Guidelines for Sharing in Classic/Basic

Expenses for any medical service/treatment provided during your membership which meets these Guidelines are shareable while you are a member in good standing except as explained below or as otherwise agreed prior to membership.

If you ever switch membership levels from Samaritan Basic to Samaritan Classic, see Section XIV for an explanation of how your membership start date will change for purposes of determining whether a condition is pre-existing.

A. Conditions Cured & 12 Months Symptom and Treatment Free

Needs that result from a condition that existed prior to membership (known or producing observable symptoms) are only shareable if the condition appears to be cured, and 12 months have passed without any symptoms (whether or not benign), treatment, or medication (even if the cause of the symptoms is unknown or misdiagnosed). Tests or a doctor’s statement may be required to verify the lapse of symptoms, treatment, and medication.

Exception: For genetic disorders, hereditary diseases, cases of related cancers, and for heart conditions, the symptom/treatment-free period is five years.

Please note: New needs are not considered as "resulting from a condition that existed before membership" unless the prior condition actually caused the new need. Be aware that even though a condition may appear at one time to have been cured, there could be a subsequent relapse or complication which is a result of the original condition. SMI may require that the member provide a written opinion from a physician that the current need was not caused by the prior condition. Even though a need may not be shared because it resulted from a condition existing before membership, it may still qualify to be shared among our members as a Special Prayer Need. See Section V.A.

B. Conditions Stabilized and Five Years Symptom Free

A condition will not be considered as existing before membership, even though it may be known that it is not “cured,” if all these are documented by the member to be true for at least five years at the time your membership began, or sometime thereafter:

1. The condition had not been treated nor was future treatment prescribed/planned;
2. The condition had not produced harmful symptoms (only benign symptoms); and
3. The condition had not deteriorated.

New members are strongly encouraged to have the condition evaluated by their physician at the time of becoming a member to document that it has not deteriorated since the previous evaluation, or to establish a baseline. The statement described in Section VII.D will be required at the time bills are submitted for a need related to such a condition.

C. Exceptions for Diabetes, High Blood Pressure, and Cholesterol Level

1. Diabetes—Needs resulting from Type 1 diabetes that existed prior to a membership will not be shared even though the member went 12 months without symptoms, treatment, or medication.
2. Diabetes Explained—By Type 1 diabetes (also called juvenile onset diabetes), we mean that condition where the body produces insufficient insulin. Type 2 diabetes (also called “non-insulin dependent diabetes”), the condition where your body is insulin resistant, and gestational diabetes, are subject to a 12-month symptom and treatment-free limitation. The condition commonly referred to as “pre-diabetes” will not be considered a condition existing before membership. For Type 2 diabetes, you will have met the 12-month limitation if:
   1. at least 12 months have passed without any symptoms, treatment, or medication; and
   2. in the month before and the month after the 12-month period (and anytime you are tested in-between) your Hemoglobin A1C test level is 7 percent or below. Documentation of these test results must be provided to the office.
3. High Blood Pressure Exception—High blood pressure will not be considered a “condition existing prior to membership” even if you have not gone 12 months symptom free, as long as you have not been treated at a hospital for high blood pressure in the past five years, and you are able to control the condition through medication or diet. Medication for treatment as a chronic condition will not be shared.
4. Elevated Cholesterol—Is not by itself considered a pre-existing condition, nor the mere fact that a person is taking a prescribed statin drug. However, if the prescription is for diagnosed arteriosclerosis for a particular location (e.g. heart, carotid artery), that condition would be pre-existing as to that location.

D. Verification of Condition/Symptom History

To determine the eligibility of a condition, a statement signed by the doctor may be required verifying that the condition did not exist prior to membership, or that the member went at least 12 months (up to five years for some conditions) without symptoms, treatment, and medication subsequent to the last time the condition occurred before becoming a member.

E. Dropping and Rejoining

A condition that developed while a person is a member, will be considered a condition existing before membership if the person ends his membership, and later rejoins, unless:

1. the condition meets the cured/symptoms/treatment criteria of Section VII.A;
2. this membership was in good standing when ended, and the person was at all times while not a member either:
   1. insured under a required employer group insurance plan with creditable coverage (If available, the member may be required to purchase COBRA coverage to deal with ongoing treatment.); or
   2. a member of another health care sharing ministry with a reciprocal arrangement. (Conditions that developed while a person was not a member will still be governed by the limitations of Sections VII.A, B, and C.); or
3. other provisions were made in writing at the time the membership ended.

F. Adoption

Any physical condition of which the adopting parents had reason to be aware that 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, will be considered a “condition that existed before membership.” However, routine maternity needs may be shared as provided in Section IX.A.6 and needs related to genetic disorders and hereditary diseases may be shared as provided in Section VIII.A.