at results in a ruptured fallopian tube, expenses eligible for
sharing include surgery, post-operative recovery of the member, follow-up care, and treatment of
any complications.
In the case of an ectopic pregnancy, expenses eligible for sharing will be subject to the applicable per-
Medical Incident limit, inclusive of costs of pre-operative tests, consultations and other expenses for
keeping the member under medical care while determining what care should be offered and, in the case
of an ectopic pregnancy that results in a ruptured fallopian tube, surgery, post-operative recovery of the
member, follow-up care, and treatment of any complications.
(s) Pre-Natal Care Visits.
Visits for standard pre-natal care are generally sharable, subject to applicable visit limits.
(t) Prostate Conditions.
Prostate Conditions are generally sharable, but during the first 36 months of membership, a Confirmation
of No Prior Existence of Condition statement may be required.
(u) Sexually Transmitted Diseases (STDs).
HIV, AIDS, or other STDs contracted due to the actions of others (e.g., blood transfusions or medical
procedures) will be shared. We do not share needs for sexually transmitted diseases, including the HIV
virus and/or AIDS, when contracted through irresponsible behavior such as sharing hypodermic needles
for legal or illegal drugs. It is the member’s responsibility to explain how the disease was contracted.
(v) Sleep Apnea.
Sleep Apnea is generally sharable, but during the first 36 months of membership, a Confirmation of No
Prior Existence of Condition statement may be required.
iii. Medical Expenses Sharable Under Limited Circumstances.
1. Injuries Caused by Motor Vehicle Accidents.
Most needs for motor vehicle related injuries are generally shared, but there are exceptions that are
described below. For purposes of these Guidelines, any vehicle with a motor or engine that is used for
transportation, work, or recreation is a “Motor Vehicle,” any person driving, riding or otherwise controlling
a Motor Vehicle is the “Operator,” and any person other than the Operator riding in, on or being pulled by
a Motor Vehicle is a “Passenger.” Before any medical expenses for Motor Vehicle related injuries will be
considered for sharing, they must first be submitted to any party that is responsible for the accident or
liable for damages resulting from the accident.
2. Accidents where you are not an Operator or Passenger.
Needs for injuries caused by or incurred in a Motor Vehicle accident where you were not an operator or
passenger (e.g., you were a bystander, pedestrian, bicyclist, etc., when injured) are sharable, but only to
the extent the costs at issue are not the responsibility of any insurance carrier or liable party.
3. Accidents where you are an Operator or Passenger.
Nee