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How Reimbursement Works

General Information:

United Refuah HealthShare is a health cost sharing organization [an IRC 501(c)(3) tax-exempt organization] for members of the Jewish religion, who practice member to member sharing of medical expenses.

Prenotification:

  • United Refuah HealthShare has no network, therefore members are able to use any provider of their choice.
  • Referrals are not required
  • Some services require a prenotification. Please call 440-772-0700, to prenotify any of the procedures/treatments listed below:
  • Organ/Tissue Transplant Services
  • Emergency Admission or Extended Emergency Department Observation - as soon as it becomes evidently needed or a least prior to discharge
  • Home Health Care and Hospice Services
  • Outpatient Surgery (including surgical centers, clinics, hospitals)
  • Obstetric and Prenatal Needs - members must notify United Refuah upon learning of pregnancy. All admits must be pre-notified.
  • Maternity - Upon admission or anticipated admission for Labor and Delivery, C-section or inpatient management during pregnancy
  • Non-Emergency Magnetic Resonance Imaging (MRI) Scans
  • Non-Emergency CT scans
  • Positron Emission Tomography Scanning (PET)
  • Infusions or Injections - pain management, etc.
  • Dental - Care for sound, injured teeth - eligibility for all other dental care is NOT eligible for sharing)
  • Acupuncture
  • Sleep Studies
  • Cardiac Catheterization
  • Cardiac Rehabilitation
  • Diagnostic or Screening Colonoscopies
  • Endoscopy
  • Prior to Initiation of any High-Dollar Drug Regimen, Treatment, Chemotherapy or Radiation Therapy
  • Diagnosis of cancer while therapeutic decisions are being considered
  • Prior to commencement of any of the following services - Occupational Therapy, Physical Therapy, Speech Therapy, Respiratory Therapy, Chiropractic Care
  • Uncommon, Unnecessary, or Expensive Diagnostic LaboratoryTesting
  • After an Evaluation for Complementary or Alternative Medical Management - or Functional Medical Doctor - regardless of whether a CAM licensed provider or an MD or DO
  • Treatment outside the United States - specific and certain conditions may apply
  • Mammograms

Payment Information:

  • Members are responsible for an Annual PreShare Amount (APA) as follows:
    • $500 for a single membership
    • $1,000 for a couple membership
    • $1,500 for a family membership
  • Members are responsible for an 20% CoShare Amount up to their Maximum Annual CoShare based on their membership size as follows:
    • $1,000 for a single membership
    • $2,000 for a couple membership
    • $4,000 for a family membership
  • Preventative Screenings and Wellness are not subject to the Annual PreShare Amount.
  • Requests for sharing must be submitted within 90 days of the date of service.
  • Bills are processed on average within 30 days of receipt.
  • General Maximum Reimbursement Rates are a maximum of 150% of Medicare allowable for the area where service is rendered.
  • Medical Bills should be submitted via HCFA 1500 or CMS UB04 to:
    • United Refuah HealthShare℠ PO Box 18523, Cleveland Heights, OH 44118
    • Faxed to 440-510-0444
    • Secure web upload
  • ID cards contain all relevant information for billing, including member number and effective date.

Enrollment for March 1st has closed.
Enrollment for April membership ends on March 15th.

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