Office Visit fee billed for physician services from that visit, such as testing, screening,
imaging, and procedures, may be sharable if applicable, subject to requirements and limitations. (If
multiple visits are required for an immunization that is eligible for sharing, the Member Consultation Fee
will apply to the initial visit and the cost of the immunization and the subsequent office visit to complete
the immunization will all be eligible for sharing.)
If imaging is done both without and with a contrast agent, that is considered two separate imaging series.
Similarly, if imaging is done on two different body parts (e.g., head and leg), that is considered two
separate imaging series.
All outpatient CT Scan, MRI, and X-Ray imaging have a 90-day waiting period and sharing eligibility is
limited to two such imaging services per year. These services are sharable only with a physician
prescription and must be procured at a free standing in-network diagnostic center and not from a hospital
unless received as an admitted patient. For eligible imaging services received other than from a hospital,
EasyShare limits sharing to not more than $400 per imaging series for CT scans and MRIs and $250 per
imaging series for x-rays with the member always responsible for any amount above that limit. Sharing is
subject to the annual program limits of EasyShare inclusive of any other eligible, sharable medical
expenses incurred throughout the Program Year.
Sharing expenses for Ambulance or Emergency Room services are only intended for medical conditions
that are life threatening or could seriously jeopardize the health of the individual and only when the injury
or illness results in an in-patient hospital stay. If eligible, EasyShare limits sharing for eligible emergency
services to not more than $1,000 per incident. All emergency and transportation-related expenses in
excess of $1,000 are always the responsibility of the member.
iv. Annual Sharing Limits.
There is an annual limit on the total amount of medical expenses that may be shared for any individual
Member in the EasyShare Program (“Annual Sharing Limit”) inclusive of any other eligible sharable
medical expenses incurred throughout the Program Year. The Annual Sharing Limits that establish the
maximum sharable amounts for any member in each EasyShare Program are as follows:
Annual Combined Program
Maximum
Routine Annual Physical, Well
Child Exam, and Preventive
Care Combined Sharing Limit
for Standard Programs
EasyShare50 $50,000 $500 maximum,
per member per year
EasyShare25 $25,000 $500 maximum,
per member per yearUHFR093021E100121 Page 104
v. Lifetime Sharing Limits.
The maximum amount of lifetime sharing available for any EasyShare50 member is $500,000 and the
maximum amount of lifetime sharing available for any for 