Understanding participation level differences

From the November 2019 issue of Heartfelt Magazine.

Are you participating at the right CHM membership level for your needs?

If the answer results in even a hint of hesitancy, then the answer may be no.

CHM’s participation levels provide different services, and it’s important for you to be certain that you’re at the right level for your individual or family needs.

Each participation level has $125,000 of sharing support for a medical diagnosis, but there are major differences between levels that might seem insignificant—until a medical event occurs.

If you’d prefer to spend no more than $500 out-of-pocket for a medical event, the Gold program is your best choice.

Also Read: CHM: Who it's for

This program is especially recommended for those with health issues or a family history of health issues, families considering having children, and people with pre-existing conditions that are being maintained (Editor’s note: Medical bills cannot be shared if, at the time you join CHM, you have experienced any signs or symptoms, or your bills are from pre-existing conditions that are actively undergoing treatment other than with maintenance [routine] medications).

Gold: The Gold program is CHM’s most recommended and extensive program. At this level, CHM shares 100 percent of bills for medical incidents exceeding $500 (when all other CHM Guidelines requirements are met), meaning that bills for an incident must exceed $500 to be eligible for sharing.

Example: Early in the year you experience pain in your lower abdomen, go to the emergency room and are treated for appendicitis. Your total bills are $6,000, and you receive $1,200 in discounts. CHM shares $4,800, which is 100 percent of the costs after discounts. A few months later you have a respiratory issue and visit your doctor. Your total bill is $75. CHM does not share this bill since it’s less than $500. Near year-end, you cut your hand and require stitches. Your total bills are $800; CHM shares the entire amount because the incident totals more than $500 and the treatment meets CHM Guidelines.

Under the Gold program, doctor’s office visits and prescriptions are shared when part of a medical event that exceeds $500. This is sharing which isn’t available for Silver and Bronze members.

Silver: At Silver, there is a $1,000 personal responsibility per incident, meaning you pay $1,000 or receive at least $1,000 on your eligible medical expenses before CHM shares your expenses. The Silver program only includes incidents that require hospital treatment.

Example: You break your leg and go to the emergency room. Your treatment totals $3,500; you receive $500 in discounts. After you pay the first $500 ($1,000 personal responsibility minus the $500 discount) CHM shares the remaining $2,500 because the treatment meets CHM Guidelines. Later that year you go to your doctor for a yearly checkup and he recommends a bloodwork panel. The cost is $550, and you receive a $250 discount. CHM does not share this incident because it is under the $1,000 personal responsibility amount and it occurs at a doctor’s office.

If you’re comfortable with being responsible for doctors’ visits of any kind, testing or treatment performed outside of a hospital, and the first $1,000 of your medical bills, the Silver program is a good option.

Bronze: At Bronze, there is a $5,000 personal responsibility per incident, meaning you pay $5,000 or receive at least $5,000 in discounts on your eligible medical expenses before CHM shares your expenses. The Bronze program only includes incidents that require hospital treatment.
Example: You have a heart attack and are treated at a hospital. Your total bills are $40,000 and you receive $16,000 in discounts. CHM shares the entire $24,000 ($40,000 minus $16,000). You require follow up visits to the doctor, an expense for which you’re responsible because office visits aren’t eligible for CHM sharing at the Bronze level.

If you’re willing to be responsible for all doctors’ visits, testing or treatment performed outside of a hospital, and the first $5,000 of your medical bills, the Bronze program is a good option.

Other notable facts:
  • All CHM programs are affordable (Gold level is $150 per month for individuals, capped at $450 for families of three or more).
  • With Brother’s Keeper participation, Gold members have no limit to medical sharing assistance, and Silver and Bronze receive $100,000 of health cost support annually, up to $1 million.
  • If you are a Silver or Bronze member and choose to switch to Gold after a medical incident occurs, your bills will be shared at the lower level.
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