Pre-Existing Conditions, Waiting Periods and Cancer
Pre-existing conditions are called the 24/24. These conditions have a 24-month lookback and 24-month waiting period. Pre-existing conditions are those illnesses that you have been seen, diagnosed or treated for within the past 24 months prior to your membership effective date.
Are Pre-Existing Conditions Eligible for Sharing?
Pre-existing conditions become eligible for sharing after a 24-month waiting period from the membership effective date. OneShare accepts all pre-existing conditions no matter the condition.
OneShare Health covers chronic maintenance for conditions including thyroid, high blood pressure, high cholesterol and diabetes. However, these conditions are only eligible for sharing for members who are enrolled in the Classic and Complete programs. During the 24 months, you can visit your PCP, Urgent Care, labs and specialists for any type of chronic maintenance. The only cost you will be required to pay during this time is the typical consultation fee for a visit.
In the Complete program, members who have a pre-existing condition and face a 24/24 limitation do not have to wait until the 24 months have elapsed to be covered. If you have the Complete Enhanced program, you can be eligible for a sharing of up to $10,000 after you double your ISA.
Those on the Complete Crown program may become eligible for a sharing of up to $20,000 after doubling their ISA. For members on the Complete Basic plan, the 24/24 pre-existing condition limitation will still hold.
Is Cancer Eligible for Sharing?
Recurring or pre-existing cancers are not eligible for sharing. If you have cancer or you have been treated for cancer and are going through checkups, OneShare may not be the right program for you. At the same time, it’s an excellent program for newly diagnosed cancers. For a member diagnosed with cancer to be eligible for sharing, the member must have been cancer-free for five years prior to the membership effective date.
For such cases, the lifetime maximum sharing for cancer is $500,000. While the maximum sharing for a member is $1 million, only $500,000 can go towards cancer treatment. When it comes to treatment, the ISA applies after which chemotherapy and radiation are eligible for sharing up to the maximum lifetime limit.
Is There a Waiting Period?
If a member has been newly diagnosed with a type of cancer they have not had five years prior to the effective date, a waiting period may apply depending on the program. Below are the OneShare waiting periods:
- Classic Program: Three-month waiting period
- Complete Program: No waiting period
- Catastrophic Program: No waiting period
Enroll in OneShare Today
Enroll in OneShare today to be part of a national healthcare cost-sharing community. Membership is just a phone call away or a few clicks away. Get in touch with Health for California at 1-707-571-7590 (Live Support), 1-877-752-4737 (Toll-Free) or visit our contact page for a fast, easy and accurate online application process.