Pre-existing conditions

This information also appears in CHM Guidelines Z and AA

Definition: A pre-existing condition is any medical condition for which you experience signs, symptoms, testing or treatment before joining Christian Healthcare Ministries (CHM), even if you have not been diagnosed.

Active vs. maintenance: We distinguish between pre-existing conditions in “active” treatment and “maintenance” treatment. Medical bills cannot be shared if, at the time you join CHM, the bills are for pre-existing conditions that are actively undergoing treatment other than with maintenance (routine) medications. After the incident is over and your doctor states that you are on a maintenance treatment regimen, bills for any new incident related to the pre-existing illness are eligible for sharing according to the information below.

Schedule: If these criteria are met, Gold level members can receive assistance with medical bills for pre-existing conditions according to the following schedule:

  • In the first year of participation, bills incurred for a pre-existing condition are eligible for sharing up to $15,000.
  • In the first two years of participation, 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 participation, 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 participation, the condition will no longer be considered pre-existing.

 

Prayer Page: Bills exceeding the three-year schedule listed above may be eligible to appear on the ministry’s Prayer Page printed in the monthly Heartfelt Magazine. All CHM members are invited and encouraged to give to Prayer Page needs (above regular monthly gifts) as they feel led. Members’ names, addresses, medical need explanation and gift updates are included on the page. Prayer Page contributions are tax-deductible, unlike CHM regular program monthly financial gifts. To learn more about the Prayer Page, call 1-800-791-6225 (ask for the Prayer Page) or send us a message.

Maternity: If a member joins CHM while she is pregnant, bills for that pregnancy cannot be shared through the regular CHM sharing program or through the Prayer Page. Members must have a due date for delivery at least 300 days after joining CHM for bills to be eligible for sharing. Please note: Our Gold program offers a generous maternity program. Silver and Bronze exclude most maternity costs. To learn more about maternity, visit our maternity page.

 

Frequently asked questions

What is a 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 the ministry.

Will my condition ever be considered not pre-existing?

A condition is not considered pre-existing if you have gone one year without signs, symptoms, testing or treatment for that condition and it is documented by your official medical records. Cancer: Cancer is no longer pre-existing if, after your doctor has pronounced you cancer-free or cured, and if your medical records show that you have gone five years without any signs, symptoms or treatment.

Why are some bills eligible for sharing through CHM’s pre-existing condition programs and others are not?

Any medical bills considered for the ministry’s pre-existing condition programs must follow all other Guidelines for sharing. For example, bills submitted to CHM more than six months from the date they were incurred aren’t eligible for sharing as per CHM Guideline J.3 (“What should I do with my medical bills?”). Also important is the distinction between active and maintenance pre-existing conditions. CHM cannot share bills if, at the time you join CHM, the bills are from pre-existing conditions for which you’re actively undergoing treatment other than with maintenance (routine) medications. What this means is described in the next several paragraphs.

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, bills for any new incident (flare-up) related to the preexisting 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 preexisting condition: Suppose that Joe X, a Gold member, had a heart attack in October 2016 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 Feb. 2017, 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 pre-existing condition programs 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).

 

What if I didn’t go to the doctor until after joining CHM or switching to a different program (Gold, Silver, or Bronze)?

If you had any signs or symptoms before you joined the ministry—even if you haven’t had testing or treatment—it is considered a pre-existing condition and will be evaluated according to whether it’s active or maintained (see above for an explanation). Please note that CHM cannot share any bills incurred before the date on which you joined the ministry. Silver or Bronze members who change to the Gold level will begin the CHM Gold schedule described below as though they are a new member. If a member changes to a lower sharing level, bills for their pre-existing condition will be shared at the lower level. If a member changes to a higher level, bills for an incident in active treatment cannot be shared at the higher level.

The CHM staff told me my bills will be shared via the Gold schedule. What does that mean?

CHM has two programs for pre-existing conditions and one of them, the Gold schedule, is only for Gold members. Bills incurred for a [non-active] pre-existing condition 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.
I have bills that exceed the eligible amount on the Gold schedule. What will happen to those expenses?

They will be shared via the Prayer Page (see explanation below).

I’m on the Silver [or Bronze] program and my bills aren’t eligible for the Gold schedule. Will I receive any help?

If you’re a Silver or Bronze member and you’re not in the middle of an active incident, your bills will be shared through CHM’s Prayer Page program (see below).

I have learned my bills will be shared via the Prayer Page. What is the Prayer Page and how does it work?

The Prayer Page appears in CHM’s monthly newsletter. Readers voluntarily donate funds above their regular CHM monthly financial gift; 100 percent of this extra giving goes to share Prayer Page needs. Members listed on the Prayer Page receive donations proportionate to their needs each month until their bills are shared in full, so long as they remain CHM members.

Is a pregnancy ever considered pre-existing?

If a member joins CHM while she is pregnant, bills for that pregnancy cannot be shared through the regular CHM sharing program, the Gold schedule or the Prayer Page. Members must have a due date for delivery at least 300 days after joining CHM for bills to be eligible for sharing.

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