This is the section of the guidelines that changes people's minds, and it is rarely read before joining. None of it is hidden; it is simply long.

Routine and preventive care is not shared

The guidelines exclude all well-patient care and screening. That means physicals, immunisations and vaccinations, lab studies, screening mammograms and screening colonoscopies are the household's own cost.

For a family of four, a year of routine care and screening is not a small number, and it recurs every year regardless of whether anyone falls ill. A single screening colonoscopy commonly bills well over a thousand dollars, and an annual physical with labs several hundred per person. On an insurance plan these are usually scheduled benefits, as we set out in how preventive care works on a fixed benefit plan.

Prescriptions are time-limited, not ongoing

Medications are eligible for 6 months from the date of diagnosis, per new condition that is not preexisting. Crucially, a new medication for an existing condition does not restart that six-month window.

The practical effect is that maintenance medication is not shared. Blood pressure, thyroid, statin, inhaler and most long-term psychiatric prescriptions become a permanent household cost from month seven onward. Exceptions may be considered for cancer and transplant recipients.

Mental health is largely outside

Psychiatric evaluation and medication related to an eligible medical condition are shared for 6 months per new condition. Counselling and psychotherapy are not eligible for sharing at all, and phone or video access is offered through the member centre instead.

Psychological care, special education charges, and counselling for learning deficiencies or behavioural problems including attention deficit disorders and autism are excluded.

Dental, vision and hearing

All excluded, which is why households often carry standalone cover for them, as we set out in dental and vision alongside limited medical. That includes wisdom tooth removal, orthodontic and oral surgery except trauma within a year, dentures and bridges, and diagnosis or treatment of TMJ dysfunction including braces, splints and surgery of any type. Complications or infections arising from dental procedures are also excluded.

Vision services and routine optometry are out, including anything for nearsightedness, farsightedness or astigmatism, contacts and eyeglasses. Hearing aids are excluded.

Therapy and equipment carry hard caps

Where therapy is eligible it is capped. Physical, occupational and osteopathic manipulation therapy run to 20 visits combined. Speech therapy is 10 visits and only post-stroke, post-surgery or post-trauma. Chiropractic is 20 visits within a six-week period and only where offered in lieu of surgery.

Home care is limited to 60 calendar days from the first date of service. A non-hospital admission to a skilled nursing or rehabilitation facility is eligible for 30 days. Durable medical equipment cannot be rented for more than 6 months.

Lifestyle-linked exclusions

Expenses related to what the guidelines call non-Biblical lifestyles and choices are excluded. That includes alcohol and drug related injuries and illnesses, sexually transmitted diseases including HIV other than innocent transmission, intentionally self-inflicted injuries, illegal acts, and maternity for children conceived outside marriage other than pregnancy resulting from rape.

Weight control and management is excluded, as is care for symptoms not related to a specifically diagnosable disease or injury, such as ongoing fatigue and malaise.

Maternity has its own gate

Maternity sharing requires a married member at an annual portion of $3,000 or higher, who has shared faithfully from the month of conception through the month of delivery. Sharing is limited to $125,000 per pregnancy event, and multiple births count as one event.

A newborn must be added within 30 days of delivery or preexisting and congenital condition limitations apply. If the mother was not a member from conception through delivery, maternity bills are not shared.

The billing rules that quietly exclude

Several provisions exclude bills for reasons unrelated to your diagnosis. Bills must be received within 12 months of the date of service. Improperly coded or submitted bills are not shared. Charges above 200% of the Medicare allowable rate for professional services and 300% for facility bills and anesthesia are treated as excessive and not shared.

Where no Medicare rate exists, charges above the 70th percentile of usual and customary are excluded. After-hours, holiday and weekend fees that are not CMS approved are excluded too.

There is also a conflict-of-interest rule. Bills are ineligible if the provider or ordering provider is related to the member by blood, marriage or adoption, or if the member has a financial interest in the provider.

Alternative and elective care is treated the same way. Acupuncture, vitamins and supplements without a diagnosed deficiency, experimental or investigational treatment, integrative medicine, functional medicine and regenerative medicine are all outside the guidelines.

So are cosmetic procedures, gender reassignment surgery and related treatment, fertility and infertility care including birth control procedures and sterilisation, embryo donation and adoption, and medication or treatment for sexual health or dysfunction.

Two more categories are worth naming because members routinely assume the opposite. Routine and preventive care recurs annually and is never shared, and maintenance medication becomes permanent household cost from month seven of any condition. Across a household of four those two alone can run to several thousand dollars in a year in which nobody is seriously ill.

Everyday items people assume are covered

Over-the-counter drugs and disposable medical supplies are excluded, which the guidelines define to include diabetic supplies, wound care supplies, ostomy supplies and custodial care supplies. Motorised locomotion equipment and home modifications are excluded. So are podiatric orthotics, missed appointment fees and Veterans Administration care.

Genetic testing is generally not eligible unless it is required for personal treatment of a diagnosed condition and not available through a patient assistance programme. Sleep studies are excluded where they relate to insomnia or hypersomnia rather than a specific disorder. Custodial and long-term care is excluded, which matters more with age, as we cover in when supplemental coverage ends.

How The Jordan Insurance Agency helps

We are an independent agency based in Charlotte, licensed in 23 states, and we have helped families choose coverage since 2006. We place sharing memberships as well as insurance, so this is not an argument against one of them. It is the list a household should price before choosing either.

Do you mind if we take a look together? Our licensed agents will add up what falls outside your guidelines across a realistic year, then compare that against a premium.

Benefit amounts and premiums shown are examples drawn from published plan schedules. Actual amounts vary by plan design, benefit level, age and state. Higher designs are available: daily hospital and intensive care benefits can be issued as high as $10,000 a day, ground ambulance up to $3,000 per transport, and calendar-year and lifetime maximums up to unlimited. Ask us what your own schedule would pay. Statements about Medi-Share on this page are drawn from the program guidelines published by Christian Care Ministry. Guidelines are amended periodically and the version current at the time of service governs, so confirm the current text before relying on any detail here.