Frequently asked questions about pre-existing conditions

From the October 2018 issue of Heartfelt Magazine.

The CHM staff is often asked how the ministry handles medical bills for preexisting conditions. If you’ve wondered how this works, this list of questions and answers will be helpful. If you need more information, see CHM Guidelines Z and AA or call 800-791- 6225, ext. 5993.

“What is a pre-existing condition?” The CHM Guidelines (chministries.org/guidelines) define a pre-existing condition as any medical condition for which you experience signs, symptoms, testing or treatment before joining the ministry. (Routine or maintenance medications are considered treatment.)

“Will my condition ever be considered not pre-existing?” A condition is not considered pre-existing if you have gone one year without signs, symptoms, testing or treatment (including no maintenance medication) for that condition and it is documented by your official medical records.

Cancer: Cancer is no longer pre-existing if, after your doctor has pronounced you cancer-free or cured, and if your medical records show that you have gone five years without any signs, symptoms, testing or treatment.

“Why are some bills eligible for sharing through CHM’s pre-existing condition programs and others are not?” Any medical bills considered for the ministry’s pre-existing condition programs must follow all other Guidelines for sharing. For example, bills submitted to CHM more than six months from the date they were incurred aren’t eligible for sharing as per CHM Guideline J.3 (“What should I do with my medical bills?”).

Also important is the distinction between active and maintenance pre-existing conditions. CHM cannot share bills if, at the time you join CHM, the bills are from pre-existing conditions for which you’re actively undergoing treatment other than with maintenance (routine) medications. What this means is described in the next several paragraphs.

If you have gone at least 90 days without testing or treatment and your doctor states you are cured or on a maintenance treatment regimen, bills for any new incident (flare-up) related to the preexisting illness are eligible for sharing on the Gold schedule (Gold members) or Prayer Page (Gold, Silver and Bronze members).

Here’s an example of the difference between an active and maintained preexisting condition: Suppose that Joe X, a Gold member, had a heart attack in Oct. 2017 and joined CHM two months later (December). During that time he had surgery and a few follow-up appointments with his cardiologist, one of which took place after Joe joined the ministry.

According to CHM’s definition of a medical incident, Joe is in the middle of an active pre-existing incident because he hasn’t been declared cured, put on maintenance medication or gone 90 days without treatment of his condition.

In Feb. 2018, Joe had an appointment with his cardiologist at which time his doctor said he didn’t need to be seen again for six months. Joe’s treatment plan specified that aspirin is the only medication he needs to take regularly. However, Joe suffered a second heart attack in June. Medical bills related to the second attack are eligible for sharing through CHM’s pre-existing condition programs because it’s a new medical incident—he has taken only routine medication and it has been over 90 days since he last received treatment (doctor’s office visit in February).

“What if I didn’t go to the doctor until after joining CHM or switching to a different program (Gold, Silver, or Bronze)?” If you had any signs or symptoms before you joined the ministry—even if you haven’t sought treatment—it is considered a pre-existing condition and will be evaluated according to whether it’s active or maintained. We may request your official medical records. Please note that CHM cannot share any bills incurred before the date on which you joined the ministry.

Silver or Bronze members who change to the Gold level will begin the CHM Gold schedule described below as though they are a new member. If a member changes to a lower sharing level, bills for their pre-existing condition will be shared at the lower level. If a member changes to a higher level, bills for an incident in active treatment cannot be shared at the higher level.

“The CHM staff told me my bills will be shared via the Gold schedule. What does that mean?” CHM has two programs for pre-existing conditions and one of them, the Gold schedule, is only for Gold members. Bills incurred for a (non-active) pre-existing condition are eligible as follows:

  • In the first year of CHM membership, up to $15,000 can be shared.
  • In the second year an additional $10,000 can be shared.
  • In the third year, another $25,000 can be shared, bringing the three-year total to $50,000.
  • After the third year, the condition is no longer considered pre-existing.

“I have bills that exceed the eligible amount on the Gold schedule. What will happen to those expenses?” They will be shared via the Prayer Page (see explanation below).

“I’m on the Silver [or Bronze] program and my bills aren’t eligible for the Gold schedule. Will I receive any help?” If you’re a Silver or Bronze member and you’re not in the middle of an active incident, your bills will be shared through CHM’s Prayer Page program (see below).

“I have learned my bills will be shared via the Prayer Page. What is the Prayer Page and how does it work?” The Prayer Page appears in each monthly issue of Heartfelt Magazine. Readers voluntarily donate funds above their regular CHM monthly financial gift; 100 percent of this extra giving goes to members in need.

Members listed on the Prayer Page receive donations proportionate to their needs each month until their bills are shared in full. (Editor’s note: According to CHM Guidelines, your membership must be continuous until bills are shared or they will be marked ineligible for sharing. This Guideline also applies to bills for pre-existing conditions.)

The Prayer Page is effective; members received over $4.7 million toward Prayer Page needs in 2017 and to date have received over $4.3 million in 2018.

“Can a pregnancy be considered pre-existing?” If a member joins CHM while she is pregnant, bills for that pregnancy cannot be shared through the regular CHM sharing program, the Gold schedule or the Prayer Page. Members must have a due date for delivery at least 300 days after joining CHM for bills to be eligible for sharing.

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