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PRE - MEMBERSHIP MEDICAL CONDITIONS

Written by Tikvah Health

Updated at November 19th, 2024

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Definition of a Pre-Membership Medical Condition Pre-Membership Medical Condition Phase-In Period Exceptions for High Blood Pressure, High Cholesterol, & Diabetes

To keep membership contributions low for all members, we implement a waiting period for sharing of medical conditions that existed prior to a member’s membership start date. We call such medical conditions: pre-membership medical conditions. This section defines pre- membership medical conditions and outlines related sharing limitations.

Definition of a Pre-Membership Medical Condition

A pre-membership medical condition is anything for which a member has

  • been examined,
  • been diagnosed,
  • taken medication,
  • had symptoms, or
  • received medical treatment

within the 24 months prior to their membership start date. Sharing requests related to pre- membership medical conditions are only shareable if the condition was regarded as cured and did not require treatment or present symptoms for 24 months prior to the membership start date.

Pre-Membership Medical Condition Phase-In Period

Pre-membership medical conditions have a phase-in period wherein sharing is limited. Starting from the membership start date, there is a one-year waiting period before pre- membership medical conditions are shareable. After the waiting period, the shareable amount increases with each membership year.

Shareable amounts for pre-membership medical conditions:

  • Year One: $0 (waiting period)
  • Year Two: $25,000 maximum per sharing request
  • Year Three: $50,000 maximum per sharing request
  • Year Four: $125,000 maximum per sharing request

After four years of membership, expenses related to pre-membership medical conditions will be shareable up to a maximum of $125,000 in a 12-month period. The shareable maximum resets each membership year.

Exceptions for High Blood Pressure, High Cholesterol, & Diabetes

High blood pressure, high cholesterol, and diabetes (types 1 and 2) are not considered pre- membership medical conditions as long as

  1. the member has not been hospitalized for the condition in the 12 months prior to joining, and
  2. the member is able to control the condition through medication or diet.
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