer": "Yes, the pre-existing condition guidelines may be altered at the discretion of Universal HealthShare to encourage participation in the Conditional Membership program."}
{"question": "What are the guidelines for out-of-network physician charges?", "answer": "Out-of-network physician services are generally not eligible for sharing, except for emergency room visits, inpatient hospitalization and surgery, or outpatient surgical procedures, which may be sharable at a percentage of the Medicare payable amount."}
{"question": "How can you determine if a provider is out of network?", "answer": "You can determine if a provider is out of network by asking your physician or hospital or by contacting your Customer Service team."}
{"question": "How does sharing work for pre-existing conditions in the UHS Healthy Life EasyShare Programs?", "answer": "Conditions that exist at the time of enrollment with symptoms, treatment, or medication within 36 months prior are not eligible for sharing during the first two years of membership."}
{"question": "After the initial two years, are pre-existing conditions eligible for sharing?", "answer": "Yes, after the first two full years of continuous monthly membership, medical expenses for pre-existing conditions are eligible for sharing up to the annual program limits."}
{"question": "What documentation is required for pre-existing conditions?", "answer": "For certain conditions, a statement signed by both the member and the doctor may be required, verifying that the condition did not exist prior to membership."}
{"question": "What are the conditions for sharing expenses related to Motor Vehicle Accidents?", "answer": "Expenses related to Motor Vehicle Accidents are sharable if certain conditions, such as valid insurance and responsible driving, are met."}
{"question": "Are expenses related to accidents involving certain vehicles sharable?", "answer": "Expenses related to accidents involving three-wheel vehicles or snowmobiles are not sharable, even if local law allows them to travel on public roads."}
{"question": "What types of injuries are generally not eligible for sharing?", "answer": "Injuries arising from occupational or work-related activities are generally not eligible for sharing."}
{"question": "What is the main goal of the Conditional Membership program?", "answer": "The main goal of the Conditional Membership program is to encourage members with certain pre-existing conditions to make lifestyle changes."}
{"question": "Who bears the costs of health coaching sessions for Conditional Members?", "answer": "Health coaching sessions and related costs are paid for by the Conditional Member."}
{"question": "Can expenses related to occupational injuries ever be eligible for sharing?", "answer": "Yes, if the state has no Worker's Compensation laws or if the business owner is not allowed to participate in Workers Compensation, expenses related to occupational injuries may be considered for sharing."}
{"question": "What is the role of health coaches for Conditional Members?", "answer": "Health coaches monitor and encourage Conditional Members' personal progTheress toward health goals."}
{"question": "Are expenses related to lifestyle changes eligible for sharing for Conditional Members?", "answer": "Certain expenses related to lifestyle changes, such as smoking cessation or weight loss programs, may be eligible for sharing for Conditional Members."}
{"question": "How are out-of-network physician charges determined for sharing?", "answer": "Out-of-network physician charges may be sharable at a percentage of the Medicare payable amount, subject to specific conditions."}
{"question": "What expenses are sharable for out-of-network physician services?", "answer": "Out-of-network physician services related to emergency room visits, inpatient hospitalization and surgery, or outpatient surgical procedures may be sharable, subject to certain criteria."}
{"question": "How long must a member have continuous monthly membership for pre-existing conditions to become eligible for sharing?", "answer": "Pre-existing conditions become eligible for sharing after the first two full years of continuous monthly membership."}
{"question": "Are there exceptions to the pre-existing condition guidelines?", "answer": "Yes, there are exceptions for certain conditions where a Confirmation of No Prior Existence of Condition statement may be required."}
{"question": "What are the criteria for expenses from Motor Vehicle Accidents to be sharable?", "answer": "Expenses from Motor Vehicle Accidents are sharable if specific conditions, such as responsible driving and valid insurance, are met."}
{"question": "Can expenses related to Motor Vehicle Accidents be submitted to other parties first?", "answer": "Yes, expenses related to Motor Vehicle Accidents must first be submitted to any party responsible for the accident or liable for damages."}
{"question": "Are expenses related to accidents involving three-wheel vehicles or snowmobiles sharable?", "answer": "No, expenses related to accidents involving three-wheel vehicles or snowmobiles are not sharable, regardless of whether they are off-road or on-road."}
{"question": "Are occupational or work-related injuries eligible for sharing?", "answer": "Expenses arising from occupational or work-related injuries are generally not eligible for sharing, except under specific circumstances."}
{"question": "What are the conditions for occupational or work-related injuries to be considered for sharing?", "answer": "They may be considered for sharing if the state has no Worker's Compensation laws or the business owner is not allowed to participate in Workers Compensation."}
{"question": "What is the process for confirming the existence of Genetic Defects for sharing?", "answer": "To share Genetic Defects, a Confirmation of No Prior Existence of Condition statement may be required."}
{"question": "What are the limits for sharing Maternity expenses related to non-medically necessary cesarean sections?", "answer": "Expenses related to non-medically necessary cesarean sections during Maternity are subject to certain limits."}
{"question": "Are the costs associated with birthing center admissions sharable for Maternity?", "answer": "Yes, expenses arising from birthing center admissions during Maternity are generally sharable."}
{"question": "What is the sharing limit for Maternity expenses in the case of complications during delivery?", "answer": "The limit for Maternity expenses in the case of complications during delivery is up to $50,000 or the Program's Annual Sharing Limit per pregnancy."}
{"question": "Can expenses for multiple-birth pregnancies be shared?", "answer": "Yes, Maternity expenses for multiple-birth pregnancies are eligible for sharing."}
{"question": "What conditions make Maternity expenses sharable for a natural delivery or cesarean section?", "answer": "Maternity expenses for a natural delivery or cesarean section are sharable when complications at the time of delivery threaten the life of the member or infant and require care or services not normally rendered."}
{"question": "Are expenses for ectopic pregnancies sharable?", "answer": "Yes, expenses related to ectopic pregnancies are sharable, subject to applicable limits."}
{"question": "What are the eligible expenses for ectopic pregnancies?", "answer": "Expenses related to ectopic pregnancies include costs of pre-operative tests, consultations, and other expenses for keeping the member under medical care while determining the appropriate treatment."}
{"question": "Are expenses related to an ectopic pregnancy that results in a ruptured fallopian tube sharable?", "answer": "Yes, expenses related to an ectopic pregnancy that results in a ruptured fallopian tube are sharable, including surgery, post-operative recovery, follow-up care, and treatment of complications."}
{"question": "Are expenses related to ectopic pregnancies subject to any limits?", "answer": "Expenses related to ectopic pregnancies will be subject to the applicable per-Medical Incident limit, inclusive of costs of pre-operative tests, consultations, and other expenses for keeping the member under medical care while determining the appropriate treatment."}
{"question": "Can expenses for treatment of hereditary diseases be shared without conditions?", "answer": "Hereditary Diseases are sharable under the same conditions as Genetic Defects, which may require a Confirmation of No Prior Existence of Condition statement."}
{"question": "What is the process for confirming the absence of hereditary disease prior to sharing?", "answer": "Confirming the absence of hereditary disease for sharing may require a Confirmation of No Prior Existence of Condition statement."}
{"question": "How does High Blood Pressure become sharable under the guidelines?", "answer": "High Blood Pressure is sharable if you have not been treated in a hospital for it in the past four years and can effectively control it through medication or diet."}
{"question": "Can medical expenses for High Blood Pressure be shared if hospital treatment was received more than four years ago?", "answer": "Yes, as long as hospital treatment for High Blood Pressure was received more than four years ago, the incident can be considered for sharing."}
{"question": "What conditions make Pre-Natal Care Visits sharable?", "answer": "Standard pre-natal care visits are generally sharable, subject to applicable visit limits."}
{"question": "Are there any limits on the number of pre-natal care visits that can be shared?", "answer": "Yes, pre-natal care visits are subject to visit limits, so the number that can be shared may be limited."}
{"question": "What is the process for confirming the absence of Prostate Conditions for sharing?", "answer": "During the first 36 months of membership, a Confirmation of No Prior Existence of Condition statement may be required for sharing Prostate Conditions."}
{"question": "Can expenses related to the treatment of sexually transmitted diseases (STDs) be shared?", "answer": "Expenses for HIV, AIDS, or other STDs contracted due to the actions of others, such as blood transfusions or medical procedures, can be shared."}
{"question": "What are some examples of irresponsible behavior that would make STDs non-sharable?", "answer": "STDs contracted through irresponsible behavior, such as sharing hypodermic needles for legal or illegal drugs, are not sharable."}
{"question": "Under what circumstances is Sleep Apnea considered sharable?", "answer": "Sleep Apnea is generally sharable, but a Confirmation of No Prior Existence of Condition statement may be required during the first 36 months of membership."}
{"question": "What are the conditions that determine whether injuries from Motor Vehicle Accidents are sharable?", "answer": "Most injuries from motor vehicle-related accidents are sharable, but there are exceptions that require the expenses to be submitted to any responsible party for the accident first."}
{"question": "Are injuries from Motor Vehicle Accidents sharable if you were not the Operator or Passenger?", "answer": "Yes, injuries from Motor Vehicle Accidents are sharable if you were not the Operator or Passenger and the costs are not the responsibility of any insurance carrier or liable party."}
{"question": "Can you share expenses for injuries from Motor Vehicle Accidents if you were the Operator or Passenger?", "answer": "Yes, expenses for injuries from Motor Vehicle Accidents are sharable if you were the Operator or Passenger, provided certain conditions are met, such as valid insurance, responsible driving, and no impairment due to alcohol or drugs."}
{"question": "Are expenses from accidents involving three-wheel vehicles or snowmobiles sharable?", "answer": "Expenses from accidents involving three-wheel vehicles or snowmobiles, whether off-road or on-road, are generally not sharable."}
{"question": "What is the policy for sharing expenses related to occupational or work-related injuries?", "answer": "Expenses arising from occupational or work-related injuries are generally not eligible for sharing, except under specific circumstances."}
{"question": "What is the primary goal of the Conditional Membership program?", "answer": "The primary goal of the Conditional Membership program is to encourage members with certain pre-existing conditions to make lifestyle changes."}
{"question": "Who is responsible for monitoring and encouraging the progress of Conditional Members in the program?", "answer": "Health coaches are responsible for monitoring and encouraging the personal progress of Conditional Members toward their health goals."}
{"question": "Can expenses related to occupational injuries ever be eligible for sharing?", "answer": "Yes, if the state has no Worker's Compensation laws or if the business owner is not allowed to participate in Workers Compensation, expenses related to occupational injuries may be considered for sharing."}
{"question": "What is the role of health coaches in the Conditional Membership program?", "answer": "Health coaches play a vital role in monitoring and encouraging the personal progress of Conditional Members toward achieving their health goals."}
{"question": "Are expenses related to lifestyle changes eligible for sharing for Conditional Members?", "answer": "Yes, certain expenses related to lifestyle changes, such as smoking cessation or weight loss programs, may be eligible for sharing for Conditional Members."}
{"question": "How are out-of-network physician charges determined for sharing?", "answer": "Out-of-network physician charges may be sharable at a percentage of the Medicare payable amount, subject to specific conditions."}
{"question": "What expenses related to out-of-network physician services can be shared?", "answer": "Out-of-network physician services related to emergency room visits, inpatient hospitalization and surgery, or outpatient surgical procedures may be sharable, subject to certain criteria."}
{"question": "How long must a member maintain continuous monthly membership for pre-existing conditions to become eligible for sharing?", "answer": "Pre-existing conditions become eligible for sharing after the first two full years of continuous monthly membership."}
{"question": "Are there any exceptions to the pre-existing condition guidelines?", "answer": "Yes, there are exceptions for certain conditions where a Confirmation of No Prior Existence of Condition statement may be required."}
{"question": "What are the criteria for expenses from Motor Vehicle Accidents to be sharable?", "answer": "Expenses from Motor Vehicle Accidents are sharable if specific conditions, such as responsible driving and valid insurance, are met."}
{"question": "Can expenses related to Motor Vehicle Accidents be submitted to other parties first?", "answer": "Yes, expenses related to Motor Vehicle Accidents must first be submitted to any party responsible for the accident or liable for damages."}
{"question": "Are expenses related to accidents involving three-wheel vehicles or snowmobiles sharable?", "answer": "No, expenses related to accidents involving three-wheel vehicles or snowmobiles are not sharable, regardless of whether they are off-road or on-road."}
{"question": "What is the main goal of the Conditional Membership program?", "answer": "The main goal of the Conditional Membership program is to encourage members with certain pre-existing conditions to make lifestyle changes."}
{"question": "Who is responsible for monitoring and encouraging progress in the Conditional Membership program?", "answer": "Health coaches are responsible for monitoring and encouraging the personal progress of Conditional Members."}
{"question": "Can expenses related to lifestyle changes ever be eligible for sharing for Conditional Members?", "answer": "Yes, certain expenses related to lifestyle changes, such as smoking cessation or weight loss programs, may be eligible for sharing for Conditional Members."}
{"question": "How are out-of-network physician charges determined for sharing?", "answer": "Out-of-network physician charges may be sharable at a percentage of the Medicare payable amount, subject to specific conditions."}
{"question": "What expenses related to out-of-network physician services can be shared?", "answer": "Out-of-network physician services related to emergency room visits, inpatient hospitalization and surgery, or outpatient surgical procedures may be sharable, subject to certain criteria."}
{"question": "How long must a member maintain continuous monthly membership for pre-existing conditions to become eligible for sharing?", "answer": "Pre-existing conditions become eligible for sharing after the first two full years of continuous monthly membership."}
{"question": "Are there any exceptions to the pre-existing condition guidelines?", "answer": "Yes, there are exceptions for certain conditions where a Confirmation of No Prior Existence of Condition statement may be required."}
{"question": "What are the criteria for expenses from Motor Vehicle Accidents to be sharable?", "answer": "Expenses from Motor Vehicle Accidents are sharable if specific conditions, such as responsible driving and valid insurance, are met."}
{"question": "Can expenses related to Motor Vehicle Accidents be submitted to other parties first?", "answer": "Yes, expenses related to Motor Vehicle Accidents must first be submitted to any party responsible for the accident or liable for damages."}
{"question": "Are expenses related to accidents involving three-wheel vehicles or snowmobiles sharable?", "answer": "No, expenses related to accidents involving three-wheel vehicles or snowmobiles are not sharable, regardless of whether they are off-road or on-road."}
{"question": "What is the main goal of the Conditional Membership program?", "answer": "The main goal of the Conditional Membership program is to encourage members with certain pre-existing conditions to make lifestyle changes."}
{"question": "Who is responsible for monitoring and encouraging progress in the Conditional Membership program?", "answer": "Health coaches are responsible for monitoring and encouraging the personal progress of Conditional Members."}
{"question": "Can expenses related to lifestyle changes ever be eligible for sharing for Conditional Members?", "answer": "Yes, certain expenses related to lifestyle changes, such as smoking cessation or weight loss programs, may be eligible for sharing for Conditional Members."}
{"question": "How are out-of-network physician charges determined for sharing?", "answer": "Out-of-network physician charges may be sharable at a percentage of the Medicare payable amount, subject to specific conditions."}
{"question": "What expenses related to out-of-network physician services can be shared?", "answer": "Out-of-network physician services related to emergency room visits, inpatient hospitalization and surgery, or outpatient surgical procedures may be sharable, subject to certain criteria."}
{"question": "How long must a member maintain continuous monthly membership for pre-existing conditions to become eligible for sharing?", "answer": "Pre-existing conditions become eligible for sharing after the first two full years of continuous monthly membership."}
{"question": "Are there any exceptions to the pre-existing condition guidelines?", "answer": "Yes, there are exceptions for certain conditions where a Confirmation of No Prior Existence of Condition statement may be required."}
{"question": "What are the criteria for expenses from Motor Vehicle Accidents to be sharable?", "answer": "Expenses from Motor Vehicle Accidents are sharable if specific conditions, such as responsible driving and valid insurance, are met."}
{"question": "Can expenses related to Motor Vehicle Accidents be submitted to other parties first?", "answer": "Yes, expenses related to Motor Vehicle Accidents must first be submitted to any party responsible for the accident or liable for damages."}
{"question": "Are expenses related to accidents involving three-wheel vehicles or snowmobiles sharable?", "answer": "No, expenses related to accidents involving three-wheel vehicles or snowmobiles are not sharable, regardless of whether they are off-road or on-road."}
{"question": "What is the main goal of the Conditional Membership program?", "answer": "The main goal of the Conditional Membership program is to encourage members with certain pre-existing conditions to make lifestyle changes."}
{"question": "Who is responsible for monitoring and encouraging progress in the Conditional Membership program?", "answer": "Health coaches are responsible for monitoring and encouraging the personal progress of Conditional Members."}
{"question": "Can expenses related to lifestyle changes ever be eligible for sharing for Conditional Members?", "answer": "Yes, certain expenses related to lifestyle changes, such as smoking cessation or weight loss programs, may be eligible for sharing for Conditional Members."}
{"question": "How are out-of-network physician charges determined for sharing?", "answer": "Out-of-network physician charges may be sharable at a percentage of the Medicare payable amount, subject to specific conditions."}
{"question": "What expenses related to out-of-network physician services can be shared?", "answer": "Out-of-network physician services related to emergency room visits, inpatient hospitalization and surgery, or outpatient surgical procedures may be sharable, subject to certain criteria."}
{"question": "How long must a member maintain continuous monthly membership for pre-existing conditions to become eligible for sharing?", "answer": "Pre-existing conditions become eligible for sharing after the first two full years of continuous monthly membership."}
{"question": "Are there any exceptions to the pre-existing condition guidelines?", "answer": "Yes, there are exceptions for certain conditions where a Confirmation of No Prior Existence of Condition statement may be required."}
{"question": "What are the criteria for expenses from Motor Vehicle Accidents to be sharable?", "answer": "Expenses from Motor Vehicle Accidents are sharable if specific conditions, such as responsible driving and valid insurance, are met."}
{"question": "Can expenses related to Motor Vehicle Accidents be submitted to other parties first?", "answer": "Yes, expenses related to Motor Vehicle Accidents must first be submitted to any party responsible for the accident or liable for damages."}
{"question": "Are expenses related to accidents involving three-wheel vehicles or snowmobiles sharable?", "answer": "No, expenses related to accidents involving three-wheel vehicles or snowmobiles are not sharable, regardless of whether they are off-road or on-road."}
{"question": "What is the main goal of the Conditional Membership program?", "answer": "The main goal of the Conditional Membership program is to encourage members with certain pre-existing conditions to make lifestyle changes."}
{"question": "Who is responsible for monitoring and encouraging progress in the Conditional Membership program?", "answer": "Health coaches are responsible for monitoring and encouraging the personal progress of Conditional Members."}
{"question": "Can expenses related to lifestyle changes ever be eligible for sharing for Conditional Members?", "answer": "Yes, certain expenses related to lifestyle changes, such as smoking cessation or weight loss programs, may be eligible for sharing for Conditional Members."}
{"question": "How are out-of-network physician charges determined for sharing?", "answer": "Out-of-network physician charges may be sharable at a percentage of the Medicare payable amount, subject to specific conditions."}
{"question": "What expenses related to out-of-network physician services can be shared?", "answer": "Out-of-network physician services related to emergency room visits, inpatient hospitalization and surgery, or outpatient surgical procedures may be sharable, subject to certain criteria."}
{"question": "How long must a member maintain continuous monthly membership for pre-existing conditions to become eligible for sharing?", "answer": "Pre-existing conditions become eligible for sharing after the first two full years of continuous monthly membership."}
{"question": "Are there any exceptions to the pre-existing condition guidelines?", "answer": "Yes, there are exceptions for certain conditions where a Confirmation of No Prior Existence of Condition statement may be required."}
{"question": "What are the criteria for expenses from Motor Vehicle Accidents to be sharable?", "answer": "Expenses from Motor Vehicle Accidents are sharable if specific conditions, such as responsible driving and valid insurance, are met."}
{"question": "Can expenses related to Motor Vehicle Accidents be submitted to other parties first?", "answer": "Yes, expenses related to Motor Vehicle Accidents must first be submitted to any party responsible for the accident or liable for damages."}
{"question": "Are expenses related to accidents involving three-wheel vehicles or snowmobiles sharable?", "answer": "No, expenses related to accidents involving three-wheel vehicles or snowmobiles are not sharable, regardless of whether they are off-road or on-road."}
{"question": "What is the main goal of the Conditional Membership program?", "answer": "The main goal of the Conditional Membership program is to encourage members with certain pre-existing conditions to make lifestyle changes."}
{"question": "Who is responsible for monitoring and encouraging progress in the Conditional Membership program?", "answer": "Health coaches are responsible for monitoring and encouraging the personal progress of Conditional Members."}
{"question": "Can expenses related to lifestyle changes ever be eligible for sharing for Conditional Members?", "answer": "Yes, certain expenses related to lifestyle changes, such as smoking cessation or weight loss programs, may be eligible for sharing for Conditional Members."}
{"question": "How are out-of-network physician charges determined for sharing?", "answer": "Out-of-network physician charges may be sharable at a percentage of the Medicare payable amount, subject to specific conditions."}
{"question": "What expenses related to out-of-network physician services can be shared?", "answer": "Out-of-network physician services related to emergency room visits, inpatient hospitalization and surgery, or outpatient surgical procedures may be sharable, subject to certain criteria."}
{"question": "How long must a member maintain continuous monthly membership for pre-existing conditions to become eligible for sharing?", "answer": "Pre-existing conditions become eligible for sharing after the first two full years of continuous monthly membership."}
{"question": "Are there any exceptions to the pre-existing condition guidelines?", "answer": "Yes, there are exceptions for certain conditions where a Confirmation of No Prior Existence of Condition statement may be required."}
{"question": "What are the criteria for expenses from Motor Vehicle Accidents to be sharable?", "answer": "Expenses from Motor Vehicle Accidents are sharable if specific conditions, such as responsible driving and valid insurance, are met."}
{"question": "Can expenses related to Motor Vehicle Accidents be submitted to other parties first?", "answer": "Yes, expenses related to Motor Vehicle Accidents must first be submitted to any party responsible for the accident or liable for damages."}
{"question": "Are expenses related to accidents involving three-wheel vehicles or snowmobiles sharable?", "answer": "No, expenses related to accidents involving three-wheel vehicles or snowmobiles are not sharable, regardless of whether they are off-road or on-road."}
{"question": "What is the main goal of the Conditional Membership program?", "answer": "The main goal of the Conditional Membership program is to encourage members with certain pre-existing conditions to make lifestyle changes."}
{"question": "Who is responsible for monitoring and encouraging progress in the Conditional Membership program?", "answer": "Health coaches are responsible for monitoring and encouraging the personal progress of Conditional Members."}
{"question": "Can expenses related to lifestyle changes ever be eligible for sharing for Conditional Members?", "answer": "Yes, certain expenses related to lifestyle changes, such as smoking cessation or weight loss programs, may be eligible for sharing for Conditional Members."}
{"question": "How are out-of-network physician charges determined for sharing?", "answer": "Out-of-network physician charges may be sharable at a percentage of the Medicare payable amount, subject to specific conditions."}
{"question": "What expenses related to out-of-network physician services can be shared?", "answer": "Out-of-network physician services related to emergency room visits, inpatient hospitalization and surgery, or outpatient surgical procedures may be sharable, subject to certain criteria."}
{"question": "How long must a member maintain continuous monthly membership for pre-existing conditions to become eligible for sharing?", "answer": "Pre-existing conditions become eligible for sharing after the first two full years of continuous monthly membership."}
{"question": "Are there any exceptions to the pre-existing condition guidelines?", "answer": "Yes, there are exceptions for certain conditions where a Confirmation of No Prior Existence of Condition statement may be required."}
{"question": "What are the criteria for expenses from Motor Vehicle Accidents to be sharable?", "answer": "Expenses from Motor Vehicle Accidents are sharable if specific conditions, such as responsible driving and valid insurance, are met."}
{"question": "Can expenses related to Motor Vehicle Accidents be submitted to other parties first?", "answer": "Yes, expenses related to Motor Vehicle Accidents must first be submitted to any party responsible for the accident or liable for damages."}
{"question": "Are expenses related to accidents involving three-wheel vehicles or snowmobiles sharable?", "answer": "No, expenses related to accidents involving three-wheel vehicles or snowmobiles are not sharable, regardless of whether they are off-road or on-road."}
{"question": "What is the main goal of the Conditional Membership program?", "answer": "The main goal of the Conditional Membership program is to encourage members with certain pre-existing conditions to make lifestyle changes."}
{"question": "Who is responsible for monitoring and encouraging progress in the Conditional Membership program?", "answer": "Health coaches are responsible for monitoring and encouraging the personal progress of Conditional Members."}
{"question": "Can expenses related to lifestyle changes ever be eligible for sharing for Conditional Members?", "answer": "Yes, certain expenses related to lifestyle changes, such as smoking cessation or weight loss programs, may be eligible for sharing for Conditional Members."}
{"question": "How are out-of-network physician charges determined for sharing?", "answer": "Out-of-network physician charges may be sharable at a percentage of the Medicare payable amount, subject to specific conditions."}
{"question": "What expenses related to out-of-network physician services can be shared?", "answer": "Out-of-network physician services related to emergency room visits, inpatient hospitalization and surgery, or outpatient surgical procedures may be sharable, subject to certain criteria."}
{"question": "How long must a member maintain continuous monthly membership for pre-existing conditions to become eligible for sharing?", "answer": "Pre-existing conditions become eligible for sharing after the first two full years of continuous monthly membership."}
{"question": "Are there any exceptions to the pre-existing condition guidelines?", "answer": "Yes, there are exceptions for certain conditions where a Confirmation of No Prior Existence of Condition statement may be required."}
{"question": "What are the criteria for expenses from Motor Vehicle Accidents to be sharable?", "answer": "Expenses from Motor Vehicle Accidents are sharable if specific conditions, such as responsible driving and valid insurance, are met."}
{"question": "Can expenses related to Motor Vehicle Accidents be submitted to other parties first?", "answer": "Yes, expenses related to Motor Vehicle Accidents must first be submitted to any party responsible for the accident or liable for damages."}
{"question": "Are expenses related to accidents involving three-wheel vehicles or snowmobiles sharable?", "answer": "No, expenses related to accidents involving three-wheel vehicles or snowmobiles are not sharable, regardless of whether they are off-road or on-road."}