Summit Healthshare — Plan 01 Detail Sheet
PLAN01

PLAN 01 :
Core Care

Plan 01 is Core Care on its own — major medical cost sharing for hospital, surgical, emergency, and maternity events.

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PLAN01
What's included:

Core Care

For major medical expenses

Hospital &
Surgical Care
Urgent Care
& E.R.
Follow-Up
Visits
Maternity
Care
  • Medical cost sharing with no overall annual or lifetime cap
  • Member Responsibility Amount (MRA) Reduction Program
  • Includes sharing for accidents, cancer, heart attacks, maternity, and more
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Core Care
Per event, not per year

Choose Your Member
Responsibility Amount (MRA)

The MRA is what you pay toward a single eligible event. Unlike a "deductible," it is not a yearly total you chip away at. Each Sharing Request carries its own — capped at two per household in any rolling 12 months.

You choose:

$1,500
$3,000
$6,000
◀ Lower out of pocket
Higher monthly contribution
Lower monthly contribution
More out of pocket ▶

Your MRA is what you pay. The community shares the rest.

What the MRA is

The Member Responsibility Amount is what you pay toward one eligible medical event before the health share community shares the rest. You choose $1,500, $3,000, or $6,000 when you enroll. The higher the MRA, the lower your monthly contribution.

One event, one MRAPer Sharing Request

A Sharing Request applies to one member and one incident. The MRA attaches to that request, not to your calendar year. A broken arm in March and gallbladder surgery in September are two separate events, and each carries its own MRA.

It does not accumulate

Because the MRA belongs to the event rather than the year, there is no running balance to track and no reset date to race. Two unrelated needs never merge into one total, and an event that closes in December has no bearing on one that opens in January. Once an event's MRA is met, eligible bills for that event are shared at 100% with no overall annual or lifetime cap.

A year of good health

If nothing happens, you never pay an MRA at all. There is no annual amount to satisfy and nothing lost by not reaching it.

Meeting your MRAWithin six months

Related medical expenses must reach your MRA within six months of the first date of service. The Sharing Request then stays open for the full medical event — but a six-month gap in related treatment closes it, and any later care starts a new Sharing Request with a new MRA.

Changing your MRA

You may change your MRA once per membership year, with a 60-day wait when lowering it, except for accidents.

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Core Care
The two-MRA safeguard

A hard stop at two MRAs,
per year, per household

Each household is responsible for no more than two MRAs in a rolling 12-month period. After that, additional eligible events over $1,000 are shared with no MRA at all. It’s how we help you control medical costs!

Rolling 12 months, counted from the first date of service of each Sharing Request

In the example below, the household chose a $1,500 MRA. The rolling 12 month period runs from March 2027 to March 2028 — it’s not a calendar year, Jan–Dec. Because the second Sharing Request came in June 2027, any further eligible events over $1,000 through March 2028 require no MRA.

01
First Sharing Request
March 2027

Dad, skiing accident

Total cost$10,000
You pay$1,500

Eligible bills above your MRA are shared at 100%.

02
Second Sharing Request
June 2027

Mom, torn rotator cuff

Total cost$12,500
You pay$1,500

Unrelated to the first, so it carries its own MRA. That is two.

03
Third Sharing Request
October 2027

Son, rock climbing accident

Total cost$9,000
You pay$0

The health share shares in additional eligible requests exceeding $1,000, with no further MRA.

2
Two exceptions. Sharing Requests related to pre-existing conditions and maternity Sharing Requests do not count toward the two-MRA calculation, and they are not eligible for the safeguard.
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Core Care
Meet your MRA first

Medical Costs Shared in Full
once your MRA is met

Eligible bills are shared in full after the Member Responsibility Amount, on a sharing request basis.

  • Hospitalization, in-patient
  • Emergency room for a medical emergency
  • Outpatient ambulatory surgery center
  • Doctor & specialist visits
  • Advanced imaging — MRI, CT, MRA, PET
  • Radiology
  • Chemotherapy & radiation
  • Oncology services
  • Ambulance, emergency use
  • Labor & delivery

Any provider · SharedCore Care has no network. See any doctor, hospital, or specialist you choose, present as a self-pay patient, and submit a Sharing Request. These bills are shared by the community once your MRA is met.

How it works

Using your membership

Choosing a provider

There is no network. Present as a self-pay patient at any provider you choose. The member is billed directly. Our member support team can also help you locate a provider if needed.

Reducing your MRAMRA Reduction Program

Your MRA may be reduced when you help keep costs down for the community — securing prepayment discounts, using fair-cost providers, traveling to a lower-cost facility, applying for self-pay assistance, or cooperating in provider negotiations. Reductions are discretionary and decided case by case.

Scheduled careReview required

Non-emergent surgery must be reviewed and approved before care to be eligible for sharing. Tell the Member Success Team as soon as surgery is recommended — they confirm eligibility, help obtain good-faith estimates, negotiate pricing, identify fair-cost providers, and facilitate prepayment. Expert second opinions are eligible for sharing. Emergency procedures need no prior review.

How you pay

Members present as self-pay patients and can receive a debit card by email to pay for services directly, or request a reimbursement after the fact.

PrescriptionsTied to a Sharing Request

Prescriptions related to the treatment of an approved Sharing Request are shared for up to 12 months or $125,000 per Sharing Request, whichever occurs first.

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Core Care
After the MRA is met

Services with a set sharing allowance

Most eligible care is shared at 100%. These specific services carry a maximum the community will share after your MRA is met.

Congenital disorderUnknown prior to joining
$125,000◆
Medically necessary hysterectomy
$45,000◆
Medically necessary mastectomy
$30,000◆
Emergency mental health
$10,000◆
Pain injections & regenerative procedures
$5,000
Home healthcare
$5,000
Recovery therapies & fusion therapies
$3,500
Medical supplies & DME
$3,000
Breast reduction surgery
$8,000◆
Alternative treatments
$2,500
Alternative testing to determine a diagnosis
$2,500
Allergy treatment
$2,000
Diagnostic colonoscopy
$2,000
Sleep apneaTreatment only; sleep studies are not eligible
$2,000
Orthotics
$1,000
Ambulance, non-emergency use
$1,000◆

◆ Once per membership lifetime. All other allowances apply per Sharing Request.

Recovery therapies — from a new injury or illness as an active member

$3,500 allowance
  • Physical therapy
  • Occupational therapy
  • Speech therapy
  • Chiropractic
  • Acupuncture
  • Craniosacral therapy
  • Hyperbaric chamber
  • Massage therapy
  • Ozone therapy
  • Dry needling
  • Prolotherapy
  • Infusion therapy

Only one recovery allowance applies per Sharing Request.

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Core Care
Growing families

Maternity Care

Waiting period

Conception occurring within the first 30 days of membership is not eligible. A pregnancy existing before membership is not eligible. Open the Maternity Sharing Request within 30 days of pregnancy confirmation.

Prenatal & postnatal services$6,000 allowance · +$1,000 if high-risk
  • Routine visits
  • Ultrasounds
  • Midwives
  • Doula supplies & services
  • Vitamins
  • Acupuncture
  • Chiropractic care
  • Pelvic floor services
  • Breast pumps
  • Counseling
  • Postpartum care
  • Routine lab work
  • STD & STI screenings
  • Gestational diabetes care & medications
  • Lactation consultant
  • Six-week postpartum visit
  • Two-week cesarean follow-up
DeliveryNo sharing limit

No sharing limits apply to medically necessary delivery services, including labor and delivery, cesarean, premature and multiple births, anesthesiology, home birth, maternal complications, maternal-fetal specialist consultations, and one in-hospital pediatric evaluation with routine newborn testing.

NICU

Sharing is available for up to 35 days.

Congenital conditions

$125,000 sharing allowance.

Diapers

A six-month supply of disposable diapers after delivery.

Newborn enrollmentWithin 30 days of birth

Add your newborn to the household membership within 30 days of birth. If the newborn is not enrolled within 30 days, any condition present at birth is treated as pre-existing.

$0 Delivery
Scenario
MRA reduction for maternity. If total maternity expenses do not exceed $10,000, your Member Responsibility Amount is reduced by $1,500. For example, at the $1,500 MRA level, total maternity costs under $10,000 earn the full $1,500 reduction — making the cost of delivery $0.
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Core Care
Eligibility

Understanding
Pre-Existing Conditions

A pre-existing limitation is applied based on the first date of active membership. A condition counts as pre-existing if, within the 12 months before membership, a person was examined, took medication, underwent monitoring, received treatment, or experienced recurring, persistent, or progressive symptoms — even without a formal diagnosis or medical evaluation.

Phase-in period — maximum shared per pre-existing condition, per membership year Membership year
$5,000
Yr 1
$30,000
Yr 2
$75,000
Yr 3
$150,000
Yr 4
No maximum
Yr 5+

Each amount is the most shared for that condition during that membership year, across all of its Sharing Requests. Unrelated pre-existing conditions each follow their own schedule.

Treated as pre-existing — phase-in applies

Phase-in
  • Arthritis, including degenerative disc disease
  • Allergy treatment & reversal (non-seasonal)
  • Cataracts
  • Chronic fatigue
  • Chronic pain
  • Diagnostic colonoscopy
  • Ear tubes
  • Gastroesophageal reflux disease
  • Injections & regenerative procedures from non-acute injury
  • Joint replacement (not if acute injury)
  • Osteoporosis
  • Preventive mastectomy
  • Surgical repairs & revisions
  • Tonsil & adenoid removal (not if life-threatening)
  • Varicose veins

What phases in is treatment of the condition itself. Ongoing management of it never does — see below.

Not treated as pre-existing

Exception

High blood pressure, high cholesterol, hyperthyroidism, hypothyroidism, and type 2 diabetes are exceptions. Each is treated as not pre-existing if the condition is controlled and the member has not been hospitalized for it in the 12 months before enrollment.

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Core Care
Eligibility

What is not shareable

Never eligible under the phase-in schedule

Not eligible
  • Cancer diagnosed, treated, under evaluation, referred to oncology, or symptomatic within 36 months prior to membership
  • Organ failure, end-stage organ disease, renal failure requiring dialysis, or ongoing renal replacement therapy
  • Advanced systemic or degenerative conditions involving irreversible organ damage, active major organ failure, or dependence on life-sustaining therapy

There is no sharing in the maintenance of a chronic or pre-existing condition, and routine care intended to monitor, manage, or maintain one is not eligible at any time, in any membership year.

Never eligible for sharing

Not eligible
  • Abortion
  • Adult immunizations
  • Alcohol or drug abuse treatment
  • Birth control
  • Breast implant removal
  • Cosmetic surgery
  • Diabetic medications & supplies
  • Elective procedures
  • Elective sterilization
  • Genetic screening for risk assessment
  • GLP-1 & semaglutides, including complications
  • Hearing aids
  • Infertility treatment
  • IVF & fertility treatments
  • Light therapies
  • Mental health, non-emergent
  • Organ donation expenses
  • Prophylactic medications
  • Routine dental
  • Seasonal allergies
  • Sleep studies
  • Surrogacy
  • TMJ therapeutics (non-surgical)
  • Non-emergency transportation to medical appointments
  • Vision hardware

First 60 days of membership

Waiting period

Not eligible if signs, symptoms, diagnosis, or treatment occur within the first 60 days of membership:

  • Gallbladder-related care
  • Kidney stones
  • Kidney disease
  • Cancer diagnosis or staging
  • Tumors, benign or malignant
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