MEMBER GUIDELINES

DISCLAIMER

Big Stuff Health Share, doing business as MyOwn Medical Fund is not an insurance company. Neither this publication NOR membership in Big Stuff Health Share are issued or offered by an insurance company. The purpose of this Member Guide is to help Members understand and identify medical needs that qualify for potential reimbursement and the process by which reimbursements are made. This Member Guide is not for the purpose of describing to prospective Members what amounts will be reimbursed by Big Stuff Health Share.

Membership in Big Stuff Health Share does NOT guarantee or promise that a Member’s Eligible Needs will be shared. Rather, membership in the Big Stuff Health Share community merely guarantees the opportunity for Members to care for one another in a time of need and present their medical needs to other Members as outlined in this Member Guide. The financial assistance Members receive will come from other members’ monthly contributions that are placed in a benevolent fund, and not from Big Stuff Health Share.

THIS PUBLICATION AND MEMBERSHIP IN BIG STUFF HEALTH SHARE SHOULD NEVER BE CONSIDERED A HEALTH INSURANCE POLICY. IF THE MEMBERSHIP IS UNABLE TO SHARE IN ALL OR PART OF A MEMBER’S ELIGIBLE MEDICAL NEEDS, EACH MEMBER WILL REMAIN SOLELY FINANCIALLY LIABLE FOR ANY AND ALL UNPAID MEDICAL NEEDS.

THIS MEMBER GUIDE DOES NOT CREATE A LEGALLY ENFORCEABLE CONTRACT BETWEEN BIG STUFF HEALTH SHARE AND ANY OF ITS MEMBERS. NEITHER THESE GUIDELINES, NOR ANY OTHER ARRANGEMENT BETWEEN MEMBERS AND BIG STUFF HEALTH SHARE, CREATE ANY RIGHTS FOR ANY MEMBER AS A RECIPROCAL BENEFICIARY, A THIRD-PARTY BENEFICIARY, OR OTHERWISE. AN EXCEPTION TO A SPECIFIC PROVISION OF THESE GUIDELINES ONLY MODIFIES THAT PARTICULAR PROVISION AND DOES NOT SUPERSEDE OR VOID ANY OTHER PROVISIONS. THE DECISION BY BIG STUFF HEALTH SHARE TO REIMBURSE A MEMBER’S ELIGIBLE NEEDS DOES NOT AND SHALL NOT CONSTITUTE A WAIVER OF THIS PROVISION OR ESTABLISH BY ESTOPPEL OR ANY OTHER MEANS ANY OBLIGATION ON THE PART OF BIG STUFF HEALTH SHARE TO REIMBURSE A MEMBER’S ELIGIBLE NEEDS.

MEMBERS ARE PRIMARILY RESPONSIBLE FOR ENSURING THAT ALL OF SUCH MEMBER’S MEDICAL EXPENSES ARE TIMELY PAID, REGARDLESS OF THE STATUS OF ANY NEEDS REQUEST.

FOUNDATIONS FOR MEMBERSHIP

Each Member of Big Stuff Health Share must comply with the following requirements in order to preserve its membership in Big Stuff Health Share and be eligible to participate in the health share.

The requirements below benefit all Members by assuring honor and integrity on the part of Members and by minimizing medical risks and ensuring proper accountability while encouraging good health practices.

All Big Stuff Health Share Members must agree with and attest to the following statements:

  1. I believe that a community of moral, ethical, and health-conscious people can most efficiently and effectively encourage and care for one another by directly sharing the costs and expenses associated with each other’s health care needs.
  2. I understand that Big Stuff Health Share is a benevolence organization, not an insurance entity and that while Big Stuff Health Share assures that every effort will be made to have Members fulfill their monthly sharing commitment, Big Stuff Health Share, in and of itself, cannot guarantee payment of any medical expenses.
  3. I agree to practice good health measures and strive for a balanced lifestyle.
  4. I agree to contact Big Stuff Health Share by either calling the hotline (435-446-9696) or by emailing help@bigstuffhealthshare.com prior to seeking or obtaining any medical treatments (except in the case of an emergency where I will seek immediate medical attention) to ensure that I am receiving the appropriate medical treatments at a fair price and to verify the Shareability of such medical treatment.
  5. I agree to refrain from the usage of any form of illicit/illegal drugs and excessive alcohol
    consumption, all of which are harmful to the body. I understand that if members in the
    household use any form of tobacco, I will contribute an additional $50.00 (fifty) dollars per month.
  6. I believe I am obligated to care for my family and that physical, mental, or emotional abuse of any kind to a family member or anyone else is morally wrong.
  7. I agree to submit to mediation followed by subsequent binding arbitration, if needed, for any instance of a dispute with Big Stuff Health Share or its affiliates.

ELIGIBILITY

  1. Participating in Medicare/Medicaid if Medicare/Medicaid eligible.

  2. Filling out the Big Stuff Enrollment Form completely, accurately, and honestly;

  3. Meeting Big Stuff Health Share’s qualifications based upon lifestyle choices and medical history;

  4. Agreeing to abide by the Foundations of Membership; and

  5. Paying a full, monthly contribution amount1 in accordance with the Member’s Participation and IUA Elections, with the first contribution being due on or before the Effective Date and all subsequent contributions being due on the first day of each calendar month.

Membership applications will be accepted on a case-by-case basis.

MEMBERSHIP TYPES

A. Employee Only

B. Employee + 1 dependent

C. Employee + 2 or more dependents

IUA (Whatcha Gotta Pay First) Elections:

  • $1500
  • $2500
  • $4000

 

DEPENDENTS

Dependents may be included in Primary Member’s membership if:

  1. Spouse or Child is a legal dependent of Primary Member (marriage, biological birth2, adopted, legal guardianship, stepchildren, etc.)
  2. Immediate family members included up to 8 total family members.  A $10.00 monthly fee for each additional member is assessed thereafter.
  3. Child dependent is unmarried,3 and
  4. Child dependent is under the age of 274

 

EFFECTIVE DATE

Membership will begin on the 1st day of the upcoming month if:

  1. Member enrolls by the 25th of the current month, and
  2. Big Stuff Health Share receives the Member’s monthly contribution amount by the 1st of the effective month.

 

1 Payment must be received no later than the final day of the participating month for membership to remain in Active status.

2 To include a newborn child in a Primary Member’s membership retroactive to the birth date, Big Stuff Health Share must receive notification of the addition to the household within thirty (30) days of birth. If notification is received more than thirty (30) days after the child’s birth, then the child’s effective date will be the 1st day of the month following the month in which notice is given.

3 Dependents who are married may enroll in a membership separate from that of the parents.

4 Dependents age 27 and older will be automatically removed from Primary member’s membership and must enroll under a separate plan to share medical expenses.

MEDICAL NEEDS

To share in a member’s medical expenses, Big Stuff Health Share will first determine the eligibility and shareability of a medical need.

When a need is determined Eligible and Shareable, Big Stuff Health Share will disburse the Shareable Amount to the appropriate source (via reimbursement to the Member for actual amounts paid by the Member or via direct payment to the Member’s medical provider.)  

Eligible Medical Needs

An Eligible Medical Need is defined as follows:

  1. The occurrence of an injury or illness on a per Member, per incidence basis;
  2. Resulting in medical treatment expenses which are:
    • medically necessary;
    • for treatment performed by a licensed medical professional;
    • for treatment that has been pre-approved by the medical provider; and
    • for treatment related to the same injury or illness;
  3. Which injury or illness Is not deemed a Pre-Existing Condition; and
  4. Which injury or illness was not caused by the Member’s illegal activities or activities in violation of the Foundations of Membership.

Shareability (what healthcare expenses will be shared)

An Eligible Medical Need is considered Shareable (payable) if:

  1. The date of service is within a period of Active status;
  2. All required documentation listed in this section (an itemized bill, IUA receipt, etc.) is submitted within 6 months of the service date;
    • Itemized bills listing CPT codes for the services provided, the name, address, and contact information for the medical provider and the patient name; and 
    • Receipts showing proof of Member’s payment of all medical expenses charged and any discounts provided by the medical provider.
    • If a bill is adjusted, or if a Member makes a payment or obtains a discount or any refund or reimbursement after submission of a Needs Request, the Member shall promptly amend or supplement the applicable Needs Request to ensure the accuracy and completeness of each Needs Request; 
  3. The IUA has been paid in full within a period of Active status; and
  4. The need is reported prior to, during or within 2 hours of the time of service to a licensed medical professional associated with Big Stuff through a 24-hour medical line (435-850-7396)

An IUA is required for each separate Eligible Medical Need experienced within a household for up to 3 Eligible Medical Needs within a 12-month period. Additional Eligible Medical Needs arising within that 12-month period exceeding a $500 threshold will be fully shareable after the first $500 related to such Eligible Medical Need is paid by Member.

Maximum Shareable Amount

Once a medical need is deemed an Eligible Medical Need and the IUA is paid, the community will share 100% of the remaining medical expenses for that Eligible Medical Need subject to the Member’s Lifetime Limit until the Member is symptom and treatment-free for 12 months.

Insurance and Government Programs

If a Member is eligible for benefits through insurance arrangements, government programs, etc., those entities will always be considered the primary payer, and Big Stuff Health Share will always be the payer of last resort. 

Late Fees and/or Interest

Late payment fees and Interest will not be shareable if they are a result of a Member’s delay in paying the IUA amount or submitting required documentation.

PRE-EXISTING CONDITIONS

A pre-existing condition is any illness or injury within 24 months prior to the Effective Date for which a Member:

  • Had symptoms;
  • Has been diagnosed;
  • Received medical treatment;
  • Has been examined; or
  • Has taken medication

An otherwise Eligible Medical Need resulting from a pre-existing condition will only be Shareable during the first 12 months after the Effective Date if the condition is:

  1. Fully cured and
  2. Symptom- and treatment-free for 24 months before the Effective Date

Pre-Existing Condition Waiting Period

Pre-Existing Conditions have a waiting or phase-in period based on years of continued Membership:

  1. 1st Year – Waiting Period for all Pre-Existing Conditions. No otherwise Eligible Medical Needs considered Pre-Existing Conditions will be shared or paid during the first 12 months after the Effective Date
  2. 2nd Year – Up to $25,000 of Eligible Medical Needs considered Pre-Existing Conditions may be Shareable
  3. 3rd year – Up to $50,000 of Eligible Medical Needs considered Pre-Existing Conditions may be Shareable
  4. 4th year and beyond – Up to $100,000 per year of Eligible Medical Needs considered Pre-Existing Conditions may be Shareable

This program exists to help protect existing Members’ contributions from immediate, extensive medical out-payments for conditions existing prior to the membership for newly added Members.

This program exists to help protect existing members’ contributions from immediate, extensive medical out pays for conditions existing prior to membership for newly added members.

MATERNITY

Maternity Needs may only be Sharable if conception occurs 90 days or longer after the applicable Member’s Effective Date. Eligible Medical Needs related to prenatal, birth and postnatal needs may be Shareable up to $13,000.00 for normal vaginal delivery and $16,000.00 for cesarean delivery subject to the following requirements:

Separate Needs

Maternity Needs are considered two separate and distinct needs and will require the payment of two IUA amounts before the remaining financial balance of each can be shared:

  1. Mother’s Maternity Care; and
  2. Child’s Birth & Pre/Postnatal

Early Sharing Request

Maternity Needs may be Shareable prior to the child’s birth only if the maternity care provider will apply a discount or reduce UCR Costs when paid in advance.

Home Births

Maternity Needs related to in-home births may be Shareable if the expenses related thereto are less than what would normally be shared by the community, Big Stuff may waive the IUA requirement. Prior written approval must be obtained from Big Stuff to waive the IUA.

Premature Births

Maternity Needs for children born prior to the start of the 37th week of pregnancy may be Shareable.

SHAREABLE CONDITIONS

Abortion

Eligible Medical Needs related to the abortion of a living, the unborn child may not be Shareable, except in cases where extenuating circumstances exist and the mother’s life is at risk if the abortion is not performed.

Alcohol or Drug Abuse Treatment

Eligible Medical Needs related to alcohol or substance abuse or chemical dependency may be Shareable up to a $3,000 maximum Shareable amount per Member for the lifetime of such Member, provided that such Eligible Medical Need was not caused by Member’s violation of the Foundations of Membership after the Effective Date.

Allergy Treatments

Eligible Medical Needs rising from non-seasonal allergies may be Shareable.

Alternative Medical Treatment

Eligible Medical Needs for alternative medical treatments are, generally, considered Shareable. To be Shareable, the treatment should be considered safe and effective. The Member must receive written approval from Big Stuff Health Share before receiving such treatments.

To receive approval from Big Stuff Health Share, the requesting Member should provide:

  1. The provider’s notes on current condition;
  2. Explanation for why the alternative treatment was chosen;
  3. Explanation for why the alternative medical treatment should be shared;
  4. An estimated list of costs; and
  5. Written approval from a licensed medical provider (MD, DO, PA-C, APRN, NP) affiliated with Big Stuff Health Share.

Ambulance Transports

Eligible Medical Needs for ambulatory transport when medically necessary due to severity, proximity, and circumstances associated with a specific illness or injury may be Shareable.

Audiology

Eligible Medical Needs related to the correction of hearing loss may be Shareable. Hearing aids are not Shareable but may be provided through the Osmond Foundation or other charitable organizations at the discretion of a licensed medical provider affiliated with Big Stuff Health Share.

Automobile Accident

Eligible Medical Needs resulting from an automobile accident may only be Shareable when a third party or insurance entity cannot be held liable.  Auto, casualty, property, and other insurance will always take first priority positions prior to consideration of Big Stuff.

Chiropractic

Eligible Medical Needs for chiropractic treatment of a musculoskeletal injury or disease may be Shareable for up to 25 office visits and includes related items for treatment for up to 120 days. All other chiropractic services will be treated as an Alternative Medical Treatment.

Cosmetic Surgery

Only expenses pertaining to the repair of a disfiguration resulting from an eligible medical need are shareable.

Dental & Vision

Dental & Vision Services are deemed a non-shareable expense.  Only expenses for dental work or vision repair resulting from an Eligible Medical Need (accident or injury) may be Shareable.

Fertility

Expenses for fertility treatments are excluded from sharing.

Health Sharing Eligibility

Eligible Medical Needs related to any shared need will be considered only if the member is currently participating in Big Stuff Health Share at the time of their request.

Hospice Care

Eligible Medical Needs related to hospice care may only be Shareable for 90-day periods with physician approval or certification of a terminal illness.

Hospitalization

Eligible Medical Needs resulting from hospitalization may be Shareable only at a semi-private room rate and only if a licensed medical provider prescribes ICU or quarantine.

Hyperbaric Therapy

Expenses for hyperbaric therapy may only be Shareable when recommended by a licensed medical provider for treatment of an Eligible Medical Need.

Injuries Obtained from Certain Acts

Injuries or illnesses resulting from participation in a riot, criminal act, assisted suicide, or euthanasia are excluded from sharing.

Laboratory Tests and Checkups

Expenses for laboratory tests may only be Shareable when related to the need and prescribed by a licensed medical provider due to symptoms of an Eligible Medical Need.

Long Term Care and Skilled Nursing

Expenses for long term care and skilled nursing when prescribed by a licensed medical provider as a result of an Eligible Medical Need may be Shareable.

Massage Therapy

Expenses for massage therapy may only be Shareable if prescribed by a licensed medical provider for the treatment of an Eligible Medical Need, and for only up to 10 sessions.

Medical Equipment

Expenses for medical equipment may be Shareable, subject to the limitation set forth below, only if:

  1. Prescribed by a licensed medical provider associated with Big Stuff Health Share
  2. It is reasonably necessary for the treatment of an Eligible Medical Need
  3. It is approved by Big Stuff Health Share.

Limitation: Big Stuff Health Share will share the lesser of: (i) the purchase price for the medical equipment; and (ii) the rental costs of such medical equipment during the treatment period.

Medical Supplies

Expenses for medical supplies used in the treatment of an Eligible Medical Need may be Shareable within 180 days of the start date of a treatment prescribed by a licensed medical provider.

Mental Health

Expenses for mental health treatment may only be Shareable when approved in advance by Big Stuff Health Share up to a maximum lifetime limit of $1,500 per Member.

Naturopathy

Expenses for naturopathic medicine may only be Shareable with prior written approval from Big Stuff Health Share.

Newborn Care

Expenses for the following newborn treatments are shareable:

  • Circumcision
  • Immunizations

Nutritionists

Eligible Medical Needs for nutritionists may only be Shareable when prescribed by a licensed medical provider and with documentation from a licensed medical provider affiliated with Big Stuff Health Share.

Organ Transplants

Eligible Medical Needs related to organ transplants may only be Shareable when the underlying condition is not deemed a pre-existing condition and approved by a licensed medical provider affiliated with Big Stuff Health Share.

Physical Therapy

Eligible Medical Needs for physical therapy for inpatient treatment and up to 20 outpatient treatments may be Shareable.

Prescriptions

Only medications required to treat an Eligible Medical Need may be Shareable for a period of up to 3 months.  All other medications are not Shareable.

Preventive Care

Colo-rectal screening will be shared up to $750.00.  Screening colonoscopy will be covered with a flat rate of $1650.00. Breast Cancer Screening, i.e. mammogram, screening ultrasound, will be covered at a flat rate of $300.00. Big Stuff will waive the IUA for these procedures. Recommendations for locations for these screenings can be made by Big Stuff member advocates. All screenings will be ordered by the provider and will follow the American Cancer Society Guidelines for need and frequency of testing.

Office Visits

Expenses related to office visits may be Shareable when part of an Eligible Medical Need.

Speech Therapy

Expenses for speech therapy may only be Shareable when resulting from an Eligible Medical Need up to 25 outpatient visits per Eligible Medical Need.

Spine & Neck Surgery

Due to the complexity and unpredictability of outcomes, any services related to pre-existing back or neck pain will be considered with a maximum shared amount of $15,000.00.

Sporting Activities

Eligible Medical Needs resulting from injuries sustained in sporting activities, other than those specifically excluded herein, may be Shareable.  Eligible Medical Needs related to high-risk sporting events such as boxing, base jumping, bungee jumping, or paid-to-win combat sports are not Shareable unless otherwise determined by Big Stuff Health Share.

Sterilization

Expenses for elective sterilization procedures such as tubal ligation and vasectomy are excluded from sharing.

Surrogacy

Expenses related to Surrogacy, regardless of whether the surrogate is a Member, are excluded from sharing.

Weight Reduction

Eligible Medical Needs for surgical weight reduction may be Shareable, subject to a lifetime limit of $3,000 per Member when prescribed by a licensed medical provider and approved by Big Stuff Health Share.

UNSHAREABLE NEEDS

An Unshareable Need is any medical expense:

  • Whose total falls short of a Member’s IUA amount
  • Deemed a Pre-Existing Condition, or
  • Considered unshareable for other reasons specified in this Member Guide.

END OF LIFE ASSISTANCE

Upon the death of a Member, financial assistance may be provided to the immediate family of the Member when the following conditions are met:

  • Big Stuff Health Share has received 2 years of continuous contributions on account of the deceased Member, and
  • A certified copy of the death certificate has been provided to Big Stuff Health Share

Any End-of-Life financial assistance provided by Big Stuff Health Share will be in such amounts as deemed appropriate by Big Stuff Health Share, but shall never exceed the following amounts: 

  • Primary Member Death: $10,000
  • Dependent Spouse Death: $10,000
  • Dependent Child Death: $3,000

DEFINITIONS

Active Member

A Member who is in good standing with Big Stuff Health Share by:

  1. Enrolling successfully as a Big Stuff Health Share Member
  2. Abiding by the Foundations of Membership, and
  3. Being current on all contribution amounts according to the Membership Type and IUA Elections made by the Member. 

Benevolence Organization

An organization whose primary purpose is to care for the needs of the persons/members who make up the membership. A Benevolence Organization is not an insurance company.

Benevolent Fund

A fund maintained by Big Stuff Health Share created from the contributions of Members for the exclusive purpose of reimbursing Eligible Medical Needs of Members.

Date of Service

The day medical services were rendered to a participating Member.

Dependent

The Primary Member’s spouse or unmarried child(ren) age 26 or under who is the Primary Member’s dependent by birth, legal adoption, or marriage, who is(are) participating under the same combined membership. 

Effective Date

The 1st day of the calendar month in which a person’s membership begins, being the first day of the first calendar month after a Member’s successful enrollment in Big Stuff Health Share.

Health Share

A membership-based non-insurance arrangement established for the purpose of sharing legitimate healthcare expenses amongst a collective pool of funds contributed by Members.

Inactive Member

A contributor, and contributor’s dependents if applicable, who has/have not submitted Monthly Contributions in the manner established by this Member Guide. An Inactive Member is not eligible for sharing.

Ineligible Need

A need disqualified from voluntary sharing of contributions from Member contributions due to a policy set forth in this Member Guide or any need that is not considered an Eligible Medical Need.

IUA (Initial Unshareable Amount) (Whatcha Gotta Pay First)

The specified financial amount that Members are required to bear on their own prior to any amount that may be eligible for sharing. 

Licensed Medical Professional

An individual who has successfully completed a prescribed program of study in a variety of health fields and who has obtained a license or certificate indicating his or her competence to practice in his or her respective field (MD, DO, NP, PA-C). 

Lifetime Limit

The Lifetime Limit on Shareable Eligible Medical Needs and any other financial assistance provided by Big Stuff Health Share to a Member shall be $1,000,000, such that the cumulative amount paid to, on behalf of, on account of, or for the benefit of, a Member by Big Stuff Health Share shall not exceed $1,000,000 in the aggregate during the lifetime of such Member. 

Maternity Need

A need specifically relating to a pregnancy. To qualify as a Maternity Need, the /Need Request must be accompanied by a pregnancy verification form from a licensed medical provider request that must be completed once a Member becomes pregnant and is submitted by the Member to Big Stuff within 30 days of confirmation of pregnancy from a Licensed Medical Professional.

Maximum Shareable Amount

Certain medical conditions have a maximum dollar amount (limit) that can be shared for any one need as described in the guidelines. This maximum amount is referred to in each such instance as the Maximum Shareable Amount.

Medically Necessary

A service, procedure, or medication necessary to restore or maintain physical function that is provided in the most cost-effective setting consistent with the Member’s condition. The fact that a provider may prescribe, administer, or recommend services or care does not make it medically necessary. This applies even if it is not listed as a membership limitation, or in the Member Guide. To help determine medical necessity, Big Stuff Health Share may request medical records and information from the applicable Licensed Medical Professional.

Member

A person (or a dependent thereof) who has successfully enrolled in Big Stuff Health Share and satisfies the Eligibility requirements as set forth in this Member Guide. 

Membership

This term applies to the collective body of all active, participating in Big Stuff Health Share.

Membership Cancellation Request

A form submitted by a Member to Big Stuff Health Share informing cancellation of their membership. The form must be received by the 25th day of the month for the cancellation to become effective for the following month or any future requested month. Cancellations become effective on the 1st day of the requested month following the timely receipt by Big Stuff Health Share of the Membership Cancellation Request Form.

Membership Update

A communication from a Member to Big Stuff Health Share communicating any changes to the details of such Member’s membership information (i.e. change of address, phone number, etc.) or requesting that any membership elections be changed. The change request or update may take up to three business days to complete. Once a representative of Big Stuff Health Share approves the requested changes, the approved changes may go into effect in the month following the approval of the requested changes.

Membership Limitation

A specified medical condition for which medical needs arising from or associated with the condition is ineligible for reimbursement from the Benevolent Fund. An associated condition is one that is caused directly and primarily by a medical condition that is specifically ineligible. 

Membership Withdrawal

The occurrence of membership termination due to the submission of a Membership Cancellation Request Form, a violation of the Big Stuff Health Share Membership, or non-receipt of a voluntary Monthly Contribution 30 days past the date such payment was due. Such membership termination is referred to as Membership Withdrawal.

Monthly Contributions

Voluntary monetary contributions in an amount determined by the Member’s Membership Type and IUA Election placed in the care of Big Stuff Health Share by a Member to maintain active membership and to be used in the Benevolent Fund administered by Big Stuff Health Share and disbursed according to the Eligible Medical Needs of its Members in accordance with this Member Guide.

Need Request

The submission of an Eligible Medical Need for reimbursement. A request that is required to process medical needs for accidents, injuries, or medical conditions that result in a visit to the emergency room or other Eligible Medical needs. Members must notify Big Stuff Health Share within 30 days of discharge. Need requests can be submitted on the Big Stuff Health Share Portal. Members are encouraged to call the Big Stuff Health Share hotline (435-446-9696) for any questions related to the submission of Need Requests. The Need Request must be submitted to Big Stuff Health Share within 6 months of the first date of service for the Eligible Medical Need.

Office Visit

Sick visits, wellness visits, specialists, and urgent care are generally considered to be Office Visits. For the need to qualify as an Office Visit, the medical bill must include an Office Visit CPT code and be part of an Eligible Medical Need.

Health Share Administration

Big Stuff Health Share reserves the right, but not the obligation, to advocate on behalf of a Member to negotiate discounts or payment terms related to a Member’s medical expenses. This advocation includes the verification and assessment of Needs Requests submitted to Big Stuff Health Share by a Member to determine the eligibility and Shareability of that need. Once a Medical Need is deemed an Eligible Medical Need and Shareable, Big Stuff Health Share may work directly with the applicable medical provider(s) to negotiate, process, and pay the bill(s) submitted for payment, the appropriate party.

Members are encouraged to contact Big Stuff Health Share by either calling the hotline (435-446-9696) or by emailing healthshare@myaliveandwell.com prior to seeking or obtaining any medical treatments (except in the case of an emergency where Members are encouraged to seek immediate medical attention) to ensure that Member is receiving the appropriate medical treatments at a fair price and to verify the Shareability of such medical treatment.

Pre-Existing Condition

Any illness or accident for which a person has been diagnosed, received medical treatment, been examined, taken medication, or had symptoms for 24 months prior to the Effective Date. Symptoms can include but are not limited to the following: abnormal discharge or bleeding; abnormal growth; break; cut or tear; discoloration; deformity; full or partial loss of use; obvious damage, illness or abnormality; impaired breathing; impaired motion; inflammation or swelling; itching; numbness; pain that interferes with normal use; unexplained or unplanned weight gain or loss exceeding 20% of the total body weight occurring within a six-month period; fainting, loss of consciousness, or seizure; or abnormal results from a test administered by a medical provider. Needs that result from a Pre-existing condition that existed prior to a Member’s Effective Date (known or producing observable symptoms) are only shareable if the condition appears to be fully cured and 12 months have passed without any symptoms (either benign or deleterious), treatment, or medication, even if the cause of the symptoms is unknown or misdiagnosed.

Primary Member

The person who initiated the membership by enrolling with and contributing to. All other Big Stuff Health Share.  Other persons joining under this Primary Member are considered Dependents.

Proration

If Shareable Eligible Medical Needs are ever significantly greater than the funds available for sharing in any given month, Big Stuff Health Share may pay a pro-rata portion of the Shareable amount based upon available funds and the Shareable amount of other Member’s Shareable Eligible Medical Needs.

Shareable Amount

The amount of the Need Request for a Shareable Eligible Medical Need that remains after the Member’s IUA has been satisfied by Member.

Sharing Summary

Correspondence that is delivered to the participating Members and their providers once medical needs have been processed, are pending, or have been rejected. The Sharing Summary will state the Member’s IUA as well as any amounts shared by the Benevolent Fund on the Member’s behalf.

Special Giving

Voluntary contributions by Members for the purpose of offsetting expenses for other Members’ Special Needs.

Special Needs

Medical needs that do not fall within the definition of Eligible Medical Needs but are not a violation of the Foundations of Membership or this Member Guide but are deemed Special Needs by Big Stuff Health Share.

UCR (Usual, Customary, And Reasonable) Costs

The average cost of medical services in a geographic area, as determined by Big Stuff Health Share, based on what providers in the area usually for the same or similar medical service.

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Are you ready to join?