Member Guidelines:

Bethany Basic
Health Share Program

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 Guidelines for Health Sharing Participants

I. About Joppa Health Share ............................................................................................ 3

II. Membership .................................................................................................................... 4
III. Eligible Dependents of Members .................................................................................. 5
IV. Pre-Notification .............................................................................................................. 8
V. Cancellations and Withdrawals .................................................................................... 9
VI. Reapplication After Cancellation ................................................................................. 9
VII. Member Responsibility Amounts ............................................................................... 10
VIII. Determining Eligibility for Sharing ........................................................................... 11
IX. Medical Conditions and Services Not Eligible for Sharing ...................................... 13
X. Motor Vehicle or Aircraft Accidents.......................................................................... 16
XI. Members Entitled to Insurance or Other Benefits ................................................... 17
XII. Injury on the Property of Another ............................................................................. 17
XIII. Joppa Health Share and Subrogation ........................................................................ 17
XIV. Impartiality................................................................................................................... 21
XV. Sharing Appeal ............................................................................................................. 21
XVI. Biblically Based Mediation and Arbitration ............................................................. 21
XVII. Glossary of Terms ........................................................................................................ 22
XVIII. Bethany Basic Health Share Program ....................................................................... 26
XIX. Eligible Sharing Explanations and Limitations ........................................................ 26

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 I. About Joppa Health Share

Welcome to Joppa Health Share – A Unified Body that will be Blessed. Joppa Health Share is a
healthcare sharing ministry, a subsidiary of the National Hispanic Christian Leadership
Conference or NHCLC, based on a biblical model. The NHCLC is a not for profit corporation
that is recognized as tax exempt under Internal Revenue Code 501(c)(3).

The purpose of Joppa Health Share is to bring Christians together in sharing God’s blessings and
to share each other’s burdens. The concept of “sharing” is not new. For centuries, Christians all
over the world have shared their lives, resources, and blessings as first outlined in the book of
Acts. “All the believers were united in heart and mind. And they felt that what they owned was
not their own, so they shared everything they had. The apostles testified powerfully to the
resurrection of the Lord Jesus, and God’s great blessing was upon them all." —Acts 4:32–33

Each month, Members of Joppa Health Share make fixed monthly contributions to the health-
sharing community according to the sharing level elected. Eligible medical bills are shared with
the funds of Members who faithfully share. The following Guidelines explain the program
requirements and how Joppa Health Share facilitates medical bill sharing.

A. Board of Directors

NHCLC is the Board of Directors – The NHCLC Board of Directors aims to strengthen the
Joppa Health Share program and/or protect its Members. The Board may modify these
Guidelines from time to time. Guideline changes by the Board of Directors must be presented to
the Members.

The NHCLC and Joppa Health Share is not insurance or insurance companies. The payment of
your medical needs through Joppa Health Share or otherwise is not guaranteed in any way. Joppa
Health Share is not, and should never be construed as, a contract for insurance or a substitute for
insurance. There is no transfer of risk for any purpose from a Member to Joppa Health Share or
from a Member to other Members; nor is there a contract of indemnity between Joppa Health
Share and any Member or between the Members themselves.

B. Health Sharing Not a Substitute for Insurance Required by Law

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Joppa Health Share is not insurance. However, Joppa Health Share may be used as an exemption
from mandated insurance coverage in the following circumstances:

1. Federal mandate that became effective January 1, 2014 requiring "applicable

individuals" to maintain "minimum essential [insurance] coverage”.
2. Massachusetts requirement to maintain "minimum creditable [insurance] coverage."

These are the only exceptions. Otherwise, Members must not certify that Joppa Health Share is
insurance to avoid purchasing insurance required by law, rule, or regulation (e.g. worker’s
compensation insurance or sports activity insurance).

C. Assumed Liability and Responsibility

Joppa Health Share is not insurance. Joppa Health Share is a Healthcare Sharing Ministry as
outlined in the Patient Protection Affordable Care Act. Each Joppa Health Share member is
always solely responsible for the payment of his or her own medical bills. Neither Joppa Health
Share nor Members of Joppa Health Share (a.) guarantees payment of a Member’s medical bill,
or (b.) assumes liability for the payment of a Member’s medical bill. Furthermore, no Member
shall be compelled to make sharing contributions. If sharing occurs, the shared medical bills are
paid by the Member that incurred the bill solely from voluntary contributions of Joppa Health
Share Members and not from funds of Joppa Health Share itself.

II. Membership
A. Testimony of Faith

Joppa Health Share Membership is built on a foundation of like ideals agreed upon by the
Members. The peace of mind of knowing the people sharing your contributions are not using
your money for things that conflict with your faith is a blessing many Members enjoy.

Adult Members must affirm the following Member Shared Beliefs to qualify for Joppa Health
Share membership:

1. We believe it is our right to make our own decisions regarding healthcare, in

consultation with physicians, family and/or other valued advisors, free from
government dictates, restraints and oversight.

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 2. We believe that the Bible is God’s word to teach, correct, and train us to live.
Timothy 3:16-17

3. We believe our actions must be in accordance to biblical teachings.

4. We believe it is our spiritual duty to God and our ethical duty to others to maintain a
healthy lifestyle and avoid foods, behaviors or habits that produce sickness or disease
to ourselves or others. 1 Corinthians 6:19-20

5. We believe it is our biblical and ethical obligation to assist others with medical needs
according to our available resources and opportunity. Gal 6:2

Healthy Lifestyle

Joppa Health Share Members highly value the biblical principle that our physical bodies are
temples of the Holy Spirit and should be kept pure. Members should strive to maintain healthy
lifestyles, as this glorifies God while keeping medical costs down.

All Members commit to the following lifestyle choices:

• Live by Biblical standards.

• Believers are to bear one another's burdens.
• Attend and actively support a fellowship of believers regularly

Refrain from unhealthy lifestyles, including but not limited to:

• Use of Tobacco
• Use of Illegal Drug
• Misuse of Alcohol
• Living an Immoral Lifestyle

III. Eligible Dependents of Members

The following family Members may be included or added to the Member Household if they meet
the qualifications for membership:

• Spouse

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 • Biological Children
• Adopted Children

A. Dependent Spouse
If the application to add a spouse is submitted and approved before or within 30 days after the
marriage date, sharing in eligible needs, including a pregnancy occurring on or after the marriage
date, will start on the marriage date. The share increase will take effect on the first day of the
month following approval.

B. Adult Children

Unmarried adult children (age 18+) of Members may be part of their parent(s) Member
Household if they are claimed as a dependent on their Parent or Guardian’s Federal Income
Taxes and/or are a full-time student, until they reach age 26* years old.

*Exception: Adult children age 26 years and older who are severely disabled and unable to live or work
outside a special environment, who are still dependent upon and under the care of their parent(s).

It is the responsibility of the Member to notify Joppa when an adult child no longer qualifies as
part of the Member Household. Continuing to submit the Monthly Contribution at the level that
included the adult child does not extend the membership.

C. 65 Years of Age and Older

Applicants who are 65 or older are ineligible for Joppa Health Share.

D. Non-U.S. Citizens

Non-U.S. citizens who live full-time in the U.S. qualify for Joppa Health Share membership.

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E. Life Milestones

Joppa Health Share, as a Unified Body, changes and grows with Members as they go through
life. The following are instances where life changes may call for a Member to take action to
maintain membership1:

i. Adult Children:
a. May be considered a dependent child up to their 26th birthday, unless he or she is
no longer a full-time student and/or is no longer listed as a dependent on their
Parent or Guardian’s tax return, and therefore no longer qualifies to participate as
part of the parent(s)’ Member Household;
b. May apply for an individual membership1 after their 18th birthday

ii. Holy Matrimony of an Adult Child

a. The Adult Child Member may no longer participate under the Member Household
of the parent(s) as of the date of Holy Matrimony and must apply for his or her
own membership1.
1
Continuing to submit Monthly Shares does not extend the child’s membership.

iii. Adding Dependent Children

a. A child may be added to an existing membership by submitting an Application to

Add-On Family Member(s).

b. A newborn may be a member from birth when the application is submitted within
30 days of birth. If the application is not submitted within 30 days of birth, the
newborn's effective date will be the first day of the month following approval of
the Application to Add-on Family Member(s).

c. An adopted a child or otherwise has obtained legal custody with legal

responsibility for a child’s medical care, that child can be added to the Member
household by submitting an Application to Add-On Family Member(s) with
acceptable forms of proof listed below:

• Valid, signed court order of adoption

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 • Valid pre-adoption placement order issued by a licensed child
placement agency
• Adoption certification
• Adoption placement and petition for adoption

The child may be a member from the time of placement, court order or other legal procedure
when the application to Add-on Family Member(s) is submitted within 30 days of any such
action. When the application is not submitted within 30 days, then the child’s effective date of
membership would begin on the first day of the month following approval of the Application to
Add-on Family Member(s).

iv. Marriage/Divorce of a Member

a. Marriage – A spouse must apply and qualify to be added as a Dependent Spouse

of a Member. The application may be submitted up to 30 days before or after the
matrimonial date. Membership will begin on the matrimonial date. If the
application is not submitted within 30 days of matrimony, the spouse’s effective
date will be the first day of the month following approval of the Application to
Add-on Family Member(s).

b. Divorce – Members who are experiencing a divorce or whose marriage has ended
in divorce should contact Member Services for information regarding making
changes to their Household sharing level.

IV. Pre-Notification
Pre-notification of medical bills does not guarantee eligibility or sharing.

A Member may receive an optional, preliminary determination of whether or not his or her
proposed treatment appears to be eligible for sharing. This is done by requesting a medical
history review to determine if the condition is related to a pre-existing condition. To request a
review, members should call the ‘pre-notify’ phone number printed on the member’s ID card in
advance of their procedure or treatment. Final eligibility determination is always made after the
medical bills are submitted for processing. It is possible a treatment that appeared to be eligible
for sharing during the preliminary review will be determined to be ineligible if:
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 a. New information or additional medical records are provided that make the treatment
ineligible due to pre-existing condition(s).
b. New information or additional medical records are provided that make the treatment
ineligible due to lifestyle issue(s).

The number of days required to complete a preliminary review depends on the responsiveness of
the providers who are asked to send in medical records.

V. Cancellations and Withdrawals

Joppa Health Share membership will be suspended if a Member is more than 30 days behind in
making their monthly contributions. Only Eligible Medical Bills incurred on or before the last
day of the monthly membership period in which the Member’s last contribution amount was paid
through will be considered for sharing.

VI. Reapplication After Cancellation

Members who cancel their membership are welcome to reapply. All medical conditions arising
before the date of reapplication will be subject to the Pre-Existing Condition limitation. This
includes the medical conditions that arose during the prior Joppa Health Share membership.

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 VII. Member Responsibility Amounts
A. Annual Sharing Maximum

The Annual Sharing Maximum is the dollar limit for sharing of Eligible Medical Bills per
member each Program Year. Expense amounts in excess of the Annual Sharing Maximum
amount is the Member’s responsibility. The Annual Sharing Maximum amount resets every 12
months on the Effective Date.

B. Changing Sharing Levels

Members may change their Sharing Level, thereby changing their Annual Sharing Maximum
amount, via reapplication of Membership. Members who change to a new Sharing Level with a
different Annual Sharing Maximum will restart their membership at the new Sharing Level as if
they were a new member and the Effective Date resets. Any change in the Bills will be processed
according to the member’s Sharing Level at the time the bills were incurred.

Members who intend to change their sharing level, add, or remove dependents, discontinue their
membership, or change the status of their membership in any way should allow 30 days for the
change(s) to take effect.

C. Visit Fees

It is the Member’s responsibility to pay the applicable visit fee at time of service or upon being
billed by the provider at a later date. The visit fee is an initial payment applied toward the total
office visit charges.

D. Using the Preferred Provider Organization (PPO)

In order to receive the most from health sharing, Members have access to use a PPO provider
whenever possible. These PPO providers have agreed to discount their fees for Members.
Subsequently, using this network generally offers significant savings, both for individual
Members in the form of lower out-of-pocket expenses and for the membership in the form of
lower Monthly Share Amounts.

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It is best to identify PPO providers and facilities in your region before you seek care.
a. Locate a PPO provider by following the instructions printed on your Joppa Member ID
card.
b. Your Joppa Member ID card must be presented to the provider before services are
rendered or the discount may not be honored.
c. As a courtesy, many PPO providers also honor their discount agreement for services
ineligible for sharing (such as routine care) when Members make payment promptly after
receiving the Explanation of Sharing (EOS).

E. Using Non-PPO Providers

Members are not required to use a PHCS Provider for their healthcare needs; however, by doing
so, a member will have the optimal plan sharing. For services provided by a non-PPO provider,
charges will be shared as outlined below:

i. Physicians and Other Professionals

If a Member uses a non-PPO professional service provider, bills eligible for sharing are
limited to the Usual and Customary (U&C) charge for that service based on independent
norms. Charges above that amount are the Member’s responsibility.

ii. Hospitals and Other Facilities

If a Member uses a non-PPO hospital or other facility, any Eligible Medical Expenses
will be shared at Referenced-Based Pricing (RBP) amount for the services. Charges in
excess of that amount are the Member’s responsibility.

Members should review the Eligible Sharing Explanations and Limitations (Section XX) for
specific healthcare service types.

VIII. Determining Eligibility for Sharing

For care not requiring pre-notification (Section C.), the eligibility of a medical bill for sharing is
determined after medical services are rendered. Medical and lifestyle information help determine
eligibility. Medical records from 24 months prior to membership may also be needed. The need

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for medical records is determined by the nature of the illness or the circumstances of the injury.
If access to requested medical records is refused, the medical bill(s) cannot be shared.

A. Lifestyle
Members must follow the Christian lifestyle and agree to the Statement of Faith. This is essential
for Eligible Medical Bills to be shared. Examples of behavior that can lead to non-sharing and/or
cancellation of membership include, but are not limited to:
a. Use of Tobacco in any form.
b. Use of Illegal Drugs.
c. Abuse of drugs including legal drugs, such as alcohol, prescription and over the
counter medications.
d. Sexual Relations outside of Biblical Christian Marriage.
e. Participation in Activities that represent a willful disregard for personal safety.

B. Pre-Existing Medical Conditions or Related Conditions

Medical bills for diagnosis or treatment of a non-congenital pre-existing medical condition,
defined as signs/symptoms, testing, diagnosis, treatment, OR medication for a condition
within 24 months prior to membership (based on medical records), will only be eligible for
sharing as follows:
a. High Blood Pressure or Cholesterol that is controlled through medication or lifestyle
will not be considered a pre-existing medical condition for purposes of determining
eligibility for future vascular events.
b. Where there has been a lapse in Membership, a condition will not be considered pre-
existing if the first instance of the condition appeared during the previous
Membership. An exception would be maternity that occurred outside the current
Membership period, which will not be eligible for sharing.

IX. Medical Conditions and Services Not Eligible for Sharing

When a medical bill is related to a diagnosis, treatment or procedure that is ineligible for sharing
in any way, that medical bill is also ineligible.

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Listed below are the treatments, medical conditions, procedures, and services that are ineligible
for sharing:

A. Expenses related to non-Biblical lifestyles and choices – including but not limited to:
i. Abortion of a live fetus (baby)
ii. Alcohol and drug-related injuries and illnesses
iii. Sexually transmitted diseases (STDs) including HIV - Exceptions include
innocent transmission via transfusion, rape, work-related needle stick, or sex
within marriage
iv. Illegal acts - Any charges for a condition, disability or expense resulting from
being engaged in an illegal occupation or the commission of or attempted
commission of a crime
v. Intentionally self-inflicted injuries (e.g. suicide or attempted suicide)
B. Alternative Care including, but not limited to:
i. Vitamins/Supplements without a diagnosis of a specific deficiency
ii. Acupuncture
iii. Services from unapproved providers.
iv. Experimental or investigational treatments
C. Behavioral/Mental Health care – including, but not limited to:
i. Psychiatric or psychological care
ii. Special education charges
iii. Counseling or care for learning deficiencies or behavioral problems, whether or
not associated with a manifest mental disorder or other disturbance (e.g. Attention
Deficit Disorders or Autism)
D. Cosmetic procedures – including, but not limited to:
i. Breast augmentation or reduction (exceptions for breast reconstruction after breast
cancer for the affected breast and the non-affected breast if recommended for
purposes of symmetry)
E. Dental and periodontal services – including, but not limited to:
i. Removal of wisdom teeth
ii. Orthodontic/oral surgery (exception for trauma within one year of diagnosis)
iii. Repair or replacement of dentures, bridges, and appliances
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 iv. Diagnosis and treatment of temporal mandibular joint (TMJ) dysfunction or
disease related to the joint that connects the jaw to the skull. This includes, but is
not limited to braces, splints, appliances, or surgery of any type
v. Complications or infections related to dental procedures
F. Durable Medical Equipment (DME), Motorized locomotion equipment (such as
motorized wheelchairs and scooters), exercise equipment and home modifications.
G. Fertility/ Infertility Care – including, but not limited to:
i. Birth control procedures, such as IUD, and/or related supplies
ii. Infertility testing and treatment
iii. Sterilization or reversals (vasectomy and tubal ligation)
iv. Embryo donation or adoption
v. Medication or treatment for sexual health or dysfunction
H. Counseling or consultation expenses including, but not limited to:
a. Dietary counseling
b. Diabetic counseling
c. Lactation counseling
d. Genetic counseling
e. Custodial Care/Long-term Care
I. Educational services and materials including, but not limited to:
i. Lamaze classes
ii. Breast feeding classes
iii. Early childhood intervention
J. Hearing Aids
K. Non-prescription (over the counter) drugs and medical supplies/equipment. Supplies are
defined as medical equipment which is disposable (requiring replacement within six
months) which is purchased by the member for use at home outside of home health
needs. This includes but is not limited to:
i. Diabetic supplies
ii. Supplies for wound care
iii. Ostomy supplies
iv. Podiatric Orthotics (shoe inserts)

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 L. Telephone consultation, Internet consultations, missed appointment fees
M. Veteran Administration care and treatment
N. Weight control and management
i. Weight Loss Center
ii. Bariatric Surgery
iii. Gym Membership
iv. Medication, Supplements, or Injections
O. Vision Services and routine optometry care, including but not limited to:
i. All services related to nearsighted/farsighted/astigmatism, including contacts and
eyeglasses
ii. Refractive services
iii. Prophylactic and preventive surgery without personal history of diagnosis and
doctor recommendation
P. Sleep studies not related to a specific disease or disorder including, but not limited to:
i. Insomnia
ii. Hypersomnia
iii. Parasomnia
Q. Surgery for gender identity disorder
R. Billing irregularities
S. Delayed submissions– including, but not limited to:
i. Bills are to be received by Joppa Health Share within 12 months from the date of
service to be considered for sharing.
ii. Additional information requested from the Member and/or provider needs to be
received by Joppa Health Share within the 12 months of service or the 90 days
from the date requested, whichever is greater.
T. Improper submissions– including, but not limited to:
i. Bills are to be submitted by the provider following standard healthcare industry
submission and coding guidelines. This is necessary for bills to be considered for
sharing.
ii. Improperly coded or submitted bills will not be shared.
iii. Excessive or unnecessary provider charges are not eligible for sharing.

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 U. Provider Relation – including, but not limited to:
i. Provider or ordering provider is related to the Member by blood, marriage, or
adoption.
ii. Member has a financial interest in the provider.
iii. Provider has a financial interest in the Member.
V. Newborn initial well-baby care and inpatient hospital services.
W. Prosthesis.
X. Laboratory Testing for non-preventive services.
Y. Therapy– including, but not limited to:
i. Physical Therapy
ii. Occupational Therapy
iii. Speech Therapy
Z. Ambulance Transportation.
AA. Cancer Treatment

X. Motor Vehicle or Aircraft Accidents

If a motor vehicle or aircraft accident occurs, there are some additional considerations for
sharing eligibility. Diagnosis and treatment of injuries will not be eligible to be shared if any of
the following applies:
• There was abuse of alcohol or legal drugs, or the use of Illegal Drugs.
• The vehicle or aircraft was used in a race, to perform a stunt, or in the commission of a
crime.
• The minimum operator age recommended by the manufacturer or required by law was
not followed.
These apply regardless of whether the Member was operating the vehicle or was a passenger.

XI. Members Entitled to Insurance or Other Benefits

There are many benefits to participating in a healthcare sharing ministry. However, it is
important Members understand Joppa Health Share is not insurance. If a Member has insurance

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or is eligible/qualified for any of the following, the Member must cooperate with Joppa Health
Share in qualifying for such payments:
• Worker’s Compensation
• Fraternal benefits designed to pay all or part of medical bill(s)
• Those resources must be exhausted before medical bill(s) will be considered for
sharing.

XII. Injury on the Property of Another

If a Member is injured on the property of another, the following apply:
• Members are encouraged to work with Joppa to pursue claims against the property
owner.
• If the injury is a result of an incident eligible for worker’s compensation or
negligence on the part of the property owner, the Member must cooperate with Joppa
in the pursuit of the claim before medical bill(s) will be considered for sharing.

XIII. Joppa Health Share and Subrogation

Joppa Health Share, for the benefit of Members, will be subrogated to any and all rights that a
Member has against any and all parties responsible for causing the injuries or illnesses for
amounts Members provided to or for the benefit of the Member, including any and all first
monies paid (or payable) to or on behalf of the Member and regardless of whether or not the
Member has been made whole. Joppa Health Share, for the benefit of Member, will also be
reimbursed for any and all amounts Members provide to or on behalf of a Member as a result of
injuries or illnesses which result from the actions or liability of a third party, and/or which result
in a settlement, judgment or other award or recovery to or by a Member from a third party
tortfeasor, including any person or entity liable for or indemnifying the Member. Joppa Health
Share subrogation rights for the benefit of Members are listed below and a Member’s
membership in Joppa Health Share is subject to and conditioned upon fulfillment of the
following terms and conditions.

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 A. Joppa Health Share, once Members have made payment of any amount to or for the
benefit of the Member, is granted a lien for the benefit of Members on the proceeds of
any payment, settlement, judgment, or other remuneration received by the Member from
a third party tortfeasor, person or entity, and the Member hereby consents to this lien and
agrees to take any actions or steps necessary to secure this lien and help Joppa Health
Share recover same;
B. Joppa Health Share is granted a specific right of reimbursement for the benefit of
Members out of the proceeds of any settlement, judgment, or other payment by a third
party tortfeasor, person, or entity to or on behalf of the Member. Until reimbursement is
received in full, Joppa Health Share is entitled to the right of setoff against any eligible
sharing requests of the Member or any Member of the Member’s family to recover the
reimbursement amount on behalf of the Members. This right of reimbursement is
separate and apart from the subrogation rights of Joppa Health Share and are limited only
by the actual amount provided by Members to or for the benefit of the Member.
C. The Member and his attorney, if he has one, shall execute and deliver a subrogation
agreement to Joppa Health Share and any and all other instruments, documents, or papers
necessary to affect and/or secure subrogation and reimbursement rights.
D. The Member agrees to and is obligated to cooperate with Joppa Health Share and/or any
and all representatives of Joppa Health Share, including subrogation counsel, in
completing discovery, attending depositions, and/or attending or cooperating in trial in
order to affect Joppa Health Share’s subrogation rights for the benefit of Members.
Furthermore, the Member shall do nothing to prejudice the aforementioned subrogation
rights. The Member must freely give any and all information surrounding any accident
that Joppa Health Share or its subrogation counsel or representatives may deem necessary
to fully investigate the injuries or illness or that may affect these subrogation rights.
E. Joppa Health Share’s subrogation, reimbursement and lien rights, as stated above, apply
to any recoveries made by the Member as a result of the injuries sustained or illness
suffered for which amounts were provided to or for the benefit of the Member by other
Members, including but not limited to the following:
i. Any award or settlement or benefits paid under any workers’ compensation law or
award.

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 ii. Any and all payments made directly by a third party tortfeasor, person, entity, or
any insurance company on behalf of the third party tortfeasor or any payments or
installments made to the Member on behalf of the third party tortfeasors, person,
or entity responsible for indemnifying the third party tortfeasors;
iii. Any arbitration awards, payments, settlements, structured settlements, or other
benefits paid by an insurance company under an uninsured or underinsured
motorist coverage policy, whether on behalf of the Member, his employer, or any
other person.
iv. Any other payments designated, delineated, earmarked, or intended to be paid to
the Member as compensation, restitution, or remuneration for injuries sustained or
illnesses suffered as the result of the negligence, or liability, including contractual,
of a third party.
F. No Member may assign any rights or causes of action that he or she might have against a
third party tortfeasor, person, or entity, which would grant the Member the right to
recover medical expenses or other damages, without the express, prior written consent of
Joppa Health Share. Joppa’s subrogation and reimbursement rights for the benefit of
Joppa Health Share Members apply even if the Member has died as a result of his or her
injuries and is asserting a wrongful death or survivor claim against the third party
tortfeasor under the laws of any state. Joppa’s right to recover by subrogation or
reimbursement shall thus apply to any settlements, recoveries, or causes of action owned
or obtained by a descendent, minor, incompetent, or disabled person.
G. Joppa’s right of subrogation and reimbursement, as set forth herein, will not be affected,
reduced, or eliminated by the “made whole doctrine” or any other equitable doctrine or
law which requires the Member to be “made whole” before subrogation rights are
allowed. Furthermore, it is prohibited for a Member or beneficiaries to settle a claim
against a third party for certain elements of damages, but eliminating damages relating to
medical expenses incurred.
H. Joppa’s right of subrogation and reimbursement for the benefit of Members will not be
reduced or affected as a result of any fault or claim on the part of the Member, whether
under the doctrines of imperative causation, comparative fault or contributory negligence,
or any other similar doctrine in law. Accordingly, any so called “lien reduction statutes”

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 which attempt to apply such laws and reduce a subrogation recovery for any reason,
including contributory negligence, will not be applicable to Joppa and will not reduce
Joppa’s subrogation recovery. Amounts provided to or for the benefit of the Member by
other Members are secondary to any benefits or coverage provided under any no-fault
laws or similar legislation or no-fault-type insurance.
I. Upon providing Joppa Health Share with a copy of its fee agreement with the Member
and a copy of the settlement agreement, judgment, arbitration award or other document
evidencing a recovery obtained on behalf of the Member, the attorney for the Member, if
any, may reduce Joppa’s lien by an amount equal to the lesser of (1) the proportional
share of the attorney’s actual fees incurred in obtaining the recovery for the Member or
(2) thirty three percent (33%). Except as otherwise provided in the preceding sentence,
Joppa will not be responsible for any expenses, fees, costs, or other monies incurred by
the attorney for the Member or his beneficiaries, commonly known as the common fund
doctrine. The Member is specifically prohibited from incurring any expenses, costs, or
fees on behalf of Joppa Health Share in pursuit of his rights of recovery against a third
party or Joppa’s subrogation/reimbursement rights as set forth herein. No court costs,
experts’ fees, filing fees or other costs or expenses of a litigation nature may be deducted
from Joppa’s recovery for the benefit of Joppa Health Share Members.

XIV. Impartiality
Joppa serves Members who share in the burdens of fellow Christians. Joppa does not gain
financially by determining medical bills are ineligible for sharing among Members. Joppa, as a
subsidiary of the NHCLC, is a not-for-profit corporation, recognized as tax exempt under
Section 501(c)(3) of the Internal Revenue Code. Joppa has no owners, stockholders, or investors.
Joppa impartially carries out the wishes of the Members as expressed in these Joppa Health
Share Guidelines.

XV. Sharing Appeal

A Member can appeal bill-sharing decisions with which they disagree. Before appealing, a
Member should engage in careful thought and prayer about whether he or she honestly believes
an error was made. Members have 90 days from the day the decision in question was made to

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request a review by Joppa.
A Member can issue an appeal if he or she believes:
• the medical records were misread,
• the Guidelines were misapplied, or
• one or more of the Member’s providers incorrectly recorded the medical history.
After a review by Joppa, if the Member disagrees with Joppa’s decision, the Member has 90 days
to request a review by the board. Joppa and the Member will both submit a written position
statement to the panel. A teleconference will be held where the panel can ask questions of both
the Member and Joppa. A simple majority vote (four out of seven) will carry the decision.

XVI. Biblically Based Mediation and Arbitration

As Christians, the Members and the staff of Joppa Health Share believe that the Bible commands
them to make every effort to live at peace and to resolve disputes with each other in private or
within the Christian community in conformity with the biblical injunctions of 1 Corinthians 6:1-
8, Matthew 5:23-24, and Matthew 18:15-20. Therefore, the parties agree that any claim or
dispute arising out of, or related to, this agreement or any aspect thereof, including claims under
federal, state, local statutory or common law, the law of contract or law of tort, that may remain
after a Member has exhausted his appeals provided for in Section XIII. B., including a
determination whether this arbitration provision is valid, shall be settled by biblically based
mediation.

If resolution of the dispute and reconciliation do not result from mediation, the matter shall then
be submitted to an independent and objective arbitrator for binding arbitration. The parties agree
that the arbitration process will also be conducted in accordance with the Rules of Procedure for
Christian Conciliation, with each party to bear their own costs, attorney’s fees, and 50% of the
arbitrator’s fee, and with the arbitration filing fee to be borne by Joppa. Each party shall agree to
the selection of the arbitrator. If there is an impasse in the selection of the arbitrator, the parties
agree that the Institute for Christian Conciliation shall choose the arbitrator.

The parties agree that these methods of dispute resolution shall be the sole remedy for any

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controversy or claim arising out of this agreement, and they expressly waive their right to file a
lawsuit against one another in any civil court for such disputes, except to enforce a legally
binding arbitration decision.

XVII. Glossary of Terms

Annual Sharing Amount per Program Year – The peak amount of eligible medical expenses
shared for one member in an enrolled membership. Expenses that are ineligible for sharing are
not calculated toward the Annual Sharing Amount per Program Year.

Biblical Christian Marriage – A marriage which is a union of one man and one woman.
(Genesis 2:22-24, Matthew 19:5, Ephesians 5:22-32)

Bill Approved for Sharing – An Eligible Medical Bill that meets the criteria for sharing in the
Guidelines and meets the other conditions for sharing, including whether the member’s sharing
limits have not been exceeded.

CMS-The Centers for Medicare & Medicaid Services is nationally recognized and provides
listings for providers, services, procedures, and facilities to ensure they meet specific criteria to
ensure the safety of the beneficiaries receiving these services.

Cancellation Date – The month and day membership end due to the Member’s withdrawal, for
reasons including not following the Guidelines or for nonpayment of monthly contributions.

Effective Date – The month and day membership begin or the month and day of the most recent
Sharing Level change. Effective Date is used to determine when the 12-month period begins and
ends for the purpose of the Member Responsibility Amount.

Eligible for Sharing – Any testing, treatment, procedure, or service that meets the criteria for
sharing as established in the Guidelines.

Eligible Medical Bill – An incurred medical bill that meets the criteria for sharing as established
in the Guidelines. The Eligible Medical Bill will be reduced by any discounts, fees, or other
sources of payment.

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Explanation of Sharing (EOS) – A statement for Members and providers that reflects how
medical bills are processed. The EOS reports how much of the bill was shared, how much was
discounted through the PPO network, and the amount of the Member’s responsibility, if any.

FDA – The Food and Drug Administration is responsible for protecting the public health by
assuring the safety, efficacy and security of human and veterinary drugs, biological products,
medical devices, our nation's food supply, cosmetics, and products that emit radiation.

Illegal Drugs – Drugs which are classified as Schedule 1 in Title 21 United States Code
Controlled Substances Act.

Incident – The occurrence of an illness or an injury of a member, requiring a diagnosis of

symptoms and treatment of a specific condition.

Lifetime Maximum Share Amount – The peak amount of eligible medical expenses shared by
Joppa Health Share under the enrolled membership or the member’s life cycle. Expenses that are
ineligible for sharing are not calculated toward the Lifetime Maximum Share Amount.

Medical Necessity – A medical service is generally considered to meet the criteria of medical
necessity when it is considered appropriate, consistent with general standards of medical care,
consistent with a patient's diagnosis, and is the least expensive option available to provide a
desired health outcome. Of course, preventive care services that may be covered under a health
insurance plan are not always subject to the criteria of medical necessity.

Member – Any Member of Joppa Health Share, including each family member participating in a
Member Household.

Member Household – Every member who participates in Joppa Health Share with his or her
immediate family under the same monthly contribution and Maximum Sharing Amount. A single
Member is also considered a Member Household.

Monthly Contribution – The dollar amount that a Member faithfully contributes each month as
his or her Monthly Contribution amount and Monthly Administrative amount. The Monthly
Contribution is subject to change without notice.

• Monthly Contribution amount – The dollar amount of a Monthly Contribution that pays
all or part of one or more of another Member’s Eligible Medical Bills.
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 • Monthly Administrative amount – The dollar amount of a Monthly Contribution that is
transferred to Joppa for the payment of its administrative expenses.

Notification of Sharing – The act of notifying the membership of an Eligible Medical Bill that
is approved for sharing.

Pre-existing – A sign, symptom, diagnosis, testing (including labs and/or radiology studies),
medication or treatment of a condition that a Member has before the start of membership.

Referenced Based Pricing (RBP) – commonly known as Cost Plus Pricing, offers self-insured
plans a defined benefit structure based on more economical reimbursement levels designed to be
fair and reasonable to providers based on various pricing data sets, most notably Medicare.

Sign – An objective observation or finding.

Standard of Care – Treatment that is accepted by medical experts as a proper treatment for a
certain type of disease and that is widely used by healthcare professionals.

Symptom – A subjective experience, observation or finding.

U&C (Usual, Customary, and Reasonable) – The amount paid for a medical service in a
geographic area based on what providers in the area usually charge for the same or similar
medical service based on CPT codes and provider zip code.

Visit Fee – The portion of a medical bill that a Member pays at each visit to a medical provider.
The Visit Fee is an initial payment applied toward the total office visit charges.

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 XVIII. Bethany Basic Health Share Program
The tables below represent a condensed explanation of preventive medical services considered for
plan sharing. Though some requirements may be defined by the service itself, certain limitations,
restrictions, and exclusions may still apply.

Services Benefit

Preventive Care3 Shared at 100%*

Primary Care—Sickness/Illness2 $25 Visit Fee

Specialty Care2 $75 Visit Fee

Number of Primary Care & Specialist Visits per Program Year (Includes Pediatrics) 4

1 Visit per Year

Urgent Care2 $75 Visit Fee

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 XIX. Eligible Sharing Explanations and Limitations
A. Primary Care Physician (PCP) Visit for Sickness/Injury: Medical care performed by a
Physician for the diagnosis or treatment of an eligible illness or injury after a 1-month waiting
period. PCP Visits are combined with SPC Visits (includes Pediatrics).
• $25 Office Visit Fee.
• PPO services are Shared at the contracted rate up to $125 after Visit Fee.
• Non-PPO services are Shared at U&C and up to $125 after Visit Fee.
Amount in excess of U&C fees or $125 will be the member’s responsibility.
Limit of 4 Visits per Program Year of any combination after initial One Month Waiting Period.
B. Specialty Care Physician (SPC) Visit: Medical care performed by a Physician for the
diagnosis or treatment of an eligible illness or injury after a 1-month waiting period. SPC Visits
are combined with PCP Visits (includes Pediatrics and Maternity Prenatal/Postnatal).
• $75 Office Visit Fee.
• PPO services are Shared at the contracted rate up to $250 after Visit Fee.
• Non-PPO services are Shared at U&C and up to $250 after Visit Fee.
Amount in excess of U&C fees or $250 will be the member’s responsibility.
Limit of 6 Visits per Program Year of any combination after initial One Month Waiting Period.
C. Urgent Care: Visit to a licensed Urgent Care facility for the treatment of an illness or injury
serious enough to seek care immediately and does not require Emergency Services.
• $75 Visit Fee.
• PPO Service are Shared at the contracted rate up to $375 after Visit Fee.
• Non-PPO services are Shared at U&C and up to $375 after Visit Fee.
Amount in excess of U&C fees or $375 will be member’s responsibility.
Limit 1 Visit per Program Year.

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 D. Wellness and Preventive Care Visits: Medical Care preformed for preventive measures to
maintain overall health and wellness. Preventive Care Visits may not be combined with a
Diagnostic (sick) Visit. Member may have subsequent visit scheduled as PCP or SPC Visit for
Sickness/Injury and billed separately.
Specific details of wellness and preventive services are listed on below:

Shared Preventive Services for Adults as defined by CMS Preventive Services

Wellness Office Visits and Lab Services Shared Limits

Office Visit Exam & Includes Services For: Limited to preventive diagnosis only
One-time screening for males of ages 65 to 75 who
*Abdominal Aortic Aneurysm
have ever smoked
*Alcohol Misuse Screening and Counseling Not shareable - based on Membership Agreement
A low-dose aspirin for prevention of cardiovascular
*Aspirin use for Men and Women disease and colorectal cancer in adults aged 50-59
years.

*Blood Pressure Screening One screening every two years for ages 18 to 39
One Screening per calendar year for ages 40 and over
One screening per calendar year for men 35 and older.
Men under 35 who have heart disease or risk factors for
*Cholesterol Screening
heart disease or women who have heart disease or risk
factors for heart disease
Limit $1500
Colorectal Cancer Screening Cologuard Included 1 Screening every 5 years for adults ages 50-75.
6 month waiting period for Colonoscopies
Screening for depression in the general adult population,
*Depression Screening
including pregnant and postpartum women.
*Type 2 Diabetes Screening Screening for adults with high blood pressure only.
*Diet Counseling Screening for adults at higher risk of chronic disease.
For members at high risk, including members in
countries with 2% or more Hepatitis B prevalence, and
*Hepatitis B Screening US born people not vaccinated as infants and with at
least one parent born in a region with 8% or more
Hepatitis B prevalence.
*Hepatitis C Screening For adults ages 18 - 74
*HIV Screening Screening for adults at higher risk
Immunizations
Listed immunizations are once per membership year.
Hepatitis A Hepatitis B Herpes Zoster
Human Papillomavirus shots up to age 26.
Human Papillomavirus Influenza (Flu Shot) Measles,
Pneumococcal shots for adults 65 and older Shingles
Mumps, Rubella Meningococcal Pneumococcal
shots for adults 60 and older
Shingles, Tetanus, Diphtheria, Pertussis Varicella
*Latent Tuberculosis Infection Screening for latent tuberculosis infection (LTBI) in
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 populations at increased risk
For adults 55-80 at high risk for lung cancer because
*Lung Cancer Screening
they're heavy smokers or have quit in the past 15 years
*Obesity Screening and Counseling
*Sexually Transmitted Infection (STI) Screening and Prevention counseling for adults at higher risk, includes
Counseling syphilis screening
Adults aged 40-75 years with no history of
cardiovascular disease (CVD) use a low to moderate
dose
statin for the prevention of CVD events and mortality
when they have one or more cardiovascular disease risk
*Statin
factors and a calculated 10-year CVD event risk of 10%
or greater; screening for cardiac risk may include
assessment of blood pressure, smoking status,
screening for lipid disorders and use of ACC/AHA CVD
to estimate 10-year risk.
*Syphilis Screening For all adults at higher risk
*Tobacco Use Screening Not shareable - based on Membership Agreement

Shared Preventive Services for Women as defined by CMS Preventive Services

Wellness Office Visits and Lab Services Shared Limits

† Anemia Screening For pregnant women
† Bacteriuria urinary tract or infection Screening For pregnant women
*BRCA Counseling Not shareable
Limit $500
Breast Cancer Mammography Screening Includes 3-D 1 Screening every 2 years for women ages 50-75.
*Breast Cancer Chemoprevention Counseling Counseling for women at high risk
Breast Pumps Not shareable
*Breastfeeding Consultations Not shareable
For ages 21-29, PAP smear every 3 years
For ages 30-65, with cytology and human
papillomavirus testing (HPV) with Pap smear every 5
*Cervical Cancer Screening years or a regular cytology alone (without HPV
testing) every 3 years
Women with an average risk shouldn’t be screened
more than once every 3 years
*Chlamydia Infection Screening For younger women and women at high risk
ONLY the office visit is shareable.
*Contraception Oral Generic Birth Control Pills may be shared under
your Rx program if applicable.
Screening for depression in the general adult population,
† Depression Screening
including pregnant and postpartum women

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 Annual screening for women to obtain a referral to initial
intervention services, which include counseling,
*Domestic and Interpersonal Violence Screening
education, harm reduction strategies and referral to
appropriate support services.
All women who are planning or capable of pregnancy
† Folic Acid Supplements
take a daily supplement containing 0.4-0.8mg
For women 24 to 28 weeks pregnant and / or at
† Gestational Diabetes Screening high risk of developing gestational diabetes should be
screened prior to 24 weeks of gestation
*Gonorrhea Screening For all women at higher risk
† Hepatitis B Screening For pregnant women at their first prenatal visit
*Human Immunodeficiency Virus (HIV) Screening and
For women sexually active
counseling
One test every 3 years for women with normal cytology
*Human Papillomavirus (HPV) DNA Test
results who are 30 or older
*Osteoporosis Screening For women over age 60 or at high risk
Screening for preeclampsia in pregnant women with
† Preeclampsia
blood pressure measurements throughout pregnancy
For pregnant women and follow-up testing for women at
† Rh Incompatibility Screening
higher risk
*Tobacco Use Screening and interventions Not shareable - based on Membership Agreement
† Syphilis Screening For all pregnant women or other women at increase risk
*Sexually Transmitted Infection (STI) and Sexually
transmitted Diseases (STD) Screening and counseling, Counseling for sexually active women
includes Gonorrhea & Syphilis Screening
† Urinary Tract or other Infection Screening for Pregnant
Women
Shared Preventive Services for Children as defined by CMS Preventive Services

Wellness Office Visits and Lab Services Shared Limits

Office Visit Exam & Includes Services For: Limited to preventive diagnosis only
*Alcohol and Drug Use Assessments Not Shareable
For children at 18 months to 24 months Not Shareable -
*Autism Screening
based on Exclusion#3.
*Behavioral Assessments For children to age 18
Not Shareable - based on Exclusion#3.
*Blood Pressure Screening For children to age 18
*Cervical Dysplasia Screening For sexually active females
*Congenital Hypothyroidism Screening For newborns,

*Contraception Only the office visit is shareable.

*Depression Screening Screening for major depressive disorder (MDD) in

adolescents aged 12 to 18 years

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*Developmental Screening For children under age 3 and surveillance throughout
childhood
*Dyslipidemia Screening For children at high risk of lipid disorders
*Fluoride Chemoprevention Supplements For children without fluoride in their water sources
*Gonorrhea Preventive Medication for the Eyes For all newborns
*Hearing Screenings For all newborns
*Height, Weight and Body Mass Index Measurements For children to age 18
*Hematocrit or Hemoglobin Screening For children to age 18
*Hemoglobinopathies of Sickle Cell Screening For all newborns
*HIV Screening For sexually active children
*Hypothyroidism Screening for Newborns For all newborns

Immunizations:
* Acellular Pertussis For children to age 18
* Diphtheria, Tetanus, Pertussis

* Haemophilus influenza type B

* Hemophilia

* Hepatitis A

* Hepatitis B

* Human Papillomavirus

* Inactivated Poliovirus

* Influenza (Flu Shot)

* Measles, Mumps, Rubella

* Meningococcal

* Meningococcal B Vaccine

* Pneumococcal

* Rotavirus

* Varicella

*Interpersonal and Domestic Violence Screening Annual screening for women to obtain a referral to initial
intervention services, which include counseling,
education, harm reduction strategies and referral to
appropriate supportive services.
*Iron Supplements For children ages 6 to 12 months at risk of anemia
*Lead Screening For children at risk of exposure
*Medical History For all children throughout development
Screening for obesity in children and adolescents
six years and older and offer to refer them to
*Obesity comprehensive,
intensive behavioral interventions to promote
improvements in weight status
At risk assessment for your children ages newborn to
*Oral Health
age 10
*Phenylketonuria (PKU) Screening For genetic disorders in newborns

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*Sexually Transmitted Infection (STI)
For children at higher risk, includes gonorrhea
and Sexually Transmitted Diseases preventive medication for newborn eyes
(STD) Screening and Counseling
*Syphilis Screening For all adolescents at higher risk
*Tuberculin Testing For children at higher risk of tuberculosis to age 18
Screening at least once in all children ages 3 to 5 years
*Vision Screening
to detect amblyopia or its risk factors.

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