Resource Documents

The AUA is the dollar amount a Member must pay toward their Eligible Medical Expenses during a 12-month period. The AUA 12-month period resets on the Effective Date.

The Plan utilizes a base AUA of $1,000 of eligible expenses for the Individual and $2,000 of unshared eligible expenses for the Family. After the base AUA, members are responsible for 20% of additional eligible expenses until they reach the maximum of $4,000 for the Individual and $8,000 for the Family.

Every time you visit a medical provider, present your Member ID card. The card will inform your provider to submit your medical bills to The Plan. The Plan will process, negotiate, and pay the bill. Then the member will receive an invoice from the Plan for the Annual Unshared Amount of eligible expenses and ineligible expenses. Within a 12-month period, once the amount that you pay meets your AUA, the eligible medical bills will be 100% shared.

Quarterly Medical Contributions are structured by Individual or Family. See green rows in Table 1. Secondly, the contributions are determined by whether a person’s age is Under 65 or Over 65. Children under the age of 19 are automatically part of the Family without additional contributions.

A preexisting condition is a condition with or without a medical diagnosis present in the two-year period prior to application for membership.

• Applicants are not excluded from membership due to preexisting conditions.
• If at least 70% of a Member’s church participates in The Plan, there is no annual sharing cap for preexisting conditions.
• If less than 70% of a Member’s church participates in The Plan, preexisting conditions are shared but with the following limitations.
  • Any condition with annual expense of $5,000 within the last two years or an anticipated expense of $5,000 in the next twelve months is limited to an annual sharing cap of $10,000.
  • The $10,000 annual expense sharing cap remains in place for the duration of the condition.
  • A preexisting condition needs to be free of symptoms, treatment, and medication for a period of 24 months before being considered cured.

Yes, The Plan values a commitment to healthy living and rewards Members for their healthful choices through a health discount of the quarterly medical contribution. The Plan offers a 10% Health Incentive Discount of the quarterly medical contribution to Members above 60 years of age that meet the healthy living requirements. Qualifying for the health requirements is determined with a doctor’s office visit, blood test, and other health metrics. The health requirements are measured annually.

The Alms Plan provides financial support for widows, people with disabilities, low income, and catastrophic medical events over $100,000.

The Quarterly Alms Contribution amount is prorated across seven income tiers. The tiers are based on the annual household income level, using the Adjusted Gross Income (AGI) from line 11 of the household’s most recent Form 1040 tax return.

The Annual Alms contribution amount is prorated across seven income tiers. It is paid once per year.

The Plan is structured so that those with the responsibility of wealth can carry the bulk of the burden of the widows, people with disabilities, low income, and catastrophic medical costs.

When the oldest Member of the family turns 65 years of age, the Household Family quarterly medical contribution amount switches to Over 65. The Over 65 contribution change occurs in the quarter following the 65th birthday of the oldest person in the Member Household.

They receive the following discount of the Over 65 quarterly medical contribution amount:

1. Members on Medicare Part A receive a 50% discount.
2. Members on Medicare Parts A and B receive a 60% discount.
3. Members on Medicare Parts A, B, and D receive a 70% discount.

If a Member utilizes Medicare A, or B, or C, The Plan shares eligible expenses not covered by Medicare with an AUA of $1,000 for the individual or an AUA of $2,000 for the family.

Children of Members may be part of the parents’ Member Household until they reach age 19. Within 30 days after the adult child’s 19th birthday, he or she must complete the Member Application and become an adult member. In addition, a child may no longer participate under the Family Member Household of the parent(s) after getting married and must apply for their own Family membership.

Yes. The Alms Plan functions as a backup plan for those that are struggling financially. If you need financial assistance, contact your deacon or church representative and request assistance from the Alms Plan.

To steward our resources, Members must provide pre-notification for elective procedures that exceed $20,000 or for procedures with estimated cumulative costs that could exceed $20,000. Pre-notification enables the Plan to provide significant knowledge of cost savings or higher quality providers or facilities. Pre-notification of medical bills does not guarantee eligibility or sharing. No pre-notification is needed for emergencies.

The Plan does not use government-funded programs to cover costs and reduce expenses. It does not expect Members to utilize Medicare or Medicaid to cover expenses, unless a Member stays on the Plan after 65 years of age and is on Social Security and utilizes Medicare Parts A, B, and D.

A reimbursement is a member request for The Plan to process an eligible bill you have already paid. Members can seek eligible reimbursement on medical bills, adoption, out-of-country emergencies, or prescription costs.

Here are the steps to follow to ensure a smooth, confident experience.

Step 1: Present Your Member ID Card
Your Member ID Card is designed to make your experience stress-free and more affordable while building trust with the provider. Always present it at the time of your visit. The card includes:

• Your Household Member ID number
• Billing and contact information
• A clear message about Brotherhood's sharing plan
• The electronic address (ANB25)

The provider can use the electronic address to instantly confirm your identity, eligibility, and current membership status. They can also use it to send the bill directly to Brotherhood. If they don't have access to the electronic address, they can mail the bill to the P.O. Box listed on the card. Presenting your Member ID card gives the provider confidence that you are with a credible sharing plan.

Step 2: Have the Provider Call Our Office
If a provider doesn't accept the Member ID Card, it's often because they aren't familiar with our principles. The next step is to have them call Brotherhood's office using the phone number on the card. A brief conversation is usually all it takes to reassure them of our trustworthiness and resolve the issue.

Step 3: Suggest the Provider Send You the Bill
If the provider still won't accept you as a Brotherhood Member, suggest they send the bill directly to you. Do not pay the invoice. As soon as you receive it, send it immediately to Brotherhood. We will process it using our reference-based pricing, pay the fair price, and then invoice you for your Annual Unshared Amount (if any). Our prompt payment builds trust with the provider.

Step 4: Pay at the Time of Service
If the provider rejects the first three steps and requires immediate payment, we advise caution. Only agree if:

• You are certain the price is fair and reasonable.
• The bill is not over $1,000.

It is quite common to pay at the time of service for primary care visits. If you do pay a bill at the time of service, be sure to send a copy of the paid receipt to Brotherhood. We will reimburse you if the eligible expenses exceed your Annual Unshared Amount

Brotherhood uses advanced software and medical pricing data to arrive at a fair and reasonable price. This approach is called reference-based pricing and includes various steps. First, the bill is evaluated and corrected for medical coding errors. Second, it is compared to industry benchmarks and adjusted to a fair and reasonable price based on medical pricing data. Third, the payment to providers contains a complete and clear explanation of the payment that provides true reasons behind a fair and reasonable price.

After receiving a fair payment for medical services from the Plan, some providers will still demand payment for the remaining balance of the unfair and exorbitant bill. In this situation, a provider or hospital will invoice the Member for the unpaid balance. This is called balance billing. If you receive a balance bill, do not pay it. Send it to The Plan. Brotherhood engages in respectful bill resolution on behalf of its members. This includes interactive negotiation with providers to show medical pricing data and objective industry standards demonstrating the integrity of a fair and reasonable price.

No. Exception: Members during a pregnancy, that join with 70% church participation, can share maternity expenses prior to the Effective date.

Per the guidelines, bills must be submitted on Forms CMS-1500/HCFA or UB-04/CMS 1450 (or equivalent) for medical bill to be considered for sharing. If the provider has questions about billing, please contact The Plan.

• Anabaptist Brotherhood, P.O. Box 144, Guys Mills, PA 16327
• Email: [email protected]
• Phone: 574-354-4449