Member Decision GuideIs this programright for you?
A plain-English guide to your Basic Benefits package — a VitalCare medical plan paired with a Zion HealthShare membership. How the two pieces work, real examples, and an honest look at who it fits.
A different wayto cover your healthcare.
Health insurance has gotten very expensive. When the enhanced ACA subsidies expired at the end of 2025, marketplace premiums jumped sharply — and in early 2026 roughly 5 million fewer people were enrolled than the year before. Many who left were healthy individuals and families who simply couldn’t make the new math work.
This program exists for people in exactly that situation. It protects you and your family with two pieces that work together:
A VitalCare medical plan
Handles your day-to-day care — doctor visits, preventive care, urgent care, labs, x-rays, and prescriptions — all with simple copays.
A Zion HealthShare membership
A health care sharing ministry is a community of members who help pay one another’s large medical bills. Yours is Zion HealthShare — it helps with the big, unexpected costs like the ER, a hospital stay, surgery, or having a baby, after you pay a set amount called an IUA.
Together, the two pieces are designed to cover the full range — from a routine checkup to a major medical event. This guide walks you through how it works, shows real-life examples, and is honest about who it fits and who it doesn’t.
Before you read on,see how it fits you.
Answer honestly — there are no wrong answers, and nothing is saved. Your result points you to the parts of this guide that matter most for you.
I'm generally healthy — I mainly want everyday coverage plus protection if something big happens.
I'm priced out of the ACA marketplace, or I earn above the subsidy cliff and pay full price.
I'm comfortable checking networks, asking for cash prices, and submitting itemized bills.
I could pay $1,250 — and up to $3,750 in a bad year — without going into debt.
I have a pre-existing condition that needs significant treatment soon.
I'm currently pregnant.
I depend on specialty or brand-name maintenance medications.
I likely qualify for meaningful ACA premium tax credits.
I'm 65 or older.
Answer a few more to see your result
Tap Yes or No above. Nothing is saved, and you can change any answer.
This self-check is a conversation starter, not a decision. Your agent and the Member Guidelines are the final word.
How your two pieceswork together.
Your VitalCare plan — day-to-day care
A PPO medical plan administered by SBMA. It covers everyday care with fixed copays when you stay in network, and there is nothing to meet before those copays apply:
| Service | What you pay |
|---|---|
| Preventive care, screenings & immunizations | $0 · covered 100% |
| Primary care visit | $25 |
| Specialist visit (no referral needed) | $25 |
| Urgent care | $50 |
| Labs and x-rays | $50 |
| Prescriptions (30-day, by tier) | $15 / $30 / $50 / $75 |
| 24/7 virtual doctor visits | $0 |
| Virtual counseling (therapist / counselor) | $0 |
Virtual care runs around the clock through the plan’s virtual health partner; counseling is by appointment. Your member ID card lives in the HealthWallet app.
VitalCare uses the MultiPlan PHCS network, and out-of-network services are not covered at all. Before any appointment, confirm your provider is in-network: 1-800-457-1309 or multiplan.com/sbmaspecificservices.
Emergency room care, hospital stays, surgery, CT/MRI/PET imaging, and childbirth & delivery. It also excludes specialty and non-preferred drugs, durable medical equipment, and other items in your plan documents. This is exactly why the second layer exists.
Your Zion HealthShare membership — the big stuff
A health care sharing ministry is a community of members who share each other’s large, unexpected medical expenses. Yours is Zion HealthShare. It is not an insurance company, and membership is not insurance. Here’s how it works:
- You pay a monthly contribution to keep your membership active.
- Something big happens — an ER visit, hospital stay, surgery, or delivery. In cost-sharing language, this is a "Need" or sharing request.
- You pay the first portion yourself. That amount is your IUA (Initial Unshareable Amount) — $1,250 on this program.
- Zion HealthShare members share the eligible expenses above your IUA, often negotiating the bills down with providers.
- You're a self-pay patient on the sharing side — no network. Ask for cash pricing, collect itemized bills, and submit them within 6 months of service.
Think of the IUA (Initial Unshareable Amount) like a deductible — with one big difference. A deductible resets once a year; an IUA applies per medical event. A broken arm and a later surgery are two separate Needs, each with its own IUA. The good news: no matter how many Needs you have, you’ll never pay more than 3 IUAs per household in any rolling 12-month period. On this program your IUA is a flat $1,250 per Need — there is no tier to choose.
Your membership is not insurance. Sharing is voluntary — there is no legal guarantee any bill will be shared, and you are always ultimately responsible for your own medical bills. Members have relied on these communities for years, but join with your eyes open. Zion HealthShare’s official Member Guidelines are the controlling document for what’s shareable.
Your IUA is$1,250.
There’s no tier to pick — this program has one IUA. The number that matters is your worst case, so ask yourself: if I had a bad year, could I pay $3,750?
Here’s the whole picture in three numbers:
Because the IUA is fixed, your job isn’t choosing a number — it’s being ready for it. Four things to know:
A year in the life:five real examples.
These stories show how the two layers work together in the situations members ask about most. Watch which layer picks up each bill.
Pregnancy, planned ahead
Maria joins in January and wants to start a family, so she checks the timing rules first. Because she enrols through her employer group, no conception waiting period applies — but conception still needs to happen after her membership begins. A pregnancy that began before joining is generally not shareable. She conceives in the fall.
- VitalCarePrenatal OB/GYN visits: $25 specialist copay in network.
- VitalCareRoutine prenatal labs: $50 copay in network.
- Cost sharingUltrasounds (hospital outpatient): not covered by VitalCare, but may be shareable in her maternity request.
- Cost sharingDelivery (hospital, OB, anesthesia): a maternity sharing request — Maria pays her maternity IUA, Zion HealthShare members share the rest.
- VitalCarePostpartum checkup: back to a simple office-visit copay.
A broken arm
David slips on ice and breaks his arm.
- Cost sharingThe ER visit: VitalCare doesn't cover the ER. It becomes a Need — David pays his $1,250 IUA, Zion HealthShare members share the rest.
- VitalCareFollow-up care: orthopedic visits are $25 copays; follow-up x-rays are $50, in network.
- Cost sharingThe brace: durable medical equipment isn't covered by VitalCare, but may be shareable as part of the same Need.
- VitalCarePrescriptions: VitalCare formulary tier copays apply ($15 / $30 / $50 / $75).
A heart attack
James, 54, has chest pain and is rushed to the hospital — ambulance, ER, a five-day stay, and surgery.
- Cost sharingThe acute event: VitalCare covers none of it. ER, hospital, and surgery are all excluded.
- Cost sharingThe community responds: one Need, one IUA. James pays $1,250; Zion HealthShare members share the rest — often tens of thousands — and Zion handles bill negotiation.
- VitalCareRecovery: follow-up cardiology is $25 in network; heart meds run through VitalCare's formulary, since ongoing-med sharing is time-limited.
A new diabetes diagnosis
Priya is diagnosed with Type 2 diabetes a year after joining.
- VitalCareDay-to-day management: $25 primary care visits, $50 quarterly labs, and a generic like metformin at the lowest tier ($15).
- Cost sharingIf a complication hospitalizes her: it's a new Need after her $1,250 IUA — her diabetes began after joining, so it's not pre-existing.
- Either wayThe honest contrast: had she joined already living with diabetes, it would be treated as pre-existing (phasing in over years), while VitalCare would still cover her day-to-day care.
Scheduled knee surgery
Marcus tears his ACL and needs outpatient surgery.
- Cost sharingThe surgery: VitalCare doesn't cover surgery or facility fees. Marcus shops self-pay pricing with the member tools, pays his $1,250 IUA, and Zion HealthShare members share the rest after negotiation.
- VitalCareBefore and after: pre-op and post-op office visits run $25–$50 in network.
- Cost sharingMRI and physical therapy: not covered by VitalCare, but may be shareable as part of the same Need.
Names and scenarios are illustrative. Actual sharing eligibility is governed by the Member Guidelines.
Who it fits —and who it doesn't.
We’d rather lose a sale than have you join a program that doesn’t fit. Read both lists honestly.
- You are generally healthy. You want preventive and everyday care, plus protection if something big happens.
- You are priced out of the ACA marketplace. Subsidies expired or you earn above the cliff and pay full price.
- You're an active healthcare shopper. You'll check the network, ask for cash prices, and submit bills.
- You want a backstop, not a blank check. You understand Zion HealthShare is a community of members, not an insurance company.
- $1,250 is within reach. And so is $3,750 — the most a household pays across any rolling 12-month period.
- You have a pre-existing condition needing treatment soon. Sharing is $0 in year one and phases in over years; VitalCare doesn't cover hospital or surgery. An ACA plan is almost always better.
- You're already pregnant. There's no conception waiting period on this employer group, but a pregnancy that began before your membership started is generally not shareable. Planning to conceive after you join is a different situation — ask an advisor.
- You depend on specialty or brand-name meds. They're off VitalCare's formulary and maintenance-med sharing is time-limited — you'll pay a lot out of pocket.
- You qualify for meaningful ACA tax credits. A subsidized marketplace plan with full benefits is usually the better deal. Check HealthCare.gov first.
- You want one-card simplicity. This asks you to verify networks, present as self-pay, and submit itemized bills within 6 months.
- You use tobacco and are over 50, or are 65+. Zion HealthShare's Member Guidelines limit tobacco-related sharing for older users; age and Medicare rules restrict eligibility at 65+.
- You live where MultiPlan PHCS providers are scarce. VitalCare covers nothing out of network — rural members should check density first.
- $3,750 in a bad year would break you. That's the household maximum — 3 $1,250 IUAs across a rolling 12-month period. If you couldn't cover it, choose a different option.
Your responsibilitiesas a member.
This program works best for members who stay engaged. Tap each item as you go — it’s your running checklist.
0 of 10 done
Questions to askbefore you enroll.
Bring these to your agent — and answer the personal ones honestly for yourself.
Key termsin plain English.
The amount you pay per medical event before Zion HealthShare members share eligible expenses. It works like a per-incident deductible, except a deductible resets once a year while an IUA applies to each separate event. Yours is $1,250, capped at 3 per household in any rolling 12-month period — $3,750 maximum.
A large, unexpected medical event you submit for sharing — a hospitalization, surgery, or delivery.
The basic coverage the ACA requires. Your VitalCare plan provides it; a health care sharing membership alone does not — one reason the two are paired.
The providers a plan contracts with. VitalCare requires the MultiPlan PHCS network with no out-of-network coverage. The sharing side has no network — see any licensed provider as self-pay.
Telling a provider you're paying cash and asking their self-pay price. This is how members access care for shareable events.
Health care sharing communities accept members with pre-existing conditions, but sharing starts at $0 in year one and rises gradually over several years. Details are in Zion HealthShare's Member Guidelines.
Importantdisclosures.
Please read this section carefully before enrolling.
Zion HealthShare is not an insurance company and your membership is not insurance. It is a voluntary health care sharing ministry whose members share one another's eligible medical expenses.
There is no legal obligation for Zion HealthShare or its members to share any expense, and no state guaranty fund protects you. You are always ultimately responsible for your own medical bills.
Zion HealthShare's official Member Guidelines govern what's eligible, all limits, timing rules, and exclusions. This guide is a summary only.
Your VitalCare plan provides Minimum Essential Coverage (MEC) but does not meet Minimum Value standards. Being offered MEC through an employer may affect ACA premium tax credit eligibility.
Visit HealthCare.gov or speak with a licensed agent before choosing this program. If you qualify for meaningful premium tax credits, a marketplace plan may fit better.
Sharing for conditions that existed before membership is limited and phases in over years. Review Zion HealthShare's Member Guidelines carefully if you have ongoing conditions.
Monthly contributions and plan costs come from your agent and the official enrollment materials. Your IUA is fixed at $1,250 per Need.
This program is administered by Basic Benefits LLC.
This guide is educational material — not a contract, a plan document, or an offer of insurance. Benefits and sharing eligibility are governed solely by the VitalCare plan documents and Zion HealthShare’s official Member Guidelines. This guide contains no pricing; monthly contributions are available from your agent. Your IUA is $1,250 per Need, capped at 3 per household in any rolling 12-month period. This program is administered by Basic Benefits LLC.