What is KNEW Health?
KNEW Health is the cheaper, more flexible alternative to traditional health insurance. At KNEW Health, we are pioneers in a model called “medical cost sharing.”
Think of it like a community contributing to a huge pool–except, instead of being filled with water, the pool is filled with money that each community Member has been adding to in small contributions each month.
If one of the community Members has an eligible Need, the community provides funds from our sharing pool so that the Member can pay their medical bills.
It’s that simple!
Click here to find out how much you can save with KNEW Health.
Medical cost sharing is a new concept. Does it really work?
The concept of medical cost sharing has been highly successful within the confines of faith based Christian groups for more than 25 years. Hundreds of thousands of Members have shared hundreds of millions of dollars in medical expenses. Hence, there is a strong precedence in the concept. We believe that a community of health conscious individuals can successfully share financial medical burdens.
Is there a penalty if I don’t have health insurance?
No, there is no longer a fine for not having health insurance in 2019 under the Affordable Care Act(ACA). You don’t need an exemption in order to avoid the penalty.
However, there are some states in the US which have state-level mandates and associated tax penalties for not having qualified insurance coverage. Each potential Member will need to understand their state level requirements, any associated penalties, and make the decision that is best for their individual case.
Can I choose my own doctors?
Absolutely! Having the personal freedom to select the medical providers of your choice is a cornerstone of medical cost sharing. There are no networks limiting your choice of healthcare providers.
Are there age restrictions?
American adults of at least 18 years of age who are residing in the U.S. can be primary Members.
However, we cannot accept a Member into the KNEW Health community if they are within three months of their 65th birthday or older. In the United States, reaching the age of 65 means entry eligibility for the Medicare insurance program. Medicare has very specific and strict rules that govern healthcare visits, billing, and payment that are not compatible with medical cost sharing.
We will, however, be offering other KNEW Health programs in the future that will give these individuals an opportunity to join our movement and benefit from health promotion services.
What is the cost?
Members will pay one annual enrollment fee each year. This fee will be per membership, not per individual.
Members will also provide a monthly contribution to the sharing pool.
To receive a quick and easy quote for your membership options and your monthly contribution costs, please visit our Savings Calculator.
Are my monthly shares a pre-tax deduction like health insurance premiums?
No, the monthly share is a voluntary contribution towards a KNEW Health membership. As such, the monthly contributions are a post-tax contribution.
Does KNEW Health use deductibles and co-insurance?
KNEW Health uses an Initial Unshareable Amount. This is the specific amount that Members will pay before they can share costs with the community.
Can I make changes to my membership after I join?
No. Generally, the membership plan and the Initial Unshareable Amount that is chosen must remain as is for the membership year, unless there is a life event(e.g. marriage, birth of child).
Can adult children be enrolled in a family plan?
Unmarried, adult children ages 19-25, who are legal dependents, can be on their parent’s membership regardless of whether they are a student or not.
Special consideration, on a case-by-case basis, may be given to unmarried children aged 26 and older who remain dependent on their member parent(s) due to special needs.
How am I billed? Can I change my payment method?
After you pay your Annual Membership fee and first monthly contribution, you will be automatically charged for that contribution one month in-advance for each month of your membership.
You can also update your billing information by logging in to your KNEW Health Member Portal. Once there, you will click on the drop-down option next to your name in the upper right of the member area and select “Billing Info.”
Prior to removing any existing billing information, you will need to add a New Payment Method. After you have added a new payment method, you will be able to remove any existing billing data from your Member profile.
Is membership automatically renewed annually? Is my health status reviewed year-to-year?
No. Membership is not automatically renewed each year. All Members agree to sign and submit a membership continuation agreement each year to confirm a continued commitment to the KNEW Health community tenets that govern membership.
There will be no review of your health status upon renewal. Health status is not a contributing factor in determining eligibility for medical cost sharing. American adults residing in the U.S. are eligible for renewed membership as long as they are not within three months of their 65th birthday.
Are my monthly shares higher if a membership includes a tobacco user?
Yes. Tobacco use of any kind is clinically proven to cause serious health conditions. Due to the increased likelihood of higher medical costs associated with tobacco use, KNEW Health households with one or more tobacco users are required to share a higher monthly contribution.
Can my membership be dropped if I have very high medical costs?
Members cannot be dropped from this program due to their medical Needs. Neither your membership nor your monthly contribution amounts will be affected by the amount of medical expenses that may occur.
How long is a KNEW Health membership?
KNEW Health membership is month-to-month. There is no required length of membership.
Medical Cost Sharing
What’s the advantage of medical cost sharing?
When health care costs are paid by someone other than the person receiving care, typically an insurance company or government entity, the health care model can be undermined and often over-charged. We believe many of the current problems with the health care system are the direct result of restricting personal freedom and responsibility through dependence on third-party payers.
Medical cost sharing allows Members to help one another while maintaining freedom of choice and personal responsibility. In this way, the vision is for the community to choose the best healthcare at the lowest costs for the betterment of all KNEW Health members.
Is medical cost sharing just another name for health insurance?
No. Insurance arrangements are a contract whereby one party agrees to be legally responsible for and accept another party’s risk of loss in exchange for a payment – a premium.
Medical cost sharing is an arrangement whereby Members agree to share one another’s medical expenses through an act of voluntary giving. KNEW Health and it’s partners are not licensed or registered by any insurance board or department since we are not practicing the business of insurance.
Who is your medical cost sharing partner? Are they experienced?
Our medical cost sharing partner, Sedera Health, is a benevolence organization that fosters direct, non-insurance solutions to manage larger healthcare needs. They provide the framework and administrative support for our medical cost sharing membership, as well as access to a number of supportive health services. Sedera Health has years of experience and expertise in medical cost sharing and allows KNEW Health members to join a community of over 15,000 members to help ensure financial stability for our Members.
In this way our Members get the best of KNEW Health’s commitment to community, education, and support combined with an organization dedicated to delivering medical cost sharing in the best ways possible for long-term success and sustainability.
Can I see the "fine print" for the medical cost sharing program? I have some detailed questions about my specific situation.
Sure! Here you can see the detailed Guidelines from our medical cost sharing partner, Sedera Health, which reflects current legislation.
What are the requirements for participating in medical cost sharing?
Members must agree to abide by a set of principles that govern the membership. These principles focus on prioritizing a healthy lifestyle and understanding and agreeing that medical expenses resulting from the use of illegal drugs, or while participating in unlawful activities, will not be shareable.
Is this legal?
The medical cost sharing model has been operating successfully for over three decades. KNEW Health and our partner, Sedera Health, have no legal barriers within the Unites States, of which we are aware.
How do I know that all Members are on board with medical cost sharing?
Trust. It’s the base on which any true community is built.
Our screening questionnaire and every Member’s agreement to KNEW Health’s principles ensure that the medical cost sharing community is being built by like-minded people. This means we are each striving for both personal and collective health in the community. It also means we are looking out for the best opportunities for cost saving which benefit both you and the community.
How do you know a fair prices for services?
This is where you can leverage your Cost Sharing Member Adviser. Your membership gives you direct access to assistance in researching self-pay friendly providers and facilities who charge fair prices.
In addition to this, KNEW Health is dedicated to health care transparency and ideal costs. For example, we offer Members access to low-cost supplements and have secured the lowest lab costs available by opting out of commissions on these services.
Can I plan an annual budget of health expenses?
Medical cost sharing is a unique and proven-successful model where Member budgeting is essential.
Indivuduals will never pay more than three Initial Unshareable Amounts in a year. Family membership will never pay more than five Initial Unshareable Amounts in a year.
When establishing an annual budget, you might think in terms of your maximum amount for larger, unforeseen, and new medical Needs to be three times your Initial Unshareable Amount within you membership year (or 5 times your Initial Unshareable Amount for a family). We suggest keeping this on hand, along with your monthly contributions, for ideal annual budgeting.
What other services are available KNEW Health members?
Here are some of the resources provided to KNEW Members via our medical cost sharing partner, Sedera Health:
- Billing concierge services are available to any Member who wished to have a substantial medical bill negotiated professionally in order to minimize to cost. This service is available to a Member regardless of whether that particular medical cost is shareable. This service can also help you to identify a suitable, low-cost provider of a particular medical service in your area.
- 24-hours Teladoc service is available to any Member who wishes to consult with a conventional physician via phone at any time for a personal or family member health concern. This includes dermatology and behavioral health concerns.
- 2nd.MD, a 2nd opinion service, is an opportunity to consult with a physician if Members receive a new diagnosis or prior to major medical intervention/procedure in order to re-assess medical necessity and available alternatives. Our medical cost sharing partner, Sedera Health, actually requires this service in advance for Members who intend to pursue an elective surgery and submit those medical expenses for sharing. By using this service, Members can reduce their IUA (Initial Unshareable Amount), if applicable, by 50%.
In addition to these services, KNEW Health Members will also have access to:
- free health coaching
- 35% discount on MSRP for supplements
- discounted laboratory diagnostic services
- discounts on other health promotion resources, like qigong
Stay tuned! We are constantly adding to our Member resources.
When can I meet with a KNEW Health Coach?
As part of your membership, adult Members have the option to meet with one of our KNEW Health Coaches to discuss personalized health goals and guidance right after joining. Members are provided with two free coaching sessions per year. These sessions are held via phone call to ensure convenience and privacy.
Which lab companies can we use if we’d like to take advantage of lower cost lab assessments for members?
We are excited to partner with Evexia Diagnostics as our 3rd party lab provider. They offer an array of conventional and specialty lab tests that can be self-ordered by Members throughout the country.
What kinds of Needs do KNEW Health Members share?
In general, Needs for illnesses, injuries, and pregnancies resulting in visits to licensed medical providers, emergency rooms, testing facilities, or hospitals, whose costs exceed the Member’s Initial Unshareable Amount(IUA), are shared on a per-person, per-incident basis.
KNEW Health does not share “well visits” such as annual checkups or preventive care. There are also restrictions on sharing costs from alternative/complementary providers such as acupuncture, massage, and chiropractic. Members can connect with Member Services prior to proceeding with any non-emergent care to determine whether or not those costs would shareable.
What can I do if my Need is not shareable?
Even if your Need does not qualify for sharing, if the bill is above $500, the Billing Concierge services included with KNEW Health membership will negotiate your bill with the medical provider.
Are there any exceptions to sharing preventive or general wellness costs?
Health cost sharing membership is designed to help with the costs of unexpected illnesses, injuries, and pregnancy. Expenses for wellness/maintenance activities are generally not shareable (e.g. routine physicals, checkups, flu shots, long-term maintenance prescriptions).
There are a few specific exceptions which will have a $0 IUA (Initial Unshareable Amount). These include (1) Colonoscopy, to screen for colorectal cancer, for persons age 50 and older, (2) Mammography, to screen for breast cancer, for women age 40 and older (for eligible screenings not more than every 1-2 years as determined by a physician), and (3) routine childhood vaccines.
Routine diagnostic care when medically indicated (high-risk circumstance, family history, etc.) are shareable after the Member has met their Initial Unshareable Amount. For example, an accelerated schedule of colonoscopies if there is a prior history of polyps or a family history of colon cancer.
Are mental health Needs shareable?
Needs related to mental health may be eligible for sharing based on the circumstances of the Need.
Inpatient psychiatric care due to involuntary commitment and the treatment for injuries and detectable organic agents causing cognitive disabilities are shareable. All medication, prescribed or not, administered during inpatient hospital stays will be shareable.
Psychotropic medication to treat chemical imbalances not demonstrable by lab tests is not shareable except as part of an involuntary commitment, though, other types of psychiatric care or services are shareable.
While psychological/counseling services are not shareable, KNEW’s membership includes access to professional counseling services. All Members of the KNEW community will have three hours of free counseling per year, per household. Additional behavioral health services are available through telemedicine.
Are prescription costs considered a shareable Need?
Prescription medication related to an eligible Need are shareable for the first 120 days*. All medication, prescribed or not, administered during inpatient hospital stays will be shareable.
Costs of prescriptions for long-term maintenance of a chronic or recurring condition(e.g. diabetes, eczema, blood pressure control) beyond the initial 120-day period are not shareable with the community. Subsequent sharing of prescription for maintenance of the same condition will occur only when there is a new Need.
The community will not share expenses for psychotropic medications for chemical imbalances that cannot be verified by laboratory tests.
Prescriptions related to infertility treatments are also not shareable.
*Treatments for cancer and sublingual immunotherapy – a curative treatment for allergies – are not subject to this limitation; medications related to organ transplants are limited to a 12-month duration.
My doctor charges a Membership fee to be a part of their practice; is that shareable?
A Membership fee is not a medical intervention for a new Need, so it cannot be submitted for sharing.
What about pre-existing conditions?
The Guidelines of our medical cost sharing partner, Sedera Health, state that health conditions that have been diagnosed/treated or that have exhibited observable symptoms within 36 months prior to the Membership effective date will have limitations on sharing.
A pre-existing medical condition, as previously defined, is a condition for which the applicant has either received medication treatment, taken medications for, or exhibited observable symptoms(regardless of whether diagnosed or not). However, any prior medical condition that has not exhibited symptoms or been treated during the 36 contiguous months prior to Membership effective dates is considered cured and will have no sharing restrictions.
Pre-existing medical conditions will become partially eligible for sharing after the first year on an incremental scale(see below).
Medical costs(except some medications*) associated with pre-existing conditions are:
- Not shareable at all during the first twelve months of membership(following the effective date of services).
- Shareable up to a maximum of $15,000 cumulative during months 13-24(following the effective date of services).
- Shareable up to a maximum of $30,000 cumulative during months 25-36(following the effective date of services).
- Fully shareable in months 37 and beyond(following the effective date of services.)
*The cost of maintenance(vs. curative) meditations and related maintenance equipment associated with pre-existing conditions are never shareable.
Can I share medical expenses that occur abroad?
Medical Needs incurred internationally would be shareable with the community in the same way as any other legitimate medical Need within the U.S. Bills from medical treatments that occurred overseas must be written or translated into English and the price converted to U.S. dollars.
Are maternity costs shareable?
Maternity expenses incurred after 12 months of continuous membership are generally shareable with the KNEW community. Shareable maternity Needs included expenses for prenatal care, delivery, postnatal care, miscarriage, and congenital conditions. Bills for all pregnancy and birth-related complications of the mother will be shared as part of the maternity Need.
All maternity Needs are subject to a $5,000 Initial Unshareable Amount(IUA) regardless of the Initial Unshareable Amount that was elected during annual enrollment.
Here are some other important things to note about maternity Needs:
- The Initial Unshareable Amount Will be reduced to $500 for a home birth.
- The Initial Unshareable Amount will be reduced by 50% for utilizing a birthing center.
- The Initial Unshareable Amount will be reduced by 50% for a vaginal birth after cesarean (VBAC).
- Non-emergency/elective Cesarean section deliveries have a total Initial Unshareable Amount of $7,500.
- Medical Needs resulting from miscarriages will revert to the Member’s standard Initial Unshareable Amount.
Are any prenatal medical Needs of the child included in a maternity Need?
No, any pre-birth Need or post-birth Need of the child, beyond routine care, will be considered a Need separate from the mother’s maternity Need.
A baby’s Need is fully shareable for a baby born prematurely, requiring extraordinary medical care.
Is surrogacy a shareable Need?
No, medical costs related to surrogacy are not shareable with the KNEW community.
What is an Initial Unshareable Amount?
An Initial Unshareable Amount is the portion of a Member’s medical bills that will not be eligible for sharing. This amount applies to all participants in the group.
At enrollment, you can elect a $500, $1500, or $5000 IUA.
What is the process for paying my medical bills when I have a Need?
You should disclose to medical providers (doctors, laboratories, clinics, hospitals, etc.) that you are a cash-pay patient. It is helpful to speak directly with the provider’s billing department, as they will have a protocol for cash-pay patients.
Any bills you receive for an eligible Need will be submitted for medical cost sharing through our online portal. It will then take between 14 and 60 days to process the Need. When this process is complete, you will be provided with the necessary funds to pay your medical bills.
How long does it take to process a medical Need?
It can range from as little as 14 days to up to 60 days for a medical Need to be processed.
What happens when a provider requires payment upfront for services?
Members are encouraged to ask their medical providers to bill them for medical services received. For smaller bills, office visits and the like, providers may require payment at time of service. We advise our Members to avoid paying more than their IUA (Initial Unshareable Amount) toward the cost of any medical Need, as doing so dilutes our medical cost sharing partner’s ability to negotiate fair prices. In cases where Members pay more than their IUA, the community will share the excess amount back to the Member.
What do I do if I have an urgent health Need?
Our medical cost sharing partner, Sedera Health, has secured a relationship with a 24- hour telemedicine delivery system that allows you online access to a doctor at any time. Our KNEW Health coaches are not appropriate for urgent health concerns and should only be utilized for non-urgent health concerns. In the event of an emergency, please call 911 and/or proceed to the nearest urgent care facility or emergency room; then reach out to your medical cost sharing Member Adviser as soon as feasible.
Is there a time limit on submitting costs for sharing?
The sooner that bills are submitted typically enables the best opportunity for price reduction via negotiations with medical providers. When there are a number of bills related to treating the same incident, it is helpful for them to be submitted together if they are all obtained within a 30-day period.
Barring extraordinary circumstances, bills submitted more than 6 months after the date of service will not be shared.
Is there a lifetime or yearly maximum on how much a member can share?
There is no annual or lifetime maximum for sharing most medical Needs, and no limit on the number of Needs that an individual Member or household may have. Health cost sharing is, however, limited to the total number of shares that contributed by all participating Members.
What happens if there aren’t enough shares to go around?
Membership in medical cost sharing requires agreeing to the fact that payment is never guaranteed, but is always based on the commitment of Members to each other. Sometimes Needs from multiple months can be overlapped so that there is enough money for all Needs. However, in the unusual event that all Needs cannot be met, our medical cost sharing partner, Sedera Health, uses a prorating method to evenly distribute the burden. For example, if there are only enough shares available for 90 percent of the Needs submitted for a particular month, 90 percent of each Need will be shared. In order to prevent this and cover Needs fully, the Concierge Service and the Member’s attempts to work with the medical provider to bring the costs of services down become essential for the whole community.
If prorating occurs three months out of six at any time, Sedera Health will evaluate, with Member input, whether there needs to be an increase in the Monthly Member Contributions.
Want to know more about medical cost sharing? Click here to download a free guide from our partner, Sedera Health.
Curious to know how much you can save as a KNEW Health member? Click here to get a free and easy quote with our Savings Caclulator!
Ready to join KNEW Health? Click here to become a member today!