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.

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 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 products include but are not limited to cigarettes, cigars, chewing tobacco, snuff, pipe tobacco, and inhaled products through vape, hookah, and similar 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 cancellation request must include the reason for cancellation and the month in which the 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.

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 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 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 or once per membership lifetime.

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

Each household is responsible for no more than two MRAs within a rolling 12-month period. After two MRAs have been met, EverTrust will share additional eligible Sharing Requests exceeding $1,000 without requiring an additional MRA.

A condition is considered pre-existing if, within twelve months prior to membership, the member was examined, taken medication, received treatment, underwent monitoring, or experienced recurring, persistent, or progressive symptoms. A condition may be deemed pre-existing even in the absence of a formal diagnosis.

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

Exceptions — Not Considered Pre-existing

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

Sharing Requests related to a pre-existing condition are subject to the following sharing limits based on years of participation. Limits 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.

Conditions Not Eligible for Phase-In Sharing

• Cancer diagnosed, treated, under evaluation, referred to oncology, or symptomatic within 36 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

EverTrust does not share in the maintenance or ongoing management of pre-existing conditions. The phase-in applies only to new, acute, or corrective treatment. Routine or maintenance care intended to monitor or manage a chronic condition is not eligible at any time.

Examples of non-shareable expenses include: routine MRIs or CT scans ordered solely to monitor a known condition, follow-up visits for continued condition management, and maintenance medications for a condition existing prior to membership.

Conditions Treated as Pre-Existing for Phase-In Purposes

The following healthcare services and expenses are not eligible for sharing under a Sharing Request subject to the MRA. Some may qualify under a Preventive Sharing Request if specifically included in a member's preventive benefits.

Additional Ineligible Categories

Contraception: Eligible only when required to treat an approved Sharing Request. Elective contraceptive use is not eligible.

Dental: Routine dental services are not eligible. Dental treatment required as the direct result of an approved accident or injury may be eligible.

Preventive & Genetic Screening: Eligible only when required to treat an approved Sharing Request. Screening performed solely for risk assessment does not qualify for MRA-based sharing.

Medical Non-Compliance: Failure to comply with a licensed provider's treatment plan, or leaving a medical facility against medical advice (AMA), may result in ineligibility.

Mental Health (Non-Emergent): Diagnosis, treatment, therapy, and medications related to mental health conditions are not eligible for MRA-based sharing, including ADHD, anxiety, panic disorders, insomnia, stress-related conditions, bipolar disorder, depression, OCD, PTSD, schizophrenia, and eating disorders. Emergency mental health evaluations and related ER expenses are eligible under the Specific Sharing Allowances section.

Sterilization: Elective sterilization procedures including tubal ligation, vasectomy, and preventive hysterectomy are not eligible.

Vision: Vision-related hardware expenses including glasses and contact lenses are not eligible.

Category A — allowance applies per Sharing Request. Category B — allowance applies once per membership lifetime.

Subject to the $3,500 sharing allowance. 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.

Subject to the $5,000 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, and other regenerative therapies.

Alternative treatment and alternative diagnostic testing are eligible under their respective sharing allowances. For alternative treatment requests, members must submit:

1. Medical notes from the prescribing provider
2. Estimated costs and available discounts
3. 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.

If a Sharing Request involves injury or illness resulting from an automobile accident or third-party liability, EverTrust will share only after any applicable primary coverage has processed and made final payment. Primary payors include: automobile insurance, health insurance, workers' compensation, government assistance programs, and liability insurance.

Acute Allergic Reactions

Each acute allergic reaction is treated as a separate medical event requiring a separate Sharing Request with its own MRA. Acute allergic 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. 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 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 death certificate:

• $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

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 is not eligible under MRA-based sharing.

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

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 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

As a nonprofit organization, EverTrust may allocate funds from the Charitable Sharing Fund to assist with Sharing Requests previously deemed ineligible. Distribution is subject to availability of funds and approval by the EverTrust board of directors.

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.

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 prenatal and postnatal 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, and 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 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.

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 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.