How our community works together.

EverTrust Health Share is a voluntary medical cost-sharing community designed for individuals and families who take responsibility for their health and value stewardship, accountability, and mutual support.

Our community exists for members who pursue balanced lifestyles, make thoughtful healthcare decisions, and are committed to working together to keep medical costs fair and reasonable. EverTrust encourages proactive health practices, transparent pricing, and cooperative engagement with providers to sustain the integrity of the community.

EverTrust is not insurance. It does not assume financial risk or guarantee payment of medical expenses. Sharing occurs voluntarily among members in accordance with these Guidelines.

Each member affirms the following:

• I believe a community of ethical, health-conscious individuals can most effectively care for one another by directly sharing healthcare expenses.
• I recognize that EverTrust Health Share affiliates and considers itself accountable to a higher power. I welcome members of all faiths.
• I understand that EverTrust is a benevolent organization, not insurance, and cannot guarantee payment of medical expenses.
• I agree to practice responsible health measures and strive for a balanced lifestyle.
• I am obligated to care for my family and treat others with dignity and respect.
• I agree to work with EverTrust to utilize fair-cost healthcare services when appropriate.
• I agree to mediation and binding arbitration to resolve disputes.

To be eligible, members must:

1. Adhere to the Principles of Membership
2. Submit monthly contributions
3. Reside in the United States and states where EverTrust is available
4. Be under age 65

Membership terminates on the first day of the month in which a member turns 65 and becomes eligible for Medicare.

Sharing Requests must be submitted within 30 days of that termination date.

Membership pricing is determined by household size, tobacco usage, and selected Member Responsibility Amount (MRA).

Dependent children must be unmarried and under age 26. An adopted child cannot be added to membership before birth, and the newborn's membership start date can be no sooner than seven days after delivery.

Households with one or more tobacco users must pay a $100 monthly surcharge.

Failure to report tobacco use results in:

• A one-time $500 household fee
• All open Sharing Requests paused until paid in full
• Tobacco surcharge applied beginning next billing cycle

The tobacco surcharge does not apply to dependent children.

Tobacco use is considered one or more members within a household, who has used any tobacco product one or more times per month is considered a tobacco user. Tobacco products include, but are not limited to, cigarettes, cigars, chewing tobacco, snuff, pipe tobacco, and inhaled products through vape, hookah, and similar delivery devices.

Membership is active when monthly contributions are paid on time and the member remains in good standing.

For a Sharing Request to be eligible, membership must be active at:

• The date(s) of service
• The date medical bills are received by EverTrust
• The date medical records are received by EverTrust
• The date proof of MRA payment is received by EverTrust
• The date a formal Sharing Request has been submitted to EverTrust

The request must include the reason for cancellation and the month in which the membership cancellation is to be effective. The member must provide notice 14 days before the due date. EverTrust does not prorate cancellations or gift refunds. Cancellation requests become effective the day before the due date.

The Member Responsibility Amount (MRA) is the amount a member must pay before eligible medical expenses become eligible for sharing.

There is no annual or lifetime maximum for eligible Sharing Requests. However, certain services are subject to defined sharing allowances outlined in these Guidelines.

Members may change their MRA once per membership year. If lowering the MRA, a 60-day waiting period applies except for accidents.

The MRA may be reduced when a member:

• Secures prepayment discounts
• Uses fair-cost providers
• Travels to lower-cost facilities
• Applies for self-pay assistance
• Cooperates in provider negotiations

Reductions are discretionary and determined on a case-by-case basis.

A Sharing Request is submitted by members on a per-member, per-incident basis. Each Sharing Request is the sum of related eligible medical expenses incurred by receiving medically necessary treatment from licensed medical professionals and facilities, such as physicians, emergency rooms, and hospital facilities.

To establish eligibility, related medical expenses must accumulate to the Member Responsibility Amount (MRA) within six months of the initial date of service.

Once the MRA has been met, the Sharing Request remains open for the duration of the medical event, provided there is no six-month consecutive gap in related treatment or expenses.

Sharing Requests must be submitted to EverTrust as soon as reasonably possible.

Required documentation for a Sharing Request includes, but is not limited to:

• Original, itemized medical bills
• Provider clinical notes supporting medical necessity
• Proof of payment applied toward the Member Responsibility Amount (MRA)

EverTrust reserves the right to request additional documentation necessary to determine eligibility. Incomplete documentation may delay review or result in limitation of sharing.

A determination is the formal review process conducted by EverTrust to evaluate eligibility under these Member Guidelines.

All documents submitted by the member or on the member's behalf will be reviewed for compliance with eligibility requirements, applicable limitations, pre-existing criteria, and sharing allowances.

Eligibility determinations are made solely in accordance with the Member Guidelines.

Certain services are subject to defined sharing allowances once the Member Responsibility Amount (MRA) has been satisfied. A sharing allowance is the maximum amount eligible to be shared for a specific service under a Sharing Request.

Allowances may apply:

• Per Sharing Request
• Once per membership lifetime

All applicable allowances are outlined in these Member Guidelines. Sharing is limited to the specified allowance amount for eligible accrued medical expenses. Amounts exceeding the allowance are not eligible for sharing but may be applied toward satisfaction of the MRA where applicable.

Prior medical review and approval is required for non-emergent surgical procedures to be eligible for sharing.

Members must notify EverTrust as soon as surgery is recommended. This allows the Member Success Team to:

• Confirm eligibility
• Assist in obtaining good-faith cost estimates
• Assist with pricing negotiations
• Help identify fair-cost providers
• Help facilitate prepayment

Expert second opinions associated with a recommended surgical procedure are eligible for sharing. The EverTrust community encourages members to obtain expert second opinions prior to surgery and will assist in facilitating those consultations when requested.

Members should attempt to work with surgery centers and outpatient facilities whenever possible to avoid inflated hospital-based charges.

Emergency surgical procedures are not subject to prior review.

Each household is responsible for no more than two MRAs within a rolling 12-month period beginning on the first date of service for each Sharing Request.

After two MRAs have been met within that 12-month period, EverTrust will share additional eligible Sharing Requests exceeding $1,000 without requiring an additional MRA.

The following Sharing Requests do not count toward the two-MRA safeguard calculation and are not eligible to benefit from the safeguard:

• Sharing Requests related to pre-existing conditions
• Maternity Sharing Requests

These categories neither trigger nor benefit from the safeguard limit.

A condition is considered pre-existing if, within twelve months prior to membership, the member:

• Was examined
• Taken medication
• Received treatment
• Underwent monitoring
• Experienced recurring, persistent, or progressive symptoms

A condition may be deemed pre-existing even in the absence of a formal diagnosis or medical evaluation.

The following are not eligible if signs, symptoms, diagnosis, or treatment occur within the first 90 days of membership:

• Gallbladder-related care
• Kidney stones
• Cancer Diagnosis or Staging
• Tumors, benign or malignant
• Kidney Disease

Pre-existing for Cancer

Any testing, treatment, prophylactic intervention, oncology referral, or cancer-related medication within 36 months prior to membership will cause any recurrence or related cancer to be treated as pre-existing.

Exceptions That Are Not Considered Pre-existing

High blood pressure, high cholesterol, hyperthyroidism, hypothyroidism, and type 2 diabetes will not be considered pre-existing conditions if it's controlled, and the member has not been hospitalized for the condition 12 months before enrollment.

Sharing Requests related to a pre-existing condition are subject to the following sharing limits based on a member's years of participation. The limits apply per pre-existing condition and do not reset for that condition in future membership years.

If a member has more than one unrelated pre-existing condition, the phase-in schedule applies separately to each condition.

Preventive & Genetic Testing

Preventive screening, genetic testing, or diagnostic testing performed solely to evaluate health risks, genetic predisposition, or family history does not constitute a pre-existing condition unless an active disease requiring treatment is identified.

Testing or tests resulting in high risk alone do not create a pre-existing condition.

Conditions Not Eligible for Phase-In Sharing

If a condition meets the pre-existing definition and involves any of the following, it is not eligible for sharing under the phase-in schedule at any time:

• Cancer diagnosed, treated, under evaluation, referred to oncology, or symptomatic within thirty-six months prior to membership
• Organ failure, end-stage organ disease, renal failure requiring dialysis, or ongoing renal replacement therapy
• Advanced systemic or degenerative conditions involving irreversible organ damage, active major organ failure, or dependence on life-sustaining therapy

Maintenance and Ongoing Management of Pre-Existing Conditions

EverTrust does not share in the maintenance or ongoing management of pre-existing conditions. This includes any care, testing, imaging, treatment, or medication received solely due to a condition that existed prior to membership.

The pre-existing condition phase-in applies only to new, acute, or corrective treatment related to a pre-existing condition. Routine or maintenance care intended to monitor, manage, or maintain a chronic or pre-existing condition is not eligible for sharing at any time.

Examples of non-shareable expenses include:

• Routine MRIs, CT scans, or laboratory testing ordered solely to monitor a known condition
• Follow-up or specialist visits for continued condition management
• Maintenance or preventive medications for a condition existing prior to membership
• Diagnostic mammograms or colonoscopies for high-risk status or prior symptoms.

The following healthcare services and expenses are not eligible for sharing under a Sharing Request subject to the Member Responsibility Amount (MRA).

Some services listed below may qualify under a Preventive Sharing Request if specifically included in a member's preventive benefits. Members should refer to their preventive services guide for details.

The following are not eligible for MRA-based sharing:

Contraception

Contraceptive services are eligible only when required to treat an approved Sharing Request. Elective contraceptive use is not eligible.

Dental

Routine dental services are not eligible for sharing. This includes caps, crowns, root canals, fillings, wisdom tooth extractions, anesthesia, sedation, and cleanings. Dental treatment required as the direct result of an approved accident or injury may be eligible.

Preventive & Genetic Screening

Genetic screening and testing are eligible only when required to treat an approved Sharing Request. Screening performed solely for risk assessment or preventive evaluation does not qualify for MRA-based sharing.

Medical Non-Compliance

Failure or refusal to comply with a licensed provider's treatment plan, or leaving a medical facility against medical advice (AMA), may result in ineligibility of the Sharing Request and any related complications.

Mental Health (Non-Emergent)

Diagnosis, treatment, therapy, and medications related to mental health conditions are not eligible for MRA-based sharing. This includes, but is not limited to:

• ADHD
• Anxiety
• Panic disorders
• Insomnia
• Stress-related conditions
• Bipolar disorder
• Depression
• OCD
• PTSD
• Schizophrenia
• Eating disorders

Emergency mental health evaluations and related emergency room expenses are eligible under the Specific Sharing Allowances section and are limited to the defined per-membership lifetime allowance.

Sterilization

Elective sterilization procedures, including but not limited to tubal ligation, vasectomy, and preventive hysterectomy, are not eligible for sharing.

Vision

Vision-related hardware expenses, including glasses and contact lenses, are not eligible for sharing.

Conditions Treated as Pre-Existing for Phase-In Purposes

For certain services, EverTrust offers a sharing allowance. A sharing allowance is the maximum amount that may be shared after the MRA has been met. If total costs exceed the allowance, excess may still count toward the MRA.

Allowance Definitions

Category A – Per Sharing Request: The allowance applies to each separate Sharing Request. If a member experiences different medical events that require separate Sharing Requests, the allowance may apply to each eligible request.

Category B – One-Time Per Membership Lifetime: The allowance may be used only once during the lifetime of the membership, regardless of how many Sharing Requests are submitted or which family member receives the service.

Recovery Therapies & Fusion Therapies are subject to the applicable sharing allowance outlined in the Specific Sharing Allowances section.

Eligible recovery services must be related to an injury or illness sustained while an active member.

Only one recovery allowance applies per Sharing Request.

Eligible services may include:

Additional therapy for severe medical events such as stroke, heart attack, cancer, or other debilitating conditions may be reviewed on a case-by-case basis.

Injections and regenerative procedures are subject to the sharing allowance.

Eligible services may include:

• Stem cell injections
• Platelet-rich plasma (PRP) therapy
• Epidural steroid injections not related to maternity
• Nerve blocks
• Trigger point injections
• Joint block injections
• Other regenerative therapies

Alternative treatment and alternative diagnostic testing are eligible under their respective sharing allowances.

For alternative treatment requests, members must submit:

• Medical notes from the prescribing provider
• Estimated costs and available discounts
• Explanation from a licensed medical provider supporting the treatment selection

If a member chooses an alternative treatment and later returns to conventional care, sharing may be limited based on expenses already shared toward the alternative treatment.

Preventive services performed by alternative providers may not require prior approval.

Specific Sharing Requests require additional information due to a limitation or a specifically defined description.

Acute Allergic Reactions

Each acute allergic reaction is treated as a separate medical event and requires submission of a separate Sharing Request with its own Member Responsibility Amount (MRA).

Acute allergic reactions, including food allergies and similar sudden reactions, are not considered pre-existing conditions, even if a member has experienced prior unrelated allergic episodes.

Asthma

Routine treatment and maintenance medications for asthma are not eligible for sharing. An acute asthma attack resulting in an emergency room visit may be eligible as a separate Sharing Request. Each qualifying emergency event requires a separate MRA.

End-of-Life Assistance

If a member or an eligible dependent passes away after maintaining at least one full year of active membership, EverTrust will provide financial assistance to the surviving household upon receipt of a certified copy of the death certificate.

Assistance will be distributed as follows:

• $10,000 upon the death of a primary member
• $10,000 upon the death of a dependent spouse
• $5,000 upon the death of a dependent child

Membership must be active and in good standing at the time of death for this assistance to apply.

Cosmetic Surgery

Cosmetic procedures are not eligible for sharing unless required due to disfigurement resulting from an approved Sharing Request.

Genetic Testing (Treatment-Based)

Genetic testing is eligible only when required to treat an approved Sharing Request. Testing performed solely for screening or risk evaluation falls under Preventive & Genetic Testing guidelines.

International Medical

Emergency and acute medical care received outside the United States may be eligible for sharing. Members may seek medically necessary procedures internationally if the cost is lower than comparable treatment in the United States.

Long-Term Care & Skilled Nursing

Long-term care and skilled nursing services are eligible when prescribed by a licensed provider for recovery from an approved Sharing Request. Sharing is limited to 90 days per Sharing Request.

Medically Stable Conditions

A Sharing Request may be considered medically stable when the condition is chronic and further treatment is unlikely to improve the outcome. Once deemed medically stable, future sharing related to that condition may be limited.

Prescriptions

Prescription medications are eligible when related to the treatment of an approved Sharing Request that is not subject to pre-existing limitation. Sharing for prescription costs is limited to 12 months or $125,000 per Sharing Request, whichever occurs first.

Sports

Injuries resulting from recreational sports participation are eligible. Injuries resulting from professional sports participation or compensation for competition are not eligible.

Hospice Care

Hospice care is eligible in 60-day increments when certified as terminal by a licensed medical provider.

Charitable Sharing Fund

EverTrust Health Share's Charitable Sharing Fund is a separately administered charitable resource that provides assistance to individuals facing financial hardship in accessing healthcare. The Fund may allocate resources to support eligible sharing requests that would otherwise remain unfunded due to member contribution limitations, individual financial circumstances, or other barriers to care. All distributions from the Charitable Sharing Fund are subject to Board approval and available fund balances, and are made in accordance with documented selection criteria designed to ensure charitable impact and prevent private benefit.

As with any other Sharing Request, expectant mothers pay a single Member Responsibility Amount for all eligible expenses related to their Maternity Sharing Request. The Maternity Sharing Request must be submitted within 30 days of pregnancy confirmation.

Waiting Periods

Conception occurring within (30) days of the membership start date is ineligible for sharing. Pregnancy existing prior to membership is not eligible. Medical records will confirm the date of conception. Members who purposely misrepresent the conception date may be subject to membership revocation.

Newborns not born in connection with an eligible Maternity Sharing Request may be added to a household membership by calling or emailing EverTrust. If not born in connection with an eligible Maternity Sharing Request, the newborn's membership start date can be no sooner than seven (7) days after delivery. Any complications the newborn may have or any medical conditions present at birth will be considered a pre-existing medical condition.

Prenatal & Postnatal Sharing Allowance

Up to $6,000 per Maternity Sharing Request. If the pregnancy is diagnosed as high-risk, an additional $1,000 is available.

Eligible services include:

Delivery Services

No sharing limits apply to medically necessary delivery services including:

• OB-GYN labor and delivery
• Cesarean
• Premature birth
• Multiple births
• Hospital labor and delivery
• Anesthesiology
• Home birth
• Maternal complications
• Maternal-fetal specialist consultations
• One in-hospital pediatric evaluation, including routine newborn testing

Newborns

Newborns whose birth is associated with an eligible Maternity Sharing Request must be added to the household membership within 30 days of birth.

If adding the newborn results in a membership tier change, the monthly contribution will automatically adjust beginning with the next billing cycle.

If the newborn is not enrolled within 30 days, any condition present at birth or arising prior to the newborn's membership effective date will be considered a pre-membership medical condition and subject to the limitations outlined in the Medical Conditions Existing Prior to Membership section.

If a parent wishes to add a newborn not born in connection with an eligible Maternity Sharing Request, a separate membership application must be submitted for the child. The newborn's membership effective date may be no earlier than seven days after delivery.

Any genetic condition, birth complication, or medical issue present at or prior to the newborn's membership effective date, when not associated with an eligible Maternity Sharing Request, will be considered a pre-existing condition and subject to the applicable limitations under these Guidelines.

NICU

When associated with an eligible Maternity Sharing Request, Neonatal Intensive Care Unit (NICU) services are eligible for sharing for up to 35 days following birth.

If NICU care extends beyond 35 days, continued eligibility beyond 35 days is subject to the Congenital Conditions allowance, if applicable.

Congenital Conditions

If unknown prior to membership, congenital conditions are eligible up to $125,000 once per membership lifetime. If known prior to membership, the condition is not eligible for sharing.

MRA Reduction for Maternity