Understanding Personal Responsibility and Qualifying Amount
Your qualifying amount per incident (QA) is the amount each incident must total (before discounts) to be eligible for sharing. This amount does not change and applies to each incident individually.
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 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.
Gold program incident example:
You receive treatment early in the year for a gallbladder problem. Your bills total $7,500 and you receive $2,500 in healthcare provider discounts. After you pay your Personal Responsibility of $1,000, CHM shares $4,000 ($7,500-$3,500), 100% of the cost after paying your Personal Responsibility.
In the middle of the same year you have some blood tests done (for an unrelated illness) that cost $400. CHM does not share any of these bills because the total cost of the incident is less than your qualifying amount per incident of $1,000.
At the end of the year, you break your arm and the treatment amounts to $2,500. CHM shares the entire amount of $2,500 because the incident totals more than $1,000, you've paid your Personal Responsibility, and the treatment meets all other CHM Guidelines.