How Pre-Existing Conditions Actually Work at EverTrust Health Share
One of the most important parts of your EverTrust membership is understanding how pre-existing conditions are handled.
This is an area where many members make assumptions, misunderstand timelines, or believe something will be shared when it will not. The goal of this blog is to clearly explain how EverTrust defines pre-existing conditions in the Membership Guidelines, what is eligible for sharing, what is not, and how the phase-in process works.
The most important thing to understand is this:
A condition being “pre-existing” does not automatically mean it is excluded from sharing forever. However, it does mean specific rules, timelines, and limits apply.
What EverTrust Considers Pre-Existing
A condition is considered pre-existing if, during the 12 months before your membership effective date, you:
- Experienced symptoms
- Received treatment
- Took medication
- Had testing performed
- Were monitored
- Saw a provider
- Were advised to seek treatment
- Or had knowledge of the condition
A formal diagnosis is not required.
This is extremely important because many members assume that if they were not officially diagnosed before joining, the condition will not be considered pre-existing. That is not always the case.
Example:
A member experiences recurring abdominal pain for several months before joining EverTrust but never completes testing. Four months after joining, they are diagnosed with gallstones and require surgery.
Because symptoms existed before membership began, the condition would likely be considered pre-existing.
The 60-Day Waiting Period
Certain conditions are not eligible for sharing if they occur during the first 60 days of membership.
These include:
- Gallbladder-related conditions
- Kidney stones
- Tumors
- Cancer diagnosis or staging
- Kidney disease
If one of these conditions presents during your first 60 days, related expenses are not eligible for sharing.
This applies even if the condition was unknown before joining.
Example:
A member joins EverTrust on January 1st. On February 15th, they experienced severe pain and were diagnosed with kidney stones requiring emergency treatment. Because the condition occurred within the first 60 days of membership, those expenses would not be eligible for sharing.
The timing of when the condition occurs matters just as much as whether symptoms existed beforehand.
Cancer Has Different Rules
Cancer-related conditions follow a longer lookback period than most other conditions.
If you had testing, treatment, medication, monitoring, referrals, abnormal findings, or symptoms related to cancer during the 36 months before your membership effective date, the condition will be considered pre-existing.
This includes:
- Suspicious imaging
- Biopsies
- Follow-up monitoring
- Oncology consultations
- Prior cancer treatment
- Medication related to cancer care
Members should never assume cancer-related treatment will qualify as a new condition simply because there was no recent active treatment.
Some Stable Conditions May Not Be Treated as Pre-Existing
EverTrust takes a more practical approach to common, stable conditions.
High blood pressure, high cholesterol, thyroid disorders, and Type 2 diabetes may not be treated as pre-existing if they have remained stable and have not required hospitalization during the 12 months prior to membership.
Stable generally means there has been no hospitalization, no major complications, and no significant escalation of treatment.
However, this does not mean every expense related to those conditions is automatically eligible for sharing. Eligibility still depends on the type of treatment being received and how it aligns with the Membership Guidelines.
How the Phase-In Process Works
EverTrust uses a structured phase-in system for eligible pre-existing conditions. This means sharing availability increases over time as you remain an active member of the community.
The current phase-in structure is:
| Membership Year | Maximum Sharing Per Condition |
| Year 1 | $5,000 |
| Year 2 | $30,000 |
| Year 3 | $75,000 |
| Year 4 | $150,000 |
| Year 5+ | No sharing limit |
The timeline applies separately to each condition, and once a condition begins its phase-in timeline, it does not reset as long as membership remains active and uninterrupted.
The following conditions are specifically treated as pre-existing for phase-in purposes:
Conditions Treated as Pre-Existing for Phase-In Purposes
| Arthritis, including degenerative disc disease | Allergy treatment & reversal (non-seasonal) | Cataracts |
| Chronic fatigue | Chronic pain | Diagnostic colonoscopy |
| Ear tubes | Gastroesophageal reflux disease | Injections and regenerative procedures from non-acute injury |
| Joint replacement (not applicable if acute injury) | Osteoporosis | Preventive mastectomy |
| Surgical repairs & revisions | Tonsil & adenoid removal (not applicable if life-threatening) | Varicose veins |
These conditions are automatically treated within the pre-existing phase-in structure when applicable under the Membership Guidelines.
What the Phase-In Looks Like in Real Life
Imagine a member joins EverTrust with a history of back problems that required treatment and physical therapy during the previous year. Because treatment occurred before membership began, the condition is considered pre-existing.
Two years later, the member requires a spinal procedure costing $40,000.
Under the Year 2 phase-in limit, up to $30,000 may be eligible for sharing, while the remaining $10,000 would remain the member’s responsibility.
If additional treatment is needed later, the available sharing amount continues increasing based on the phase-in schedule. By Year 5, the condition would no longer have a limit on sharing.
The condition itself does not become “new” simply because time has passed. The phase-in structure controls the maximum amount eligible for sharing.
What Is Not Eligible for Sharing
One of the biggest misunderstandings involves ongoing maintenance care.
The phase-in structure applies to new, acute, or corrective treatment related to a pre-existing condition. It does not generally apply to routine maintenance or long-term management.
Examples of expenses that are typically NOT eligible for sharing include:
- Maintenance medications
- Routine monitoring
- Long-term maintenance treatment
- Follow-up visits without acute changes
- Ongoing management of chronic stable conditions
For example, maintenance medications, routine follow-up visits, ongoing monitoring, glucose testing supplies, and long-term management of stable chronic conditions are generally not eligible for sharing.
If a member joins with pre-existing Type 2 diabetes, routine diabetic medications and maintenance care do not suddenly become eligible simply because the member progresses through the phase-in timeline.
However, a new acute complication related to the condition may qualify differently depending on the situation and the Membership Guidelines.
Conditions That May Never Qualify for Phase-In Sharing
Certain severe conditions may not qualify for pre-existing phase-in sharing at all.
These may include:
- Organ failure
- End-stage disease
- Advanced degenerative neurological conditions
- Permanent life-sustaining treatment needs
- Certain advanced cancer conditions
Members should never assume every condition will eventually become fully shareable. This is why it is important to review your specific situation before undergoing major treatment.
Why Members Need to Be Proactive
EverTrust is not traditional insurance.
Health sharing works best when members actively participate in healthcare decisions, understand the guidelines, and communicate early before treatment occurs.
One of the biggest mistakes members make is waiting until after care is received to ask whether something qualifies for sharing.
Members should review the Membership Guidelines carefully, contact the Advocacy Team before major procedures, and ask questions early whenever there is uncertainty.
Understanding timelines before scheduling treatment can prevent significant misunderstandings later.
The Role of the EverTrust Advocacy Team
One of the biggest differences at EverTrust is that members are not expected to navigate these situations alone.
The Advocacy Team helps members understand whether a condition may be considered pre-existing, review phase-in timelines, understand potential sharing limits, navigate treatment decisions, compare care options, and avoid unnecessary costs or confusion.
When members involve the Advocacy Team early, the experience is usually smoother.
The Bottom Line
Pre-existing conditions do not automatically exclude someone from EverTrust Health Share.
However, they do follow specific guidelines, timelines, and sharing limitations that members need to understand clearly.
If symptoms, treatment, testing, medication, or monitoring existed before membership began, the condition may still be considered pre-existing even without a formal diagnosis.
The most important thing members can do is avoid assumptions and ask questions early.
Health sharing works best when members stay informed, proactive, and engaged throughout the process.