Guidelines for Sharing in Classic/Basic

Maternity needs are shared when the doctor’s estimated due date is 300 days or more after the date the mother’s membership began. In general, maternity needs include bills for prenatal care, delivery, postnatal care, and miscarriage, and are treated like any other medical expense.

There are specific Guidelines for types of maternity needs that are shareable in Samaritan Basic and Samaritan Classic (Section A) and the initial unshared amount (Section B). Expenses related to pregnancies and complications of birth of the mother and child with an ineligible due date may only be shared as a Special Prayer Need (Section C).

A. Maternity Needs That Are Shareable

1. One-Person Memberships: No Maternity Sharing (Two-Person Membership Required)—Maternity needs for one-person memberships of women under age 40 when they become pregnant, for both Samaritan Basic and Samaritan Classic, are not eligible for sharing except as Special Prayer Needs. This includes post-birth needs of the mother related to complications of birth. For a maternity expense to be shareable, the membership will need to be at a multi-person size (or at an equivalent monthly share amount when multi-person is not possible or practical) at least 300 days prior to the physician-calculated due date. (One family member participating in Classic and another participating in Basic does not constitute a two-person membership eligible to share maternity needs. Likewise, a one-person membership provided in connection with an employer or other group organization does not constitute "a multi-person size or equivalent.")
2. General Rule—Shareable maternity needs include bills for prenatal care, delivery, postnatal care, miscarriage, and congenital conditions. Shareable services include those of doulas (up to $500), midwives, doctors, nurse practitioners, and other licensed medical professionals. There are special criteria for sharing needs of the child from genetic disorders and hereditary diseases. See Section VIII.A.
3. Separate Needs—Bills for all pregnancy and birth-related complications of the mother incurred up to 90 days after birth will be shared as a part of the maternity need. Any pre-birth need of the child/children and routine postnatal care of the child, including no more than one routine outpatient doctor visit, will be part of the mother's maternity need. A post-birth need of the child beyond routine natal care will be considered the child's need separate from the mother's maternity need.
4. Multiple Birth Needs—When there are complications (anything beyond routine natal care) from, or as a part of, a multi-child pregnancy, the expenses for each child will be considered a separate need.
   Exception: If a multi-child pregnancy is the result of the use of fertility drugs, in vitro fertilization, or other artificial means, all pregnancy and birth-related complications of the children will be treated as one need.
5. Ectopic Pregnancies—
   1. Expenses Shared—Procedures related to a ruptured fallopian tube (including post-operative recovery of the mother, follow-up care, and treatment of any complications), and, where an ectopic pregnancy is diagnosed before a rupture, all pre-operative tests and consultations and expenses related to keeping the mother under medical care while determining what care should be offered for the mother and child.
   2. Expenses Not Shared—Procedures directly related to the termination of a living, unborn child and/or removal of the living, unborn child from the mother due to an ectopic pregnancy are not shared (e.g. methotrexate, salpingectomy, salpingostomy), unless the removal of the child from its ectopic location was for the primary purpose of saving the life of the child or improving the health of the child.
6. Adopted Child—Medical expenses of the birth mother and an adopted child, for which the adopting parents (both a husband and wife) became liable while members and which are not from a "condition existing before membership" (see Section II.E), are shareable the same as other maternity needs (e.g. two-person membership required). The shareable amount will be reduced by any credit which the member is entitled under the federal adoption income tax credit due solely to those medical expenses. However, if the parents had reason to know of a physical condition which the adopted child had prior to the adopting parents being legally responsible for the child’s expenses, or prior to his effective date within his parents’ membership, it will be considered a "condition that existed before membership" under Section VII.
7. Early Maternity Sharing—If a maternity care provider will reduce the normal charges if a member prepays some or all of the bill, we will consider sharing prior to the birth the cost of some of the services to the mother, e.g. hospital or birthing center, physician or midwife, and a doula (up to $500), but not services for the baby or other services for the mom such as blood and lab work, ultrasounds, chiropractic, anesthesia, massage, or progesterone. The member must request an estimate from the provider and submit it with the Need Processing Form, whether submitting the need via postal mail or online via your Samaritan Dashboard. If the resulting bills are less than the prepaid amount, the member must contact Member Services who will advise where to send the surplus.
8. Maternity Co-Share—The maternity co-share in Samaritan Basic is 10%, with a maximum co-share amount of $13,500. For maternity needs in Samaritan Classic with a due date on or after October 1, 2025, the maternity co-share is 30% with a maximum co-share amount of $3,000.
9. Maximum Maternity Shareable Amount Under Samaritan Basic—The qualified bills submitted for a maternity need (defined in paragraphs A.2 & 3) for mothers participating in Samaritan Basic are shared with a $5,000 initial maternity sharing limit. After $5,000 has been shared on the maternity need, nothing more is shared on the need until the sum of the co-share plus the unshared amount over the $5,000 initial maternity sharing limit reaches the $13,500 maximum co-share.
   
   Once the maximum co-share amount of $13,500 is reached, the remaining qualified bills are shared up to the $236,500 maximum shareable amount.

B. Initial Unshareable Amount/Proration

1. Standard Initial Amount—Like any other need, only the portion of a maternity need that exceeds $1,000 for Samaritan Classic and $2,000 for Samaritan Basic is shareable. See Section VI.A.3 and 4.
2. Home Births—Home births in both Samaritan Basic and Samaritan Classic have the initial unshareable amount waived and are not subject to prorating (see Section VI.D) because they reduce overall maternity costs.
3. After Cesarean—In both Samaritan Classic and Samaritan Basic, a vaginal birth after cesarean (VBAC) is not subject to prorating and the initial unshareable amount is waived.

C. Maternity Needs for Those With Ineligible Due Dates

Expenses related to pregnancies and complications of birth of the mother (and child’s postnatal expenses when related directly to a genetic disorder or hereditary disease, unless otherwise referenced in Section VIII.A.11) where the physician-calculated due date is less than 300 days after membership began—may only be shared as a Special Prayer Need (Section V.A).