VIII. Need Sharing | Samaritan Ministries

We share expenses you incur for providing medical care to your membership household, within the Guidelines approved by the members or the Board of Directors (including the dollar and time limits of Sections VI and VII).

Every effort continues to be made to write the Guidelines to be simple and understandable. It is staff’s goal to find some way to share your medical bills within the constraints of what you as members have agreed through the Guidelines. If there is disagreement on the issue of shareability, there are multiple layers of appeals within staff, and ultimately the matter can be decided by a panel of members. See Section XII.A.

The approved Guidelines place some limitations on the types of physical maladies and medical services for which we share needs, and limit the sharing of expenses incurred due to injuries from certain listed causes.

This section is designed to allow you to quickly check the physical condition (Part A), and the medical services needed (Part B), to confirm whether or not a particular medical expense is shareable. There are special provisions for injuries from motor vehicle accidents (Part C), and a few services and charges that are not shared (Part D). There is also a section for guidelines regarding sharing of bills for new members (Part E). Please call your Member Services team if you have any questions regarding the application of these Guidelines. Also, see Section XI regarding advisory opinions and binding decisions.

A. Physical Conditions

Expenses for all types of physical conditions are generally shareable—subject to the treatment limitations of Part B—and with special provisions for some conditions as explained below:

Allergies—Shareable. A treatment plan may be required. Testing and treatment during the first 12 months of membership are generally not eligible.
1. However, acute treatment for an anaphylactic reaction from accidental exposure to an allergen is shareable even if this happens within the first 12 months of membership. Additional follow-up testing or treatment for the allergy is not eligible for sharing within the first 12 months of membership.
2. Epipens—The initial purchase of up to a double-pack of Epipens is shareable within the 120-day prescription window (Section VIII.A.29). Replacement of an Epipen after emergency use is shareable outside the 120-day window. Replacement of an Epipen due to expiration is not shareable.
3. Sublingual Immunotherapy (SLIT)—Shareable for a maximum of one year from the date of service of the first such treatment that is eligible for sharing.
4. Allergy Elimination Techniques (NAET)—Not shareable.

Arthritis—Shareable. Testing and treatment during the first 12 months of membership are generally not eligible. Undiagnosed joint pain may also not be eligible within the first 12 months of membership, unless confirmed not to be related to arthritis or any other condition with specific guidelines for new member sharing.

Autoimmune—Shareable. Testing and treatment during the first 12 months of membership are generally not eligible. General symptoms common to autoimmune conditions—e.g. general fatigue, inflammation, gut issues, etc. will be treated with the same new member sharing guidelines (Section VIII.E) as an autoimmune condition. Some common autoimmune conditions include but are not limited to, adrenal fatigue, immunodeficiency, multiple sclerosis (MS), Sjogren’s Syndrome, Epstein-Barr, Chronic Inflammatory Response Syndrome (CIRS), Mast Cell Activation Syndrome, Lyme disease, various toxicities, etc.

Back Problems—Shareable. Spinal surgery is generally not eligible in the first 12 months of membership, unless due to an acute injury or illness.

Bone Calcification—Shareable. Testing and treatment during the first 12 months of membership are generally not eligible.

Cancer—Shareable, but there may be a limitation if it is related to cancer of a type you had prior to becoming a member (see Section VII.A). During the first five years of membership, the statement described in Section VII.D may be required.

Complications from Maternity—Bills for complications to the mother incurred up to 90 days after birth are considered part of the maternity need. See Sections IX.A.3 and IX.C for details.

Complications Following Non-Shareable Medical Procedures—If complications arise from a medical procedure that is not shareable (e.g. a routine colonoscopy and most cosmetic surgery—see Section VIII.B), expenses for treating the complications are shareable unless the procedure that was the cause was not shareable due to moral reasons (e.g. Abortion—see Section VIII.D.1), or the complication itself is not shareable (e.g. a routine dental problem arising from the treatment of a routine dental problem).

Dental Conditions—Dental services are not shared, except when required due to an eligible accident or as a necessary accessory to treating another non-dental condition, such as an eligible genetic disorder (see Section VIII.A.11). The following accidents are considered ineligible: the breaking or injury of natural teeth caused by dental care, when eating, or by ineligible motor vehicle accidents (see Section VIII.C.2).

Diabetes—Shareable, unless it is related to diabetes you had prior to becoming a member and it does not come within the exception described in Section VII.C.2. During the first five years of membership, the statement described in Section VII.D may be required. Sharing of the cost of prescriptions for medication to treat diabetes is subject to a 120-day supply limit.

Genetic Disorders—Shareable when at least one of these is true:
1. Neither the condition nor a symptom of the condition was discovered until after membership had begun;
2. The condition has not required treatment or produced harmful symptoms, and has not deteriorated for at least five years;
3. The condition exists in a person who has been included in a membership from birth, and the mother was included in a membership prior to the pregnancy; or
4. If the condition exists in a person who was adopted, the person has been included in a membership since the adoption, and the adopting parents were unaware of the condition at the time the adoption was finalized.

Heart Conditions—Shareable unless related to a heart condition you had prior to becoming a member, and it does not come within the exceptions described in Section VII. During the first five years of membership, the statement described in Section VII.D may be required.

Hereditary Diseases—Shareable under the same conditions as Genetic Disorders.

High Blood Pressure—As long as you have not been treated in a hospital for high blood pressure in the past five years, and you have been able to control this condition through medication or diet, an incident that begins after your membership begins is shareable. It also qualifies for one 120-day period for sharing of prescription expenses (see Section VIII.B.25), as long as you were not previously on medication. Medication thereafter for treating a chronic condition is not shareable. See Section VII.C.3.

Hormone Imbalance—Shareable. A treatment plan may be required. Testing and treatment during the first 12 months of membership are generally not eligible.
1. Hormone Pellets and In-Office Treatment—Shareable for a maximum of one year from the date of service of the first such treatment that is eligible for sharing.
2. HGH for Insufficient Growth in Pre-Adolescents—Shareable according to the treatment plan for one year provided that the insufficient growth was not observed before membership. Sharing of treatment beyond one year will be considered based on annual growth status updates.
3. Other Hormone Treatments—Hormone products purchased through a pharmacy as prescription medication will be shared under the provisions of Section VIII.B.25 (Prescriptions) Hormone treatment purchased as a non-prescription over-the-counter medication, supplement, or cream is not eligible for sharing as explained in Supplements—Section VIII.D.22.

Joint Pain, Inflammation, and Degeneration—Testing and treatment during the first 12 months of membership is generally not shareable unless due to an acute injury or confirmed not to be related to arthritis or any other condition within the new member sharing guidelines. For eligibility of joint replacement surgery, see Section VIII.B.15.

Lipedema and Lymphedema—Shareable, but not eligible for sharing within the first 12 months of membership.

Lyme Disease, Lyme Co-Infections, and Other Tick-Born Illnesses—Shareable. Testing and treatment during the first 12 months of membership are generally not eligible. However, acute treatment for an identified tick bite with a bullseye rash within membership may be shareable within the first 12 months of membership. This may require verification from a physician.

Optical Conditions—Expenses related to diseases or injury that affect the eyes (including cornea replacement because of disease or injury) are eligible within the following limits:
1. Cataracts, glaucoma, and macular degeneration are ineligible for sharing within the first 12 months of membership.
2. Other conditions (infections, convergence insufficiency, detached retinas caused by disease, etc.) are eligible.
3. Vision therapy is shareable, and outpatient therapy will be included in the 20 total outpatient therapy sessions allowed for any particular need (Section VIII.B.33).
4. Routine and corrective optometric services, exams, or tests including eyeglasses, contacts, eye refraction, LASIK surgery, cornea replacement surgery, or other services when done primarily for corrective or cosmetic reason unrelated to disease or injury are not shareable.

Pregnancy/Maternity—See Section IX for the special provisions.

Restricted Airway Conditions—Testing and treatment during the first 12 months of membership are generally not eligible. General symptoms common to restricted airway conditions—e.g. sleep apnea, sleep disordered breathing, and temporomandibular join disorder (TMJ) will be treated with the same sharing guidelines as restricted airway conditions unless confirmed not to be related to a condition in the new member sharing guidelines (Section VIII.E.).

Sexually Transmitted Diseases (STDs)—HIV, AIDS, or other STDs contracted due to the actions of others (e.g. blood transfusions or medical procedures) will be shared. We do not share needs for sexually transmitted diseases, including the HIV virus and/or AIDS, when contracted by consensual sex outside of marriage, or through irresponsible behavior such as sharing hypodermic needles for legal or illegal drugs. It is the member’s responsibility to explain how the disease was contracted.

Varicose Veins—Shareable. Testing and treatment during the first 12 months of membership are generally not eligible.

B. Medical Services

Visits to licensed medical professionals, emergency rooms, hospitals, testing facilities, and outpatient surgery centers for treatments by a licensed medical professional (LMP) for injuries and illnesses are generally shareable when the expense is for what they may lawfully diagnose and/or treat under the license of their jurisdiction.

Examples may include Medical Doctor (MD), Doctor of Osteopathy (DO), Doctor of Nursing Practice (DNP), Physician Assistant (PA), Nurse Practitioner (NP), Certified Nurse Practitioner (CNP), Advanced Practice Nurse (APN, APRN), and Registered Nurse (RN).

Note that some LMPs may have limits within their license or certification on what they can lawfully diagnose or treatments they can perform. Examples may include Doctor of Chiropractic (DC), Licensed Physical Therapist (LPT), Licensed Occupational Therapist (LOT), Licensed Massage Therapist (LMT), Audiologist (AuD), Doctor of Podiatric Medicine (DPM), Licensed Speech Therapist, Licensed Speech Pathologist, Registered Speech Therapist, Licensed Acupuncturist (LAc), Licensed Practical Nurse (LPN), Midwife (CM, CNM, CPM, RM, RNM), Doctor of Dental Medicine (DMD), and Doctor of Optometry (OD).

Services that are eligible according to all other guidelines are also typically shareable when administered by medical professionals working with an LMP in a hospital or clinic setting. Examples include anesthesiologist, surgical tech, pathologist, radiologist, etc.

We do not share bills for treatments administered or prescribed by certain medical practitioners. Examples include Nutritionist/Dietician, Naturopathic Doctor (ND), Doctor of Naturopathic Medicine (NMD), Doctor of Natural Medicine (DNM), Traditional Naturopath (TN), Biblical Naturopath, Homeopath, Psychologist (PhD, PsyD), Doctor of Oriental Medicine (DOM), Doctor of Pastoral Counseling (D. PC), and Doctor of Pastoral Medicine (PSC.D/D. PSc).

Expenses for services rendered in any part of the world are shareable as long as the documentation meets the requirements of Section X.M. There are special rules and limitations for some services, and some services are not shareable as explained in this Section B:

Alternative Medical Practices (or non-conventional treatments)—
1. Alternative Treatments—The following alternative treatments are shareable if prescribed and administered by an eligible Licensed Medical Provider.
  - Acupuncture/Acupressure
  - Chiropractic Treatments and related services
  - Disc Decompression
  - Dry Needling
  - Hyperbaric Treatments
  - Massage Therapy and related services
  - Ozone Injections (does not include insufflation)
  - Physical Therapy and related services
  - Platelet Rich Plasma/Stem Cells
  - Prolotherapy
  - SoftWave Therapy
  Other alternative treatments are not shareable.
2. Alternative treatment defined—By alternative treatments, we mean treatments that meet one or more of the following:
  - Do not have American Medical Association (AMA) designations
  - Are not Centers for Medicaid & Medicare Services (CMS) billable.
  - Are classified as complementary and alternative medicine (CAM) rather than as evidence-based medicine (EBM).
3. Alternative testing—Alternative testing methods (muscle response testing, bioenergetic testing, kinesiology, EDSA and Zyto, etc.) are not shareable.
4. Integrative medicine programs—Bills for integrative program packages must be itemized before submitting to Samaritan to demonstrate what cost is for conventional services and what cost is for alternative services. The complementary and alternative treatments that are part of integrative medicine programs are not shareable.

Ambulance—See “Medical Transportation” (Section VIII.B.20).

Audiological—Surgery to correct hearing issues due to illness, accident, or congenital disorder is shareable. Hearing aids or any related examination or fitting, are not shareable unless for hearing loss caused by accident or disease (e.g. not shareable if due to aging or extended exposure to loud noise). Cochlear implants (and the related consultation and therapy), prosthetic inner ear stimulators, and similar implanted devices are shareable if a physician has provided written verification that the hearing loss cannot be addressed by non-surgical means.

Biofeedback Therapy—Will be shared if lawfully prescribed by a licensed medical professional for treatment of a disease, injury, or physical condition, but not if strictly for a mental disorder. Documentation of the prescription may be required and it is subject to the total outpatient therapy session limit (Section VIII.B.33).

Chiropractic—Services are shareable, including ancillary items, such as X-rays. Each office visit where adjustments, manipulations, or other therapy occurs counts toward one of the total therapy-type visits allowed for any one need (Section VIII.B.37). To be shareable, billings for each treatment must indicate the condition being treated. Maintenance treatments are not shareable.

Colonoscopy—A colonoscopy will be shareable when prescribed due to symptoms for a condition not evident prior to your membership, or when it results in the discovery of a shareable condition. Regular tests and checkups (Section VIII.B.32) are not shareable.

Concierge Medicine—See “Direct Primary Care” (Section VIII.B.10).

Cosmetic Surgery—Cosmetic surgery for disfiguration caused by amputation, disease (excluding acne), accident, and breast reconstruction following a mastectomy is shareable. All other elective cosmetic surgery done primarily for non-health reasons, including breast reduction or enhancement operations, is not shareable. See Section VIII.A.11 for cosmetic surgery related to a genetic disorder.

Dental—See “Dental Problems” (Section VIII.A.9).

Direct Primary Care—Both “Direct Primary Care” and “Concierge Medicine” are methods by which consumers pay a regular fee, usually monthly, to secure more favorable access to a primary care physician. That monthly fee for a member's household is shareable, within the limit for tests and checkups (Section VIII.B.32), as part of a shareable need, up to $100 for any month in which, in regards to that need, the physician is consulted, makes a referral, or charges for services.

Fertility—Fertility treatment or testing is not shareable. However, medical expenses for an embryo adoption and implantation by a married couple will be eligible for sharing as a Special Prayer Need.

Hospice Care—Hospice care services will be shared for 90 days upon prescription by a physician or certification that the person is terminally ill. Additional 90-day periods will be shared with a renewed prescription/certification subject to the per-need dollar maximum.

Hyperbaric Therapy—Shareable if prescribed for treatment of a specific injury or illness. Outpatient sessions will be included in the total outpatient therapy sessions allowed for any particular need. See Section VIII.B.33.

Injection and Intravenous Therapy—Shareable if prescribed to treat a specific condition. See Section VIII.A.1.a. Depending on the condition for which it is prescribed, these may not be eligible within the first 12 months of membership. Treatments that begin as maintenance, wellness, or preventive are generally not shareable.
1. Limits on Visits
  1. Inpatient—All eligible injection and intravenous therapy sessions administered as part of receiving inpatient care (e.g. while admitted to a hospital, or a long-term care hospital).
  2. Outpatient Injection and Intravenous Therapy—A treatment plan may be required. Limitations of sharing will be based on the method of treatment and treatment plan. Shareable for a maximum of one year from the date of service of the first such treatment that is eligible for sharing. The one-year limit does not apply to outpatient therapy that is a direct treatment for cancer or treats the pain or side effects of chemotherapy/radiation.
  3. Other Injected Treatments—Injected products purchased through a pharmacy will be shared under the provisions of VIII.B.25 (Prescriptions).

Joint Replacement and Spinal Surgery—Joint replacement, including disc replacement and spinal fusion surgery, is not eligible for sharing within the first 12 months of membership unless it is necessary as a result of an acute injury within membership.

Massage (Therapeutic)—Therapeutic Massage sessions are shareable if lawfully prescribed by a licensed medical professional to treat a specific medical condition. Outpatient massage sessions will count toward the 20 total of all therapy-type sessions limit for any one need. See Section VIII.B.33. To be shareable, billings for each treatment must indicate the condition being treated. Maintenance treatments are not shareable.

Medical Equipment-Rental/Purchase—Medical equipment is shareable if it is both necessary to treat a shareable condition, and if it assists with a therapy eligible for sharing (Section VIII.B.33), or it assists the member to perform normal life functions inhibited by an eligible condition within the following limits:
1. Shareable Up to $5,000 if a documented prescription is provided.
  1. Rentals—After one month, the additional rental cost of an item is shareable only if the member provides the cost of purchasing the item. The purchase price of that item will be the maximum total amount shareable for that item, whether rented or purchased.
  2. Equipment Not Shared—Indoor/outdoor exercise or gym equipment, saunas, hyperbaric chambers, home improvements to residences (anything that attaches to the dwelling), vehicles, or computers, iPads, and software.
  3. Additional Amounts—An additional amount over $5,000 may be shared if pre-approved in writing and substantial savings over other treatment options are demonstrated for that item, whether rented or purchased.
2. Maintenance/Repair/Replacement—The cost of maintaining, repairing, or replacing equipment is not shareable.
3. Sharing of Supplies for Equipment—Is subject to the 120-day Guideline limit for medical supplies. See Section VIII.B.18.
4. Equipment No Longer Needed—After the medical equipment has been shared and the member no longer plans to use it, the member is encouraged to sell the item, contact Samaritan, and return the funds to continue ministering to other members in need.

Medical Supplies—Medical supplies related to treating a qualifying medical condition are shareable for the customary cost of 120 days of treatment. All supplies provided during inpatient hospital stays and as a part of outpatient treatment by a medical provider will be shareable. Subsequent sharing for maintenance of the same condition will occur only when there is a new need.

Medical Tourism—SMI encourages its members to consider using distant providers when there are substantial savings. See the SMI website for more information. See “Travel Expenses” (Section VIII.B.35) for more details.

Medical Transportation—Medical transportation, including ambulance services and life flights to hospitals, is shareable in emergency situations or when prescribed by your health care provider for transport for admission to another medical facility. Transportation for appointments is not shared.

Newborn Care—See the Maternity and Newborn Guidelines (Section IX).

Organ Transplants—The costs to the member recipient of a routine (not experimental) organ transplant (including costs of the donor) are shareable, and are subject to the limitations for conditions that existed prior to membership (Section VII.A and B). The costs of a member donating a transplant is shareable only if the recipient is a member.

Osteopathic—Adjustments and manipulations, etc., are subject to the same total outpatient therapy limit as other therapy (see Section VIII.B.33). Other treatments that a licensed osteopath lawfully prescribes and that meet all other requirements will be shareable.

Physical Therapy—Shareable for injury or illness-related physical therapy received while you are in the hospital and for up to 20 sessions for outpatient therapy. Outpatient sessions will be included in the total outpatient therapy sessions allowed for any particular need. See Section VIII.B.33.

Prescriptions—We share up to a 120-day supply of any prescription for medication related to a qualifying medical condition purchased within 120 days of the date of the first prescription purchased for a need. Direct treatments for cancer, e.g. chemotherapy and drugs that treat the pain and side effects (but not maintenance or preventative) and anti-rejection drugs after an organ transplant, are not subject to this limitation. All medication, prescribed or not, administered during inpatient hospital stays will be shareable.
Note: We do not share the cost of prescriptions for maintenance of chronic or recurring conditions (e.g. diabetes, eczema, blood pressure control) beyond a one-time, 120-day supply. Subsequent sharing of a prescription for maintenance of the same condition will occur only when there is a new need. (See Section VI.A.1.) We do not share expenses for psychotropic medications for chemical imbalances unless they are verified by laboratory tests.

Prosthetics and Orthotics—Prosthetics are artificial devices that “replace or augment a missing or impaired part of the body.” An orthotic is a support or brace for weak or ineffective joints or muscles. The initial costs of prosthetics and orthotics are not eligible within the first 12 months of membership, unless necessary because of an acute illness or injury.
1. Certain Prosthetics Limited—Prosthetics for hair, teeth, and breasts are generally not shareable with certain exceptions for accidents and disease (see Section VIII.A.9 “Dental Problems” regarding teeth, and Section VIII.B.8 “Cosmetic Surgery” regarding breasts).
2. Replacements and Maintenance Limitations—
  1. Implanted—Expenses for replacements and maintenance of prosthetics and orthotics that are surgically implanted are generally shareable after a person has been a member for 12 months. During the first five years of membership, the statement described in Section VII.D may be required if the device was implanted prior to membership, to document that the problem with the device was not pre-existing.
  2. Not Implanted—To the extent that a prosthetic or orthotic is not implanted (i.e. it can be maintained externally without surgery or other intrusion into the body), costs of maintenance or replacement are not shareable unless it is for a condition that did not exist before membership and:
    1. the expense is due to a change in the physical condition of the member after the person has been a member for more than 12 months; or
    2. it is damaged in an accident. A failure during normal use is not an accident.
  3. Teeth—Maintenance and replacement for implanted teeth will be shared under the same Guidelines as natural teeth. See Section VIII.A.8.
  4. Heart-Related Devices—If the device is being used due to a heart condition which existed prior to membership, replacement and maintenance will be shareable after a five-year, maintenance-free period if there was no indication (besides the lapse of time) at the time of joining that replacement or maintenance might be necessary in the next 12 months. The five-year period can run both before and after joining.

Psychiatric Care—Inpatient psychiatric care due to involuntary commitment, and psychiatric treatment for changes in the brain due to injury or physical illness are shareable up to $50,000 per condition (as a part of the $250,000 need limit if not in Save to Share™). Psychotropic medication to treat chemical imbalances not demonstrable by lab tests is not shareable except for the situations described above. No other type of psychiatric care or services is shareable.

Psychological Services—Psychological services including psychophysiology are not shareable.

Sexual Dysfunction—Treatments for sexual dysfunction are not shareable unless due to injury or disease.

Speech Therapy—Therapy needs for treatment of speech problems related to an illness or accident (e.g. stroke) are shareable and subject to the total outpatient therapy session limit per need. See Section VIII.B.33.

Sterilization—Elective sterilization such as tubal ligation and vasectomy, or the reversal of the same, is not shareable. But, reversals may be shareable as Special Prayer Needs. See Section V.A. Procedures that result in sterilization are shareable if the reason for them is to treat a medical condition.

Tests and Checkups—Tests are shareable only when prescribed by a licensed provider because of symptoms that are evident for a condition that was not evident prior to becoming a member. Follow-up tests or checkups are not shareable more than one year after an illness or injury is: (1) stabilized after treatment, (2) in maintenance, or (3) in remission or is cured.

Therapy/Chiropractic—
1. For a therapy to be shared it must be an eligible treatment that is lawfully prescribed by a licensed medical professional (see Section VIII.B Intro) for a specific eligible condition:
  1. It must be a physical condition being treated—not a psychological, emotional, or spiritual condition. Examples of conditions we don’t share for: Attention Deficit Disorder, Attention Deficit Hyperactivity Disorder, Sensory Processing Disorder, Post Traumatic Stress Disorder, and cognitive developmental issues.
  2. It must be a physical treatment—not a psychological treatment. It can be physical by any of the below:
    1. Direct physical manipulation—e.g. chiropractic/osteopathic adjustments, physical and occupational therapy;
    2. Indirect physical manipulation—an outside agent’s stimuli prompts self-manipulation—e.g. speech therapy, biofeedback (non-psychological);
    3. A physical agent (matter or energy) impacts the body—e.g. radiation, oxygen, ultrasound, or heat.
2. Limits on Visits
  1. We share—
    1. Inpatient—all eligible therapy sessions administered as part of receiving inpatient care (e.g. while admitted to a hospital, or a long-term care hospital. Therapy at an inpatient rehab center is shareable for up to 45 days.) Inpatient services do not count toward the outpatient therapy limit;
    2. Outpatient—potentially up to 20 sessions of eligible outpatient therapy of all kinds combined for any one need. However, sessions prior to reaching the session limit are no longer shareable:
      1. when they become maintenance, or
      2. after one year unless a treatment plan allowing such treatments has previously been submitted and approved.
      3. A single visit to an outpatient health care provider will only be counted as one therapy session, even if multiple types of therapy are provided during that single visit.
      4. The therapy-session limit does not apply to outpatient therapy that is a direct treatment for cancer or treats the pain or side effects of chemo/radiation.
3. Misc. Requirements and Limitations
  1. Not Eligible for Sharing—
    1. Therapy that is simply maintenance, preventive, or to improve wellness/performance where no harmful symptoms are present for which the therapy is prescribed to improve;
    2. Remote therapy where the patient and the source of therapy are not in the same location. Services such as telemedicine consultation and prescriptions are eligible for sharing.

Transplants—See “Organ Transplants” (Section VIII.B.25).

Travel Expenses—Travel expenses (transportation, meals, and lodging) are not normally shared (Section VIII.D.24). However, where it can be demonstrated that a substantial savings in medical expenses resulted from the travel, reasonable expenses will be shared.

Visiting Nurses—We will share up to 45 days of prescribed visiting nursing care after you are released from a hospital. The days need not be consecutive.

C. Motor Vehicle Injuries

Most needs for motor vehicle related injuries are shared. A “motor vehicle” is any vehicle with an engine/motor used for transportation, work, or recreation. Bills must be submitted to any responsible or liable party before they will be considered for sharing. See Section VI.B.1 “Others Obligated to Pay.”

Shareable. Needs from injuries in a motor vehicle accident where the member is not an operator or passenger (in, on, or being pulled by the vehicle), but a pedestrian, bicyclist, bystander, etc., is shareable for the amount of the need that is not the responsibility of any insurance or liable party.

Shareable with Requirements. Needs from injuries in an accident where the member is an operator or passenger (in, on, or being pulled by the vehicle) of on-road or off-road motor vehicles such as snowmobiles, go-karts, off-road motorcycles, ATVs, tractors, farm implements, construction equipment, golf carts, personal moving devices, motorized watercraft of all kinds, and all aircraft, will be shareable for the amount of the need that is not the responsibility of any insurance or liable party, and if all of the following conditions are met. The operator and any rider:
1. were riding or operating the vehicle off a public road; or were riding or operating the vehicle on a public road of which the vehicle was of a type allowed on the public road, and
2. were insured as required by law (and if not insured, then only those expenses greater than the legally required medical coverage shall be shareable), and
3. were not operating the vehicle recklessly, or under the influence of alcohol or any illegal substance as defined by the applicable law.

D. Non-Qualifying Items

SMI is committed to honoring Jesus Christ in all our ways, spiritual and practical Therefore, some of the medical practices that are listed below are not shareable because they are contrary to Scripture, even though prescribed by a licensed medical professional. Additionally, other items are not shared for various practical reasons.

Because the Guidelines cannot list all possible treatments that violate Biblical principles, SMI retains the discretion to not share such treatments, whether or not doctor prescribed, even though not listed below.

Abortion—Expenses for abortion of a living, unborn baby will not be shareable.

Abuse of Drugs or Alcohol—Injuries that result from a member abusing drugs or alcohol will not be shareable.

Accidents to Teeth While Eating—The breaking or injury of natural teeth by accident when eating is not shareable.

ADD, ADHD, and SPD—Psychotropic medication to treat chemical imbalances not demonstrable by lab tests, for Attention Deficit Disorder, Attention Deficit Hyperactivity Disorder, Sensory Processing Disorder, and similar disorders is not shareable.

Aging “Reversals”—Treatments and devices for the normal, natural slow decline in bodily functions are usually not shareable as these are items for which members can normally budget, e.g. eyeglasses, hearing aids, dentures, sexual aids. (When the item is a burden beyond budgeting, it may qualify as a Special Prayer Need.) When there is a loss of function due to disease or injury, generally the treatment will be shareable subject to all other Guideline limitations.

Armed Conflict—Injuries or illness resulting from a member’s active participation as a combatant in an armed conflict, but not including acting in self-defense or in defense of hearth or home, are not shareable.

Contraceptives—Items prescribed or used primarily for contraception are not shareable.

Donations of Tissues and Organs—Not shareable unless to be used for another SMI member. Complications from the donation would be shareable, but only if not the responsibility of the donee or the providers involved.

Euthanasia—Expenses for intentionally terminating a human life are not shareable.

Infertility Expenses—Bills for prescriptions, tests, treatment, in vitro fertilization, or other procedures primarily to address infertility are not shareable. However, medical expenses for an embryo adoption and implantation by a married couple will be eligible for sharing as a Special Prayer Need.

Injuries from Certain Acts—Injuries or illness from participation in a riot, criminal act, assisted suicide, or euthanasia will not be shareable.

Interest/Late Charges—Costs incurred for late payment or interest charges from any care provider are not shareable. Interest or finance charges from a credit card or lending institution that a member borrows from to pay medical bills are also not shareable unless it results in a substantial savings for early payment (30+%), and is limited to three months.

Long-Term Care—Nursing home and other long-term care is not shareable. Separately-charged, non-routine medical services while in long-term care are shareable.

Membership Requirements Violated—Needs arising from conduct inconsistent with the membership requirements, or occurring when a member is not meeting the membership requirements, are not shareable.

Non-Medical Expenses—Phone calls, cots and/or meals for visitors, and other expenses not directly related to provided medical services are normally not shareable.

Prophylactic Surgery—Removal of healthy organs (such as due to increased risk of disease due to gene mutations) is generally not shareable.

Purchasing Supplies from Relatives—Purchases of supplies from a member's family will not be shared unless it is verified that it is being provided at cost.

Routine, Maintenance, Stabilized, Preventive, and Wellness Care—Costs that members commonly share (bear for one another) are unexpected burdens related to medical conditions. Treatments classified as “routine, maintenance, preventive, wellness,” or for a stabilized condition, are usually medical costs that should be anticipated and budgeted as part of the load for an individual to carry. For these reasons such costs are generally not shared; however, if these still present a burden, they may be eligible as a Special Prayer Need (Section V.A).

Service Animals—None of the costs of service animals are shareable.

Sex Reassignment—Procedures known as sex reassignment, gender reassignment, transmasculine procedures, transfeminine procedures, or other related procedures, including genitoplasty, are not shareable.

Sterilization—Procedures for sterilization, and not primarily to treat a medical condition, are not shareable.

Supplements (i.e. products that contain a dietary ingredient)—are not shareable.

Surrogacy—Expenses related to a surrogate pregnancy, whether or not the surrogate is a member, are not shareable.

Travel Expenses—Travel expenses and lodging expenses are normally not shareable. Reasonable travel, transportation, meals, and lodging will be considered shareable if a substantial savings will result (Section VIII.B.35).

Weight Reduction—Weight reduction programs, diet centers, and clinics are not shareable. Staples in the stomach, balloons inserted in the stomach, jaw wiring, or any other surgical procedures done primarily for weight reduction are not shareable.

E. New Member Sharing

Certain conditions and treatments are only shareable after 3 months or 12 months of membership.

The new member sharing guidelines apply to each individual based on when they began membership with Samaritan Ministries. Newborns born into membership are not subject to the new member sharing guidelines.

All Needs are subject to the pre-existing conditions sharing limits discussed in Section VII. Conditions that are pre-existing as described in Section VII will remain ineligible even if 3 months or 12 months have elapsed.

3 Month New Member Sharing—Within the first 3 months of being a Samaritan Ministries member, only Needs for eligible injuries, acute illnesses, or accidents may be shared. While Needs may be opened at any time, only bills with dates of service after the first 3 months of membership may be shared. Acute Illness Defined: A health condition developing quickly and lasting only a short period of time, such as a few days or weeks. Acute illnesses develop quickly, but often improve following the implementation of short- term or urgent care. Viruses, infections, or injuries are all common causes of acute illness e.g. pneumonia, appendicitis, influenza, etc.
12 Month New Member Sharing—Bills for certain conditions and treatments are eligible for sharing only after 12 months of being a member. If bills with dates of service prior to 12 months of membership still present a burden, they may be eligible as a Special Prayer Need (Section V.A). All conditions are also subject to the pre-existing conditions sharing limits discussed in Section VII.
1. Conditions—Bills for the following conditions are generally ineligible during the first year of membership:
  - Prosthetics (VIII.B.26)
  - Glaucoma (VIII.A.19)
  - Lyme Disease (VIII.A.3 & 18)
  - Cataracts (VIII.A.19)
  - Lipedema/Lymphedema (VIII.A.17)
  - Macular Degeneration (AMD) (VIII.A.19)
  - Varicose Veins (VIII.A.23)
  - Restricted Airway Conditions (VIII.A.21)
  - Bone Calcification (VIII.A.5)
  - Arthritis (VIII.A.2 & 16)
  - Autoimmune Conditions (VIII.A.3)
  Eligible bills for these conditions with dates of service after this waiting period may be shared.
2. Treatments—Bills for the following are ineligible within the first 12 months of membership:
  - Joint Replacement and Back Surgery
  - Hormone Therapy
  - Allergy Treatments
  Eligible bills for these treatments with dates of service after this waiting period may be shared.

Guidelines for Sharing in Classic/Basic

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