Medical Cost Sharing is not health insurance. Before replacing health insurance with a medical cost sharing membership, it is critically important to understand the requirements and restrictions for members. For example, most medical cost sharing organizations exclude or limit the amount eligible to share for pre-existing conditions. Accordingly, Medical Cost Sharing Group Memberships are not appropriate for groups of 50 or more where employees with pre-existing conditions might not be covered and the employer could be subject to a tax penalty. Likewise, there are exclusions for irresponsible behavior, including an accident or sickness related to drugs or alcohol. The website for each organization has the necessary detailed information to enable an informed decision.

The application for medical cost sharing has a limited number of health history questions, but all potential members must agree with and attest to statements including: “I agree to refrain from the usage of any form of illegal substances.” Accordingly, medical cost sharing memberships are not for everybody, but a practical solution to managing costs for health conscious individuals. It is vital to understand that local healthcare providers may require full or partial payment prior to providing services for unexpected care.

Medical cost sharing is not insurance where a premium is paid and the risk of major medical expenses are assumed by the insurance company. In medical cost sharing the patient deals directly with the doctor or hospital without the interference of an insurance company actuary. Secondly, the patient becomes a responsible, cost-conscious consumer rather than only being responsible for a co-pay and no concern what is charged to the insurance company.

The One Valley Healthcare Program is not insurance. This means the state’s consumer protections and oversight of the operation of the plan do not apply. The amounts to be paid to the plan are not insurance premiums and therefore are not regulated. The promise of future benefits is not guaranteed and thus the State of Colorado’s Guarantee Fund does not apply.

The general information provided here has been taken from reliable resources. However, Vail Valley Partnership does not provide insurance, legal or tax advice. We recommend that you seek competent legal advice for any questions on the forms and applications that you are required to sign to apply for membership to a medical cost sharing organization. The One Valley Healthcare program is not insurance and the Vail Valley Partnership is not an insurance agency or provider. This program is sponsored by the Small Association Leadership Alliance with plans provided by Apex Management Group and a Medical Cost Sharing membership provided by Sedera Health.

Vail Valley Partnership makes no recommendations, representations, or warranties regarding the terms of the SALA cost sharing arrangement or its appropriateness for any member entity or individual. Local healthcare providers may require full or partial payment in advance of providing services.

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