How are very large medical expenses handled in the medical cost sharing model?

While there is no maximum dollar limit on the amount that can be shared towards a specific medical need, the need must be within the scope of the Medical Cost Sharing Guidelines before it will be eligible for sharing. Because of the economic impact of very large medical bills (e.g. those over $150,000), there is an internal mechanism to ensure that adequate shares are available to meet both our Member’s normal and high-cost needs. For the very large medical expenses that occur from time to time, 15% of each Member’s monthly shares are set aside to help offset these situations. Our Medical Cost Sharing Partner reserves the right to negotiate medical expenses with providers, and to prorate available shares, as necessary, in order to address all Member’s medical expenses.