Sharing Guidelines

1. Overview

Pay It Forward Health operates as a health cost sharing ministry. Members voluntarily share each other's eligible medical expenses. These guidelines define what qualifies for sharing, how the process works, and member responsibilities.

These guidelines are essential reading for all members. Sharing is subject to available funds in the sharing pool and compliance with these guidelines. Pay It Forward Health is NOT insurance and does not guarantee payment of any medical expense.

2. Eligible Medical Needs

Eligible medical needs generally include:

• Hospital stays and inpatient care
• Emergency room visits for acute conditions
• Surgical procedures (inpatient and outpatient)
• Primary care and specialist physician visits
• Diagnostic tests (labs, imaging, etc.)
• Maternity care (subject to plan and waiting periods)
• Mental health counseling and therapy
• Prescription medications (subject to plan)
• Preventive care and wellness visits

Eligibility is determined on a case-by-case basis. All needs must be submitted with required documentation and meet the criteria outlined in these guidelines.

3. Ineligible Expenses

The following are generally NOT eligible for sharing:

• Expenses incurred before membership effective date
• Pre-existing conditions (subject to waiting period)
• Expenses below the Initial Unshareable Amount (IUA)
• Cosmetic or elective procedures not medically necessary
• Experimental or investigational treatments
• Substance abuse treatment (unless specified in plan)
• Dental and vision (unless included in plan)
• Expenses from providers outside our network (where applicable)
• Intentional self-injury or injuries from illegal activity

This list is not exhaustive. Members should contact us with questions about specific situations before incurring expenses.

4. Initial Unshareable Amount (IUA)

The Initial Unshareable Amount (IUA) is the amount each household is responsible for before sharing begins for a given need. Think of it similarly to a deductible. The IUA varies by plan level:

• Essential: $500 per incident
• Premium: $300 per incident
• Complete: $150 per incident

Multiple related expenses for the same medical incident may be combined toward the IUA. Once the IUA is met, eligible amounts above that threshold may be submitted for sharing. The IUA applies per incident, not per year.

5. Pre-Existing Conditions

Pre-existing conditions are medical conditions for which you received diagnosis or treatment in the 24 months prior to membership. There is typically a waiting period before pre-existing conditions become eligible for sharing:

• Most pre-existing conditions: 24-month waiting period
• Certain conditions may have longer or different waiting periods
• Routine care for pre-existing conditions may be eligible sooner

Members with pre-existing conditions should review their enrollment materials and contact us for specific guidance. We are committed to transparency about what is and is not covered.

6. Submission Process

To submit a medical need for sharing:

1. Obtain care from a qualified healthcare provider
2. Pay your provider or arrange for itemized billing
3. Submit the need through the member portal with required documentation
4. Include itemized bills, proof of payment, and any requested medical records
5. Our team will review for eligibility and process accordingly

Needs should be submitted within 6 months of the date of service. Incomplete submissions may delay processing. We aim to process eligible needs within 48–72 hours of receiving complete documentation.

7. Sharing Limits

Sharing is subject to per-incident and annual limits based on your plan. Limits are designed to ensure the long-term sustainability of our sharing community while providing meaningful support for members.

• Per-incident limits vary by plan (Essential, Premium, Complete)
• Annual sharing limits apply per household
• Lifetime maximums may apply for certain plan levels
• Sharing depends on available funds in the pool

Specific limit amounts are provided in your plan documents. We encourage members to review their plan details and contact us with questions.

8. Member Responsibilities

Members are responsible for:

• Paying monthly contributions on time
• Submitting needs with complete, accurate documentation
• Negotiating with providers for fair pricing (we encourage price transparency)
• Maintaining a healthy lifestyle in accordance with our community values
• Communicating honestly with our team about your needs
• Understanding that sharing is voluntary and not guaranteed
• Reviewing and complying with these guidelines and your plan terms

Fraudulent submissions or misrepresentation may result in termination of membership and potential legal action. We rely on the integrity of our members to maintain a sustainable sharing community.