Initial Unshareable Amount and Proration Guidelines Changes

Samaritan has taken to heart the Biblical principles in Galatians 6:2, 5 that while some burdens require the entire community to come together, we also have individual loads to bear. When we need additional contributions from members to help with the overall burdens presented by the community, we can propose a Share increase and also address the disparity through cost structure changes. We seek to balance the burdens carried both by members with and without Needs.

Prorating is a process we use when there are more Needs than Shares. In months when more Needs are submitted than the amount of Shares available, we use prorating to help balance Needs and Shares. For example, if $1,000,000 in shareable bills are submitted, but there is only $970,000 in Shares available that month, 97 percent of each Need would be shared.

Members participate in important decisions by voting directly (such as electing Board members and raising Shares) and by proxy (when the member-led Board of Directors votes on behalf of all members). See Guidelines, Section IV.A. and V.B. for more information. The Board of Directors prayerfully considers each decision in light of applicable Scriptural guidance (e.g., Galatians 6:2, 5), member feedback, and trends in health care costs and bills members submit.

Despite the steady rise in health care costs, the IUA per Need has remained the same in Samaritan Classic ($300) for over 15 years. When Needs have exceeded Shares, many members have requested that we raise the IUA to help contain costs.

Based on research and the feedback received through member requests and focus groups, the member-led Board of Directors voted to raise the IUA to $400 per Need in Samaritan Classic. The IUA and proration will no longer be offset by discounts or waived on any new Need requests submitted beginning September 1, 2020 in Samaritan Classic.

In months when proration occurs, the proration percentage will be lower. Also, there will be a maximum prorated amount per Need of $2,500, which will lessen the impact proration has on members with especially large Needs. Historically we have seen proration percentages between 10 and 20 percent, whereas with these changes we anticipate proration will be approximately 3 to 5 percent for Needs in Samaritan Classic.

Yes. Based on research and the feedback received through member requests and focus groups, the member-led Board of Directors voted to implement these Guidelines changes. It has been 15 years since the IUA has increased, and this change will better coincide with the vast inflation in health care costs during that time. While it is a significant shift, having discounts no longer offset the IUA allowed for a smaller Share increase proposal, and with discounts no longer offsetting proration, we anticipate proration will be approximately 3 to 5 percent rather than the 10 to 20 percent proration we have historically seen.

We hear you and are with you in this struggle. This year has been especially hard for all of us. The timing of these changes and the Share increase vote is tough, and we know it. While we affirm to one another and must preach to our own hearts daily that Christ is our ultimate provider, here are some of the ways we have been trying to give additional support for members during this difficult time.

• We contributed $1.5 million in administrative funds to member Needs to avoid a month of prorating.
• We delayed prorating a separate month when COVID-19 hit with its accompanying uncertainty.
• When COVID-19 began to cause restrictions to health care access around the country and the world, we worked closely with eDocAmerica to both promote telehealth (which saves members money compared to traditional access to office visits) and to waive the $25 fee for call-a-doctor through the end of May.
• We extended the sharing cycle for more than 300 Needs to give additional time for negotiations.
• We've introduced a fair-price reward to help make more members aware of Healthcare Bluebook’s resources to identify providers that offer fair prices and quality care.
• We have a designated department that works directly with members and providers to secure fair prices, sometimes through upfront payment prior to treatment.

Costs keep rising, especially for hospitals, and we’ve looked at numerous options to address this. We constantly track prices of traditional insurance and other health care sharing organizations, and it’s clear that Samaritan’s struggle to manage the rising costs is not a unique one, as reflected in prices of insurance premiums, deductibles, or sharing amounts.

With the changes to the IUA and prorating, we are trying hard to keep in mind every member in every life situation; members with Needs and those without Needs, members’ monthly Share amounts and amounts shared for individual Needs. Those who can get discounts from providers and those who cannot (though certainly not for lack of effort). We know there’s still much uncertainty and difficulty in our nation. We feel all this with you and have been actively listening to members and seeking God’s wisdom. These are tremendously difficult decisions for us all. Please know you are loved and your participation in Samaritan Ministries is deeply valued and never taken for granted.

We understand that these changes may pinch already tight family budgets. As always, we must remind ourselves and one another that Christ is our ultimate provider, and He can be trusted in all things. While our resources are limited, we want to offer additional help when and where we are able. Some ways in which Samaritan seeks to help are through the Member Assistance Fund and our Sponsorship program, which can provide temporary relief from some of the financial strain of a full Share amount. One of the ways that we are also seeking to lessen the unexpected sting of proration, when it occurs, is by reducing the average proration percentage to around 3-5 percent (as opposed to the previous average 20 percent) and by implementing a maximum prorated amount per Need of $2,500, which will lessen the impact of proration for those with very large Needs.

Many members diligently seek discounts on their bills. We are so thankful that members are engaging with their health care, as reductions help all of us steward the limited resources within our community. Every effort helps! However, it is common for hospitals and providers to offer a minimal discount (often around 20 percent) that still leaves a significantly inflated price when compared with a fair-market price for that service. This means that the membership is still bearing a heavy burden that could be further mitigated by shifting our focus from standard discounts to getting a fair price.

Yes. We have a designated team working directly with members and providers that has found significant success toward achieving fair prices. The medical industry is changing, and while many members are highly engaged and able to secure fair prices, there is a greater percentage of members in the last few years who are having difficulty negotiating with providers. More providers are requiring thousands—or even tens of thousands— of dollars in upfront payments from members prior to being treated. We are proactively responding to these changes to serve members who have been asking for our help.

Yes. We believe the $250 fair-price reward is a further incentive for members to use Healthcare Bluebook. We anticipate its success and are hopeful that we will be able to expand it in the future!

The removal of offsetting discounts was a difficult decision as it is an incentive for many members. However, discounts are no longer as effective a measure of a fair price. Hospitals in particular have greatly inflated their gross billed charges, as you can see here. So, a 20 percent or even a 50 percent (or higher) discount doesn’t necessarily indicate a fair market price or what others are paying for those same services.

Therefore, in the past couple of years we have begun to inform members of the importance of fair market pricing using industry data, such as with Healthcare Bluebook. Members using those designated providers are regularly saving 50 percent off gross billed charges. The average discount among all members is under 40 percent. The difference of savings in real numbers is in the millions of dollars, all of which directly affects the monthly Share amount for all of us.

Any Need requests submitted prior to September 1, 2020 will continue to have an IUA of $300, and discounts will continue to offset the IUA as well as proration on that Need, per the Guidelines in effect at the time the Need was started.

As always, members will have the opportunity to donate to the Member Assistance Fund. Members who need help with the prorated amount of their Need will likewise continue to have the opportunity to request assistance.

Members in Samaritan Classic and Samaritan Basic with home birth or VBAC Needs may be eligible for a $250 fair-price reward from Samaritan. To qualify, when submitting your bills include a screenshot from Healthcare Bluebook of a fair price for a local hospital birth, demonstrating that your home birth or VBAC bill is a comparable or lower price.