Benefits and sharing,line by line.
Copays and prescriptions come from the VitalCare insurance plan you choose — Standard or Deductible. Anything marked IUA is the Zion HealthShare membership, which is not insurance and shares eligible costs rather than covering them.
The two VitalCare plans
Both use the MultiPlan PHCS network. Out-of-network care is not covered, so check that your doctor is in network before you enroll and before any appointment.
| Benefit | VitalCare (Standard) | VitalCare Deductible |
|---|---|---|
| Plan type | PPO, administered by SBMA | PPO, administered by SBMA |
| Network | MultiPlan PHCS; out of network not covered | MultiPlan PHCS; out of network not covered |
| Deductible | None — copays apply from the first visit | $3,000 individual / $6,000 family |
| Out-of-pocket maximum (VitalCare) | $1,850 individual / $3,700 family | $4,500 individual / $9,000 family |
| Preventive care | $0 — covered 100% | $0 — covered 100%, before the deductible |
| Primary care visit | $25 copay | $25 copay after the deductible |
| Specialist visit (no referral needed) | $25 copay | $25 copay after the deductible |
| Urgent care | $50 copay | $50 copay after the deductible |
| Labs and x-rays | $50 copay | $50 copay after the deductible |
| 24/7 virtual urgent care | $0 | $0 |
| Virtual behavioral health (counseling) | $0, by appointment | Not included |
| Prescriptions | $15 / $30 / $50 / $75 copays by tier (30-day); 60,000+ retail pharmacies | PureRx discount program — a discount, not insurance (up to 80% on most FDA-approved medications); 60,000+ retail pharmacies |
| Emergency room, hospital stays, surgery, CT/MRI/PET imaging, childbirth | Not covered by VitalCare — the Zion HealthShare side, after your IUA | Not covered by VitalCare — the Zion HealthShare side, after your IUA |
VitalCare Deductible is designed to meet HSA-compatible high-deductible health plan requirements. Your eligibility to contribute to an HSA depends on your individual circumstances and other health coverage or arrangements, including Zion HealthShare. Enrollment does not guarantee HSA contribution eligibility.
On VitalCare Deductible, all services except preventive care are subject to the deductible, and the deductible must be met before the plan pays for other medical services. The copays in these examples apply after that. Anything not listed here is in each plan’s benefit summary below.
The Zion HealthShare IUA levels
You choose one IUA (Initial Unshareable Amount) at enrollment. You pay it per eligible need, up to 3 per household in any rolling 12-month period. A higher IUA means a lower monthly price and more paid per need. Maternity has its own IUA.
| IUA per need | Household limit (3 IUAs) | Maternity IUA |
|---|---|---|
| $1,250 | $3,750 | $2,500 |
| $2,500 | $7,500 | $2,500 |
| $5,000 | $15,000 | $5,000 |
The three-IUA limit is not an out-of-pocket maximum. It is separate from, and never added to, the VitalCare out-of-pocket maximum above.
*The three-IUA limit is not an overall medical-expense maximum. Sharing of eligible expenses is voluntary and not guaranteed. Zion HealthShare is not insurance.
What isn’t covered
VitalCare (Standard) doesn't cover: Emergency room care, hospital stays, surgery, CT/MRI/PET imaging, and childbirth & delivery. It also excludes specialty and non-preferred drugs, durable medical equipment, and other items in your plan documents. This is exactly why the second layer exists.
VitalCare Deductible doesn't cover: Emergency room care, hospital stays, surgery, CT/MRI/PET imaging, and childbirth & delivery. Prescriptions are discount only (PureRx). It also excludes durable medical equipment and other items in your plan documents. This is exactly why the second layer exists.
On the Zion HealthShare side, sharing is voluntary and not guaranteed, some expenses are ineligible, and needs that began before membership are limited and phase in. The Member Guidelines set out what is and isn’t shareable, and they control.
Documents
These are the documents that govern what you’d have. Where this site and a document differ, the document controls.
- VitalCare (Standard) — benefit summary (PDF)
- VitalCare (Standard) — Summary of Benefits and Coverage, 2026 (PDF)
- VitalCare Deductible — benefit summary (PDF)
- VitalCare Deductible — Summary of Benefits and Coverage, 2026 (PDF)
- Zion HealthShare Member Guidelines (version January 1, 2026)
Available in every state except Washington (WA). State-specific notices (Zion HealthShare)
This bundle includes a VitalCare Minimum Essential Coverage (MEC) plan and a separate Zion HealthShare medical cost-sharing membership. VitalCare MEC does not provide comprehensive major medical insurance or meet the ACA Minimum Value standard. Zion HealthShare is not insurance, and payment or sharing of medical expenses is not guaranteed. Membership is subject to Zion's Member Guidelines.
Common questions
Is this package an insurance plan?
Partly. The package has two parts. The VitalCare plan is insurance — it meets Minimum Essential Coverage (MEC) standards but does not meet Minimum Value, so it is not a major medical plan. The Zion HealthShare membership is not insurance: it is a health care sharing ministry, sharing is voluntary, and payment of your medical bills is not guaranteed.
Can I use my own doctor?
VitalCare uses the MultiPlan PHCS network, and out-of-network care is not covered. Before enrolling — and before any appointment — check that your doctor is in network at multiplan.com or by calling 1-800-457-1309.
When do my VitalCare benefits and Zion HealthShare membership begin?
Both begin together on your start date, which is the 1st of a month. If you enroll by the 25th, your start date is the 1st of the next month. Your first month's payment is charged when you enroll, and monthly payments after that are charged on the 25th. Your exact start date and payment schedule are shown on the review screen before you submit. Timing rules also apply to medical needs that began before your membership, and to maternity (a six (6)-month waiting period) — see the Member Guidelines.
What if I already have insurance?
The package pairs a VitalCare insurance plan for everyday care with a Zion HealthShare membership for large medical events. The HealthShare portion is not insurance. If you already have comprehensive coverage, talk with an advisor before making any change — and if you qualify for ACA premium tax credits, a marketplace plan may be the better fit. Check HealthCare.gov first.
Still deciding?
The decision guide walks through real scenarios at every IUA and is honest about who this program does not fit.