VI. Amounts That Members Share | Samaritan Ministries

This section explains how the shareable amount of a member’s medical expenses will be determined. There is no calendar year or lifetime limit on the number of conditions or the total dollar amount of different needs that may be shared. Itemized bills you want shared must be submitted within one year of treatment. Bills submitted more than a year after treatment will not ordinarily be shared.

A. Sharing Amounts

Medical needs are submitted on a per person per incident basis for illnesses or injuries resulting in visits to licensed medical professionals, emergency rooms, or hospitals (inpatient and outpatient).

Need Defined—Bills related to the same condition, progression of a condition, or updated diagnoses of a condition or set of symptoms—including those for separate incidents—(e.g. separate treatments or episodes of symptoms) will be shared as one need and accumulate towards the $250,000 maximum amount shared in Samaritan Classic/$247,500 in Samaritan Basic. If at least 12 months pass without any symptoms, medication, or other treatment for the condition that originally created the need (or related subsequent conditions), and the condition thereafter recurs, it will be treated as a new need. Tests or a doctor’s statement may be required to verify the lapse of symptoms, medication, or other treatment.

Multiple, Simultaneous Needs—If more than one shareable condition, progression of a condition, or updated diagnoses of a condition or set of symptoms— is treated during the same time period, the member may submit separate needs for each condition. Each need must be submitted with a separate Need Processing Form, whether submitting the need via postal mail or online via your Samaritan Dashboard. The initial unshareable amount will apply to each need.
For multiple conditions with similar symptoms and treatment protocols, Samaritan may require treatment(s) received to be considered part of a single need.

Initial Unshareable Amount—When a need is greater than $1,000 in Samaritan Classic, or $2,000 in Samaritan Basic, only the portion of the need that exceeds those amounts will be shareable. See paragraph 5. Due to current technical limitations, an amount less than $25 that is otherwise shareable may not be shared.

Effect of Discounts—
1. For Samaritan Basic—Payments by insurers and other organizations, and reductions by health care providers will be applied first, dollar for dollar, to the initial unshareable amount ($2,000) and any applicable proration of each need. Discounts do not affect the 90% sharing percentage of Samaritan Basic for need amounts over $2,000.
2. For Samaritan Classic—Effective for all needs started on or after September 1, 2020, payments by insurers and other organizations, and reductions by health care providers will not reduce the initial unshareable amount ($1,000) or any applicable proration of each need. Reductions and third-party payments will still apply toward the initial unshareable amount and proration for any need started prior to September 1, 2020.
Maximum Amount—The maximum amount shared for each non-maternity need in Samaritan Basic is $247,500 and in Samaritan Classic is $250,000. (If you desire to participate in need sharing for amounts greater than $250,000, see the Save to Share™ program Guidelines. Massachusetts’ members are required to participate in Save to Share™.) There is no lifetime maximum sharing amount for any person or household membership.

Special Guidelines for Participants in Samaritan Basic—
1. 90% Sharing Percentage—Needs for participants in Samaritan Basic are shared at 90% of the need amount that is over the $2,000 initial unshareable amount.
2. Maximum 10% Co-share Amount—The maximum amount unshareable due to the 90% sharing in Samaritan Basic is $2,500. For the maximum amount unshareable on maternity needs, see Section IX.
3. Maximum Shareable Amount—Paragraphs a & b together make $247,500 the maximum amount shared in Samaritan Basic.

B. Payments from Others

Others Obligated to Pay:
1. Insurance Type Arrangements—Bills must be submitted to insurance, Medicare, Worker’s Compensation, and any other payer who may be responsible, before submitting them to Samaritan Ministries. Members must receive notice of payment or rejection, and submit documentation thereof, before Samaritan Ministries will consider sharing the need. Any amount paid by insurance, Medicare, Worker’s Compensation, or any other responsible or liable party will not be shared. If a bill is shared and later reimbursed by a third party, or liability is released as part of a settlement, the reimbursed amount must be sent on to meet other members’ needs, even if the amount of medical expense compensation is not specified in the settlement.
2. Pursuing Legal Remedy—If a member suffers an injury and a probable liable party or his insurance refuses to pay unless legal remedies are pursued, the member must pursue his legal remedies unless he demonstrates that doing so would violate his Biblically-based conviction against initiating a lawsuit. Conditions may be placed on sharing needs related to such injuries before the matter is settled. Amounts that are received in settlement, to the extent they fairly represent compensation for shared medical expenses, must be sent on to meet other members’ needs.

Other Available Assistance—Seeking assistance from government aid programs is never required by SMI and is contrary to our understanding of God’s desire for His people. However, if a non-governmental, secular, religious, or fraternal organization is willing to pay any portion of a qualifying medical bill and the member refuses to accept this payment, the member has then chosen not to have that portion of the bill shared, unless the member demonstrates that accepting the assistance would violate his Biblical conviction. Funds raised by crowdfunding for shareable medical expenses must be reported to SMI and will be applied to reduce the shareable amount.

Health Reimbursement Arrangement (HRA), Flexible Spending Account (FSA), and Health Savings Account (HSA)—A member who has the right to a reimbursement from an HRA, FSA, or HSA for a shareable medical expense is not required to pay the bill with his HRA, FSA, or HSA although he should consider whether this resource should be used to lessen the burden that the other members will bear. If HRA, FSA, or HSA money is used to pay the expense, then that expense may still be submitted to be shared.
Note: There may be income tax consequences from using reimbursements from an HRA, FSA, or HSA to pay for an expense for which you also received share amounts. Please consult your tax advisor.

Other Health Care Sharing Organizations—If a member simultaneously participates in another health care sharing ministry, he may not seek shares/ payments from multiple ministries in excess of his shareable bills, for to do so is to obtain assistance beyond his burden.

C. Discounts

Discounts given by any health care provider should be listed in the Discounts column on the Bill List and will not be shared. However, in Samaritan Basic only, discounts do reduce the initial unshareable amount (see VI.A.5) and the amount subject to prorating (see VI.D.2).

D. Balancing Needs and Shares/Proration

The amount of a need that is shared may be affected by the amount of other members’ needs. Each month there is a fixed amount of committed shares available from members to be sent out to meet needs. However, the needs of members fluctuate, and in any one month may be greater, or less, than the shares available. Needs take varying amounts of time to process to be ready for sharing, and there is never an exact match between the amount of shares available for a month and the needs that have been received. Many times the mismatch between needs and shares is remedied by overlapping needs received in two months, but occasionally the discrepancy is too large for this simple adjustment. The handling of large fluctuations is described below:

When Shares are Greater Than Needs—If the shares available for a particular month are greater than the needs to be shared, and all of the unshared prorated needs from the previous month are also met, needs for the following month may be shared or the share amounts assigned to the members may be reduced for the month.

When Needs are Greater Than Shares/Prorating—It is our goal that all qualifying needs presented by the members will be shared. However, in the event that the shareable needs are significantly greater than the shares available for that particular month, we may use a prorating contingency plan. For example, if $1,000,000 in total needs are to be shared in a given month, but only $900,000 in shares are available, we will take the percentage of shares as compared to needs—900,000/1,000,000 = 90%—and apply that percentage to each need. Thus, we will share 90% of the normal shareable amount of each need presented for that particular month. If you have a need for which $1,000 would normally be shared, $900 would actually be shared that month. If you participate in Samaritan Basic, the 90% proration would first be applied, leaving $900 (assuming no offsetting discounts), and then multiply that amount times the 90% sharing percentage ($900 X 90%) making $810 the amount shared. We will ask members to pray that God will provide for the unshared portion of these needs in the following month. Members will also be encouraged to give more than their normal monthly share to help make up the shortfall. See Section V.B.

If in the month following the prorating we find that the shareable needs are less than the shares available, we will consider carrying over the unshared portion of prorated needs from the previous month. Once a deficit has run and one month has passed, we will not usually carry over the unshared needs to subsequent months. However, we will consider sharing prorated needs that are an excessive burden to a member as a Special Prayer Need. See Section V.A. In Samaritan Basic only, if medical providers have given you discounts on your bills, the discounts will be applied first to the initial $2,000 unshareable amount, and then to the amount that is prorated, reducing or eliminating the impact of prorating on your need.

Special Prorating Guidelines for Participants in Samaritan Classic—
1. Maximum Prorated Amount—Effective for all needs started on or after September 1, 2020, a need will not be prorated more than $2,500. A member would need to have a total of $83,500 in bills (after discounts) prorated at 3% to reach the maximum prorated amount. Bills submitted on the same need in non-prorated months would not contribute to this total since those bills are not prorated. If proration occurs for multiple months, the Board may increase the maximum prorated amount as needed.
  Example: A need of $150,000 receiving a $50,000 discount leaves a total amount of $100,000 in shareable bills. If the entire $100,000 is prorated at a standard amount of 3%, it would result in a prorated amount of $3,000 ($100,000 x .03). Thus, the need would be prorated the maximum amount of $2,500 instead of $3,000, and Samaritan would share $97,500 in shareable bills.

Samaritan Basic/Samaritan Classic/Future Programs—The balancing of needs and shares calculations may be done by sharing across two or more programs or by keeping them separate, as allowed by the SMI Board of Directors.

E. Time Limit for Submitting Documentation

The sooner that bills are submitted to SMI usually means the larger the reduction in price that can be obtained from the provider through negotiations. When there are a number of bills related to treating the same incident, it is helpful for them to be submitted together if they all can be obtained within a 30-day period. With this in mind, itemized bills should be submitted to the Samaritan office as soon as possible (either by mail using the Need Processing Form, or online via your Samaritan Dashboard). Ordinarily, bills submitted more than one year after the service was provided will not be shared.

Guidelines for Sharing in Classic/Basic

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