Don’t let medical issues—or facts and information about your CHM membership—catch you by surprise. Understanding CHM is essential for your health and your wallet. Let’s take a moment to refresh important CHM membership knowledge:
Personal Responsibility vs Qualifying Amount per Incident
Your program’s Qualifying Amount per Incident (QA) is the minimum amount the eligible medical bills in your medical incident must meet before medical bills can be submitted to CHM for sharing.
Each program has its own QA:
- CHM Gold: $1,250
- CHM Silver: $3,000
- CHM Bronze: $6,000
- CHM SeniorShareTM: $500
Personal Responsibility (PR) is the amount the member is responsible for paying directly to their provider. For medical incidents that reach your Qualifying Amount, you are responsible for the Personal Responsibility once a year, not for each medical incident.
With the exception of CHM SeniorShareTM, each program has its own Personal Responsibility:
- CHM Gold: $1,250
- CHM Silver: $3,000
- CHM Bronze: $6,000
- CHM SeniorShareTM: $0
Note: there is a separate maternity PR amount per maternity event. Click here for more information.
Illness vs. incident
An illness is a diagnosis of a disease, injury, or medical condition that has been identified and can be treated once or multiple times (multiple incidents). Members can receive up to $125,000 per illness. By participating in CHM Plus, members on CHM Silver and CHM Bronze can receive up to $1 million, and CHM Gold can receive unlimited sharing support for eligible medical expenses. Those with CHM SeniorShareTM have no lifetime sharing limits per illness.
An incident is a period of testing or treatment within an illness, and it lasts until one of the following occurs:
- There is a 90-day period without any eligible testing or treatment for the condition.
- The medical condition no longer requires treatment, as verified by official medical records.
- You experience 90 days without any kind of treatment for that particular condition.
- 12 months have passed since the onset of the incident.
If any of the above applies, any future treatment is considered a new incident, and your program’s QA and applicable PR need to be satisfied.
Sharing options for pre-existing conditions
A pre-existing condition is any medical condition for which a member experiences signs, symptoms, testing, or treatment (including routine and/ or maintenance medications) before joining CHM, regardless of whether the member has received a diagnosis.
CHM offers two sharing options for pre-existing conditions, but that condition must be considered maintained to qualify for sharing. For your condition to be considered maintained, it must meet the following criteria:
- Your medical records show that you are on a maintenance treatment regimen.
- Your medical provider states that no further testing or treatment is needed.
- At least 90 days have passed without undergoing testing or treatment.
Eligible medical expenses incurred during the first three years of membership that exceed the schedule limits for CHM Gold members will be shared through CHM Give. Additionally, CHM Silver and CHM Bronze members who participate in CHM Plus are eligible for CHM Give sharing. If your condition meets all three of the above, eligible charges will be shared on the maintained pre-existing sharing schedule and/or CHM Give.
Sharing schedule: CHM Gold members can receive assistance with medical bills for maintained pre-existing conditions according to the following schedule:
- In the first year of membership, bills incurred for a pre-existing condition are eligible for sharing up to $15,000.
- In the first two years of membership, bills incurred for a pre-existing condition are eligible for sharing up to $25,000 ($15,000 during the first year plus $10,000 during the second year).
- In the first three years of membership, bills incurred for a pre-existing condition are eligible for sharing up to $50,000 ($15,000 during the first year, plus $10,000 during the second year, plus $25,000 during the third year).
- After the third year of membership, the condition is no longer considered pre-existing.
CHM Give: Members listed on CHM Give 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. Members who indicate their bills are from preexisting conditions while submitting their medical bills through the Member Portal become participants of CHM Give for qualifying medical bills. All CHM members are invited and encouraged to give to medical bills listed on CHM Give (above regular monthly contributions) as they feel led. Members can donate to CHM Give here.
CHM Care Solutions
CHM created CHM Care Solutions to offer healthcare options that go above and beyond sharing healthcare expenses—we also want to support you in locating and receiving the best healthcare for your particular needs.
Virtual Care Solution: Powered through HealthTap, Virtual Care Solution offers all members access to primary and urgent care virtual visits with board-certified doctors. Members who register save money on visits that may otherwise not meet the QA and PR for your selected program.
Complete Surgical Care Solution: If you have a diagnosis and a surgery recommendation, our Complete Surgical Care team can help you navigate the process, quickly find high-quality providers, and save on your PR costs.
Cancer Care Solution: Cancer Care Solution offers a seamless experience for members facing a new or changing cancer diagnosis. From nurse navigators and second opinions to spiritual support, we can help provide clarity, compassion, and savings on your PR.
Maternity Care Solution: If your CHM start date is at least 300 days before your estimated delivery date, we want you to look into our Maternity Care Solution. Members who call within the first 16 weeks of pregnancy will save on their maternity PR costs.
Prescription Care Solution: We provide tips and resources to save money on prescriptions through CHM’s Prescription Care Solution.
Put your knowledge to the test
Take this short quiz to see how confident you are about your CHM membership.
