Is GoldCare+ is not an insurance company. GoldCare+ provides the framework and administrative support for a medical cost sharing membership program. When members have financial needs due to illness that are greater than they can bear individually, the goal of the GoldCare+ community is to assist members in carrying one another’s burdens. The method by which GoldCare+ seeks to facilitate the sharing of members’ medical costs is to teach and apply these principles of community and responsibility as an integral part of its sharing philosophy.

As a nonprofit corporation, GoldCare+ is required to abide by certain state and federal regulations.

Because there is no transfer of risk, as defined in applicable insurance rules and regulations, with respect to GoldCare+’ medical cost sharing program, no “claim” is ever owed by a GoldCare+ on behalf of any member. When members incur medical expenses, they submit medical need requests that may or may not be eligible for reimbursement from the Benevolent Fund. Members are required to submit proof of their medical expenses to GoldCare+. GoldCare+ then evaluates each submission for eligibility or ineligibility based on the Member Guidelines. Eligible medical need requests are designated for sharing using the funds accumulated through monthly member contributions.

If you have a health insurance, workers compensation, or liability insurance policy, you must disclose them to GoldCare+. Since yourGoldCare+ membership is not insurance, when you have traditional insurance coverage your insurance company is primarily responsible for the payment of your medical expenses. GoldCare+ will only consider bills for sharing after your insurers have processed claims. The same applies for auto insurance after a car accident. Failure to disclose your relevant insurance coverage to GoldCareTM Plus may result in sharing ineligibility. If you have a medical need arise, and you are eligible for benefits through either insurance or government assistance, please contact GoldCare+ to speak with a member advisor before you submit a medical need request.

Over 90% percent of all monthly contributions go toward sharing in medical need requests. Each month, less than 10% of contributions are retained by GoldCare+ for administrative costs. An audit of GoldCareTM Plus’ finances is conducted each year by an independent firm and made available online.

Yes. For members who are traveling abroad, acute/emergent, eligible medical expenses can be shared no matter where in the world they were incurred and treated. Members interested in medical tourism need prior written approval from HealthShare before treatment.

Anyone who agrees to follow the Member Guidelines and abide by the Principles of Membership can join GoldCare+. Membership expires when an individual reaches the age of 65. Newborns who are not born under an eligible maternity need request have a seven-day waiting period before they can be added to the family’s membership.

GoldCare+ keeps funds to share member expenses if medical need requests exceed the monthly contributions received. To date, all eligible medical expenses have been shared in full without need to draw from the saved funds. However, if the rare event occurs that all medical need requests cannot be met for a given month, GoldCare+ uses a prorating method to evenly distribute the available funds among members with medical need requests. For example, if the monthly contributions received for a given month amounts to 80% of the expenses for medical need requests submitted for that month, each member would have 80% of their eligible expenses shared that month. The GoldCare+ community has not needed to prorate member expenses in the past and has prepared for the event that expenses exceed member contributions.

Yes. Although GoldCare+ is an individual and family medical cost sharing program, we allow for a company contribution list. Employees who participate can be added or removed from the contribution list at any time and billed directly. Participation in GoldCareTM Plus’ program is always voluntary, both from the company’s and the employee’s perspectives. Business owners choose to work with GoldCare+ because they value community and personal responsibility and because they want to use a cost sharing approach to ensure provision of quality healthcare for their employees. There are numerous factors that contribute to GoldCare+’ greater efficiencies for both companies and employees.

GoldCare+ is not a substitute for insurance as defined by the Affordable Care Act and therefore is not subject to the regulatory requirements or consumer protections of your particular state’s Insurance Code or Statutes.

Limitations - Medical conditions, hospitalizations, related treatments, due to alcohol consumption are not considered shareable. Accidents that are the result of illegal alcohol consumption are not shareable. Accidents and injuries incurred while committing an illegal act under the influence of alcohol are not considered shareable.