tional Member by remitting a monthly amount set, and revised from time to time, by Universal
HealthShare. Certain expenses associated with that customized treatment plan may be eligible for
sharing based upon review and case by case determination by Universal HealthShare, to include, but not
be limited to, smoking cessation, weight loss or dietary control, diabetic testing supplies, or other program
costs that may be eligible for sharing as an incentive to lifestyle change. The normal pre-existing
condition guidelines may be altered at the discretion of Universal HealthShare to encourage participation
in the Conditional Membership program as conducted, revised and implemented by Universal
HealthShare.UHFR093021E100121 Page 115
III. Out-of-Network Physician Charges are Not
Sharable
If medical charges are incurred from providers and/or facilities that are out of network, the following
guidelines will be used to determine sharable amounts for those charges. (You can always determine in
advance whether a provider is out of network by asking your physician or hospital, or by contacting your
Customer Service team.)
Out-of-network physician services are not eligible for sharing except for emergency room visits, charges
that are part of sharable inpatient hospitalization and surgery, or sharable outpatient surgical procedures.
If eligible, these charges will be sharable at a percentage of the Medicare payable amount. Ask your
provider or call your Customer Service team for details.
IV. Sharing for Pre-Existing Conditions
All rules related to Pre-Existing Conditions referenced in the Guidelines apply to the UHS Healthy Life
EasyShare Programs, subject to the following exception:
Conditions that exist at the time of enrollment that have evidenced symptoms and/or received treatment
and/or medication within the 36 months prior to enrollment are not eligible for sharing during the first to
years of Membership, except where specifically noted within these Sharing Guidelines. After the first two
full years of continuous monthly membership, medical expenses incurred for a pre-existing condition are
eligible for sharing up to the annual program limits inclusive of any other eligible, sharable medical
expenses incurred throughout the Program Year, as if the condition was not pre-existing. For certain
conditions listed in Article VI, Section 6.02, a statement signed by both the member and the doctor must
be submitted, verifying that the condition did not exist prior to membership, or that the member went at
least 36 and in some cases 48 months (up to 60 months for some conditions, such as cancer) without
symptoms, treatment and medication subsequent to the time the condition last occurred or existed
occurred prior to the individual becoming a member (“Confirmation of No Prior E