Sharing Guidelines

1. Purpose and Scope

These Sharing Guidelines describe how medical needs are shared among Anglican Care Members. Anglican Care is a Health Care Sharing Ministry, not an insurance company. These guidelines do not create a contract, and no Member has a contractual right to receive payment for any medical expense. Sharing is voluntary and depends on the availability of shared funds.

2. Eligibility for Sharing

To be eligible for sharing, the following conditions must be met:

• The individual must be a current Anglican Care Member with contributions in good standing.
• The Member must have affirmed the Statement of Faith required for membership.
• The medical need must meet the criteria set forth in these guidelines.
• All required documentation must be submitted as described in Section 5.

3. Program Tiers and Sharing Limits

Anglican Care offers the following program tiers, each with different sharing limits:

• Foundational: Designed for individuals and families seeking essential sharing for routine and significant medical needs.
• Essential: Provides sharing for a broader range of medical needs with moderate sharing limits.
• Complete: Offers the most comprehensive sharing, including higher limits and broader eligibility.
• Senior Care: Designed for Members age 65 and older.
• Catastrophic Add-On: Available as an add-on to any program for additional protection against major medical events.

Specific Member Responsibility Amounts (MRA), annual sharing limits, and per-need limits for each tier are published on our Programs page. Members should review their program details for the applicable limits.

4. Pre-Existing Conditions

Medical needs related to pre-existing conditions are eligible for sharing after a Member has maintained continuous membership for 12 months. A pre-existing condition is defined as a condition for which a Member received medical advice, diagnosis, treatment, prescription medication, or experienced symptoms within the 12 months prior to joining Anglican Care.

After the 12-month waiting period, pre-existing conditions are shared on the same basis as all other medical needs, subject to the Member’s program tier and these guidelines.

5. Submitting a Medical Need

To submit a medical need for sharing, Members must provide:

• The completed online claim form, submitted through the Member Portal under the Medical Needs / Claims tab.
• An itemized bill from the healthcare provider.
• Any Explanation of Benefits (EOB) or similar documentation.
• The Member’s name, Member ID, and program tier.

Medical needs should be submitted online through the Member Portal, where documentation can be uploaded directly. Members without portal access may submit by email to needs@anglicancare.org or by mail to Anglican Care, Attn: Medical Need Processing. Members should submit medical needs within 90 days of receiving care.

6. Review and Processing

Submitted medical needs are reviewed to determine eligibility under these guidelines. The review process includes verifying membership status, confirming that the need meets the program criteria, and reviewing submitted documentation.

Anglican Care will process medical needs as promptly as practicable. We aim to communicate the status of a submitted need within 60 days of receiving all required documentation.

7. What Is Eligible for Sharing

Subject to program tier limits, the following types of medical needs may be eligible for sharing:

• Physician and specialist visits.
• Inpatient and outpatient hospital care.
• Surgical procedures.
• Emergency room visits.
• Diagnostic imaging and laboratory tests.
• Prescription medications related to a shared medical need.
• Telehealth services (available from day one).

8. What Is Not Eligible for Sharing

The following are generally not eligible for sharing:

• Medical needs arising before the Member’s effective date of membership.
• Pre-existing conditions during the 12-month waiting period.
• Cosmetic or elective procedures not medically necessary.
• Costs associated with unlawful activity.
• Experimental or investigational treatments not widely accepted by the medical community.
• Injuries sustained while engaged in illegal acts.

This list is not exhaustive. Final determination of eligibility is made in accordance with these guidelines and the Member’s program tier.

9. Member Responsibility Amount (MRA)

Each program tier has a Member Responsibility Amount that the Member is responsible for before sharing begins. The MRA is published on our Programs page. The MRA applies per medical need, not per year. Sharing applies to eligible needs that exceed the MRA, up to the program’s sharing limits.

10. Member Responsibilities

• Maintain monthly contributions in good standing.
• Submit medical needs promptly with all required documentation.
• Notify Anglican Care of any changes to personal, health, or financial information.
• Cooperate with the medical need review process.

11. Changes to These Guidelines

Anglican Care may revise these Sharing Guidelines at any time. Changes will be posted on this page with an updated effective date. Members are encouraged to review these guidelines periodically.

12. Contact

For questions about these Sharing Guidelines, contact members@anglicancare.org or visit our Contact page.

Anglican Care is a Health Care Sharing Ministry, not insurance. Participation is voluntary. Anglican Care does not guarantee that any medical need will be shared. Members do not have a contractual right to receive payment for any medical expense.