How EverTrust Sharing Works: A Step-by-Step Guide
Health sharing works differently than traditional insurance, so it helps to understand the process before you need to use it. At EverTrust Health Share, members participate in a cooperative community that shares eligible medical expenses in accordance with clear Member Guidelines. While the structure is different from insurance, the process itself is straightforward once you know what to expect.
How the Community Works
Members contribute monthly to the EverTrust community. These contributions are not premiums, but rather part of a shared pool used to help members with eligible medical expenses. When a medical expense arises, members do not file a claim like they would with insurance. Instead, they submit a Sharing Request, which begins the process of determining whether those expenses are eligible to be shared by the community. This model is built on participation and transparency. Members take an active role in how care is accessed, how costs are managed, and how expenses are submitted for sharing.
Start Early: Submitting a Sharing Request
The process begins when you submit a Sharing Request. This should be done as soon as you know you have a medical occurrence, whether it is related to an illness, injury, emergency visit, or planned procedure. You do not need to wait for every bill to arrive before getting started. Submitting early helps create a clear starting point, keeps everything organized, and allows the EverTrust Advocacy Team to support you throughout the process. For planned care, it also creates an opportunity to review pricing, request estimates, and make more informed decisions before receiving treatment.
Receiving Care and Presenting as Self-Pay
When you receive care, you will present as a self-pay patient. This is an important part of how health sharing works. Presenting as self-pay often leads to more transparent pricing and may open the door to discounts, bundled pricing, or other cost-saving options that are not typically available through insurance billing. In an emergency, your priority is to receive care immediately. Once the situation is stable, you can communicate that you are self-pay and begin organizing your documentation.
Meeting Your Member Responsibility Amount
Your Member Responsibility Amount, or MRA, is the portion of your medical expenses that you are responsible for before eligible costs may be shared by the community. You will pay providers directly toward your MRA and keep clear records of those payments. Receipts and itemized bills are important, as they will need to be submitted as part of your Sharing Request. Once your MRA has been met, eligible expenses beyond that amount may be considered for sharing.
Submitting Documentation
As bills and records become available, you will upload them to EverTrust to be attached to your Sharing Request. This typically includes itemized bills, receipts showing payments made, and medical records. Medical records are especially important because they provide the clinical detail needed to review the request accurately under the Member Guidelines. In most cases, the fastest way to obtain records is through your provider’s patient portal or by requesting them directly from the provider’s office.
The Determination Process
Once your documentation has been submitted, EverTrust begins the determination process. During this step, the request is reviewed to confirm that the medical expenses are eligible, that the expenses are related to the sharing request, and that all requirements under the Member Guidelines have been met. This includes confirming that your MRA has been satisfied and reviewing any applicable limitations. If additional information is needed, you will be contacted so the request can continue moving forward without unnecessary delays.
Approval and Sharing
After the review is complete and the Sharing Request is approved, eligible expenses move into sharing.
At this point, your MRA has been met, and the remaining eligible costs are prepared to be shared by the community. This is where the cooperative model becomes most visible, as members support one another by sharing in approved medical expenses.
Payment and Reimbursement
Depending on the situation, payment may be handled in different ways. If you have already paid expenses beyond your MRA, you may be eligible for reimbursement. In other cases, funds may be sent to you to pay your provider directly with a virtual card. Payment may be issued directly to your provider by EverTrust if a guest payment is available on your provider’s portal. Payment will be made based on what is most appropriate for the situation.
Example of the Sharing Process: An Emergency Room Visit
To make this more practical, it helps to see how the process works in a real situation.
A member experiences severe abdominal pain and goes to the emergency room. They receive care immediately and present as a self-pay patient. Within a few days, they submit a Sharing Request and begin organizing their documentation. Over the next few weeks, they receive multiple bills from the hospital, physician, and any related services such as labs or imaging. The initial total billed charges come in at approximately $12,000.
Because the member presented as self-pay, the billing process looks different than it would under insurance. The member receives a self-pay discount and the itemized statement to review the charges. In many cases, hospitals offer reduced rates for self-pay patients, prompt-pay discounts, or self-pay assistance programs. The member also reviews pricing using tools like Fair Health Consumer to understand typical costs in their area.
After adjustments and discounts are applied, the total cost is reduced from $12,000 to approximately $7,500. As bills are received, the member uploads itemized statements and receipts to EverTrust. They also request medical records through the hospital’s patient portal to support the determination process. The member then pays their Member Responsibility Amount (MRA) of $2,000 directly to the provider and submits proof of payment.
Once the MRA is met and all documentation has been submitted, EverTrust reviews the request. After approval, the remaining $5,500 in eligible expenses is shared by the community. At that point, payment is issued according to the situation, and the Sharing Request is completed.
What Makes the Process Work
Health sharing is designed to be simple, but it does require participation. The process works best when members stay engaged, submit information as it becomes available, and respond to documentation requests promptly. Starting early, keeping records organized, and understanding each step helps to create a smoother experience from beginning to end. Support is available throughout the process, but the most successful experiences happen when members and the EverTrust team work together.
Final Thought
EverTrust Health Share is built around a cooperative model, where members take an active role in how healthcare is accessed and managed. When you understand the process and stay engaged, it becomes much easier to navigate. Submitting your request early, presenting as self-pay, keeping documentation organized, and following through on each step helps ensure that the sharing process moves forward as smoothly as possible.