Health Sharing in Wilmington: How It Works Under NC Law

What health sharing is

A health care sharing program is a group of members who agree to share each other's eligible medical bills under written guidelines. Each member pays a monthly share. When a member has a large eligible bill, money from the group helps pay it.

It isn't insurance. Nobody is legally required to pay your bills, so sharing is voluntary and not guaranteed. It isn't Minimum Essential Coverage under the ACA, and you can't get a tax credit for it. In exchange, monthly amounts are often well below the full price of an individual plan, and there's no provider network: Novant's New Hanover, Brunswick, Scotts Hill and Pender hospitals and Dosher Memorial in Southport all work the same way.

Health sharing and North Carolina law

North Carolina's law on health care sharing is N.C. Gen. Stat. § 58-49-12 (source). An organization that meets its conditions isn't under the insurance commissioner's jurisdiction. The conditions: it's a nonprofit; its participants share similar interests as defined by the organization; it meets members' medical needs through contributions from one participant to another, under criteria it sets; there's no assumption of risk or promise to pay; and it sends every participant a monthly statement of the needs submitted and each participant's share.

Notice what's missing: unlike some states' laws, North Carolina's doesn't require a shared faith. That's why both Christian ministries and programs like Sedera operate here under the same law.

The law also requires a written notice on applications and guideline materials. In short, it says the organization isn't an insurance company, its guidelines aren't an insurance policy, nobody is required by law to help with your bills, and you're always personally liable for them. We print the full notice at the bottom of every page on this site. The NC Department of Insurance has its own consumer page on alternate plans, including sharing ministries (source). North Carolina has no state penalty for going without insurance.

How a big bill is handled

Here's how it works with the program we most often recommend (Sedera, under its current Membership Guidelines):

1. Call first. Contact a Member Advisor as soon as you know about planned care. For emergencies, notify the program within 48 hours.
2. Pay your Initial Unshareable Amount (IUA). You pay the provider up to your IUA for that Need, as a self-pay patient. The IUA applies per Need, not per year, and no more than three apply in a membership year.
3. Open a Needs case. Upload itemized bills within six months.
4. Bills are negotiated. The program negotiates bills over $1,000 on your behalf.
5. Shared money is paid to you, and you pay the provider.

What isn't shared

• Routine and preventive care, apart from some screenings. That's the job of direct primary care.
• Ongoing prescriptions beyond the first 120 days after a new diagnosis.
• Pre-existing conditions in year one. Conditions from the 36 months before joining are phased in: nothing in year one, up to $25,000 in year two, up to $50,000 in year three, then fully shareable.
• Maternity unless the due date is at least nine months after you join. The maternity IUA is twice your normal IUA, up to $5,000.
• Counseling above $750 a year, routine dental, glasses and contacts, and alternative medicine.

This list is why we pair sharing with a primary care membership and a dental savings plan.