How CHM shares pre-existing conditions

The CHM Guidelines define a pre-existing condition as any medical condition for which you experience signs, symptoms, testing or treatment before joining CHM, regardless of whether you've received a diagnosis. (Routine or maintenance medications are considered treatment.)

For example, if you have a stent that was inserted for a heart condition, the stent is considered treatment and your heart condition is pre-existing.

A condition is no longer considered pre-existing if you have experienced one year without signs, symptoms, or treatment; you're not on a maintenance medication regimen for that condition; and it's documented by your official medical records.

In contrast, cancer is no longer pre-existing if, after your doctor has pronounced you cancer-free or cured, you have gone five years without any signs, symptoms, testing or treatment (other than routine follow-up appointments).

Any medical bills considered for the ministry’s pre-existing condition programs must follow all other Guidelines for sharing eligibility. Also important is the distinction between active and maintained pre-existing conditions.

A condition is considered active and medical bills cannot be shared if, at the time you join CHM, you have experienced any signs or symptoms either before or after joining CHM (regardless of whether or not you've received a diagnosis), and your conditions actively need treatment (other than with maintenance [routine] medications). 

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, medical bills for any new incident (flare-up) related to the pre-existing 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 pre-existing condition: Suppose that Joe X, a Gold member, had a heart attack in October 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 February, 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 programs for pre-existing condition 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).

If you had any signs or symptoms before you joined the ministry—even if you haven’t had testing or treatment—your condition is considered pre-existing and will be evaluated according to whether it’s active or maintained (see the previous question for an explanation). Please note that CHM cannot share any bills incurred to joining the ministry.

If you change to a lower sharing level, eligible medical bills for your maintained pre-existing conditions will be shared at the lower level, regardless of when your medical bills were submitted or incurred.

If you change to a higher level, medical bills for any current conditions will be shared at the lower level for the lifetime of your membership. Exception: If you’re switching to Gold level, a current condition eventually may be considered for sharing at the Gold level once you are pronounced cured and one year free of signs, symptoms, and treatment (including medications). This applies regardless of whether medical bills have been previously submitted for sharing. Medical records may be requested.

New illnesses with signs, symptoms, testing, and treatment beginning after the higher level start date will be considered for sharing at the higher level.

CHM has two programs for pre-existing conditions. The Gold Schedule is only for Gold members. Bills incurred for maintained pre-existing conditions 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.

Your eligible medical expenses will be shared via the Prayer Page (see explanation below).

If you’re a Silver or Bronze member, your eligible medical bills for your maintained pre-existing conditions will be shared through CHM’s Prayer Page (see below).

The Prayer Page appears in CHM’s monthly Heartfelt Magazine. Readers voluntarily donate funds above their regular CHM monthly financial gift. One hundred percent of this extra giving goes to share Prayer Page needs. Members listed on the Prayer Page receive donations each month proportionate to their total of eligible medical expenses until their bills are shared in full, so long as they remain CHM members.

If a member joins CHM while she is pregnant, bills for that pregnancy cannot be shared through any of the CHM sharing programs, including the Gold Schedule or Prayer Page. Members must have a due date for delivery at least 300 days after joining the Gold program for maternity bills to be eligible for sharing. Additionally, any complications for an ineligible pregnancy cannot be shared through CHM.