CHM Plus is a program for medical bills exceeding the $125,000 per-illness sharing limit in our regular three programs.
A different way
to define healthcare
Essential terms for health cost sharing
As a health cost sharing ministry, not insurance, we don’t use insurance terms such as “coverage.”
We want to be clear about who we are and what we do, so we use specific words to help our members understand how CHM works.
- –CHM Plus
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). CHM sharing limits are determined by illness. Members can receive up to $125,000 per illness in the regular sharing program and up to $1 million or more per illness by participating in CHM Plus.
Example 1: Diabetes is an illness that can be treated at a maintenance level but can flare up and create an incident. The incident (medical bills related to the flare-up) has a definite start and end date; the illness can last a lifetime.
Example 2: Your knee hurts so you go to the doctor, who orders an MRI. After viewing your test results, he diagnoses you with arthritis. He gives you a cortisone shot and your knee soon feels better. The diagnosis of arthritis in your knee is an illness. The medical examinations, testing and treatment you undergo is an incident.
Two years later, your knee starts to hurt again. You return to the doctor, who says your arthritis has flared up. He gives you another cortisone shot. After two weeks, you go back because it still hurts. He tells you that you need a knee replacement and schedules the surgery. You undergo surgery and physical therapy. After a few months, he gives you a clean bill of health. This scenario describes a second incident within the illness of arthritis in your knee.
An incident includes medical treatment or testing that lasts until one of the following events occurs:
1) a certain medical condition is cured according to official medical records
2) treatment is at a routine maintenance level
3) you experience 90 days without any kind of treatment for that particular condition (testing or treatment must be an eligible expense at your chosen level of participation: CHM Gold, CHM Silver, or CHM Bronze)
The medical bills incurred from the first test to the last treatment before the doctor releases you to a regular, routine maintenance regimen are considered a single incident. If 90 days pass and you receive no further treatment, any future bills you incur will be considered a separate incident.
Example: You go to the doctor due to pain in your side. He examines you and gives you instructions before sending you home. The next week you return because the pain has continued. The doctor orders a blood test and an ultrasound. After reviewing the results, he diagnoses you with appendicitis and sends you to the hospital. He performs an appendectomy. The hospital releases you with instructions to visit the doctor’s office in one week for follow-up. At that visit, the doctor tells you to come back the following week, and he pronounces you cured. Medical bills you incur for each of these situations fall under the category of a single incident.
- –Lifetime maximum
Lifetime maximum is the total amount CHM will share through the regular sharing program. Members can receive up to $125,000 per eligible illness. Please see Guidelines for information on CHM Plus for additional sharing.
- –Personal Responsibility (PR)
Your Personal Responsibility (PR) is the amount that each membership unit is responsible to pay each year. It’s possible for this single amount to apply across multiple incidents. For example: a CHM Gold member submits an eligible $1,200 bill with $300 discount. This would mean the member pays the difference of $900 and that individual (or children unit) still has $100 left to fulfill their PR.
- –Pre-existing condition
The CHM Guidelines define a pre-existing condition as any medical condition for which you experience signs, symptoms, testing or treatment before joining Christian Healthcare Ministries. 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.
- –Qualifying Amount (QA) per Incident
Your qualifying amount (QA) is the amount each incident must total (before discounts) before medical bills can be considered for sharing.
CHM uses a unit system; a unit is defined as a participating individual(s) within a membership. Memberships can be individual or family.
A family membership can have up to three units: an individual, their spouse, and any dependent children. All dependent children are combined as a single unit (a child unit) as long as an adult is actively participating on the membership. Without an adult on the membership, two or more children must participate as two units. Individual units within the same membership may participate at different program levels.
More information about units can be found in the CHM Guidelines.