Medical Needs


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

    A. Conditions Cured and 12 Months Symptom and Treatment Free

    Needs that result from a condition that existed prior to membership (known or producing observable symptoms) are only publishable if the condition appears to be cured, and 12 months have passed without any symptoms (benign or deleterious), 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 defects, 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 publishable 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 base- line. The statement described in 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 published 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 seven 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 published.
    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 would be pre-existing as to that location.

    D. Verification for Certain Conditions

    For some of the conditions listed in Section VIII, a statement signed by both the member and the doctor must be submitted verifying that the condition did not exist prior to membership, or 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.);
      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 published as provided in Section IX.A.3 and needs related to genetic defects and hereditary diseases may be published as provided in Section VIII.A.

     

     

     



  • Although we practice good stewardship by adhering to our Guidelines and limiting needs we publish to what members have agreed upon, we also strongly encourage giving above and beyond what is required. This can be done through Special Prayer Needs, through extra giving in proration months, and through the Sponsorship Program.

    A. Special Prayer Needs

    Needs that do not meet the Guidelines may be eligible for publication as Special Prayer Needs that members may give to in addition to their regular monthly share. SMI reserves the right to decide which needs will or will not be published as Special Prayer Needs. Requests that needs be submitted as Special Prayer Needs will be evaluated on such criteria as the extent of the financial burden, the availability of assistance from other sources, the degree to which the need was avoidable, and the amount of other pending requests.

    Before submitting a Special Prayer Need, consider your financial resources, what reductions you have requested from providers, and what assistance is available from your family and local Christian church. Remember that the SMI membership will be giving beyond their monthly shares to lighten your burden. For questions concerning Special Prayer Needs call 1-877-764- 2426 to speak to your Member Services team.

    B. Proration Months

    In months where a proration occurs, most members who had a published need that month will only have the prorated amount published, which may still leave a significant burden on some families. In such cases the monthly assignment sheet will show you the extra amount you, and the other members assigned that need, would have to send so that the member’s need would be fully met. All members are asked to prayerfully consider giving out of their surplus, beyond their minimum monthly share, to minimize the effect of the proration.

    You may give extra directly to the member assigned to you, or if you want to be able to receive a federal tax deduction for your gift, send it to the office designated for the member assistance fund.

    C. Sponsorship

    Even though members work to keep the monthly share amounts as low as possible, there are still circumstances when an applicant or current member may not be able to pay the entire amount. Because we are committed to the central role of the family and the local Christian church in all of life, including health care, application for help through Sponsorship will require that these other avenues of assistance be explored first, so they have the first opportunity to receive the blessing of giving. For more information about how to apply for Sponsorship or how to give to the Sponsorship program, please call us toll-free at 877-764-2426.


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

    A. Basic Need Amounts

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

    1. Minimum Amount to be a Publishable Need—Needs of less than $300 are not considered burdens that should be borne by other members. If a need of this size is a burden that the member cannot bear alone, help can be sought from family, friends, local Christian church, or it can be submitted as a Special Prayer Need.
    2. Initial Unpublished Amount—When a need is greater than $300, only the portion of the need that exceeds $300 will be eligible for publication. Due to current technical limitations, a publishable amount less than $25 may not be able to be shared.
    3. More than Three Needs in 12 Months—The special exception for an initial unpublishable amount on a 4th or more need in a 12-month period will not apply to needs created after October 31, 2016.
    4. Effect of Discounts—Payments by insurers and other organizations, and reductions by health care providers will be applied first, dollar for dollar, to the initial $300 unpublishable amount of each need.
    5. Maximum Amount—The maximum publishable amount for each need is $250,000. (If you desire to participate in a need sharing ministry for needs 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 amount eligible for sharing for any person or household membership.
    6. Need Defined—Bills related to the same condition, including those for separate incidents, (e.g. separate treatments or episodes of symptoms) will be published as one need and accumulate towards the $250,000 maximum amount. 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.
    7. Multiple, Simultaneous Needs—If more than one publishable condition 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. The initial unpublished amount will apply to each need.

    B. Payments from Others

    1. 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 publishing the need. Any amount paid by insurance, Medicare, Worker’s Compensation, or any other responsible or liable party will not be published. If a bill is published 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 publishing needs related to such injuries before the matter is settled. Amounts that are received in settlement, to the extent they fairly represent compensation for published medical expenses, must be sent on to meet other members’ needs.
    2. 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 published, unless the member demonstrates that accepting the assistance would violate his Biblical conviction.
    3. 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 publishable 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 for publication. 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.
    4. 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 publishable 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 published. However, discounts do reduce the initial unpublishable amount (see VI.A.4) and the amount subject to prorating (see VI.D.2).

    D. Balancing Needs and Shares/Proration

    The amount of a need that is published 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 publication, 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:

    1. When Shares are Greater Than Needs—If the shares available for a particular month are greater than the needs to be published, and all of the unpublished prorated needs from the previous month are also met, needs for the following month may be published or the share amounts assigned to the members may be reduced for the month.
    2. When Needs are Greater Than Shares/Prorating—It is our goal that all qualifying needs presented by the members will be published. However, in the event that the publishable 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 published 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 percent—and apply that percentage to each need. Thus, we will publish 90 percent of the normal publishable amount of each need presented for that particular month. If you have a need for which SMI would normally publish $1,000, only $900 would actually be published. We will ask members to pray that God will provide for the unpublished 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 published needs are less than the shares available, we will consider carrying over the unpublished 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 unpublished needs to subsequent months. However, we will consider publishing prorated needs that are an excessive burden to a member as a Special Prayer Need. See Section V. If medical providers have given you discounts on your bills, the discounts will be applied first to the initial $300 unpublished amount, and then to the amount that is prorated, reducing or eliminating the impact of prorating on your need.

    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 administrative office with a Need Processing Form as soon as possible. Ordinarily, bills submitted more than one year after the service was provided will not be published.


  • We publish for sharing, 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). The approved Guidelines place some limitations on the types of physical maladies and medical services for which we publish needs, and limit the publication of expenses incurred due to injuries from certain listed causes. We do not require that treatments be approved by the American Medical Association and welcome nutritional treatment approaches within the limits described in Section VIII.

    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 publishable. There are special provisions for injuries from motor vehicle accidents (Part C), and a few services and charges that are not published (Part D). Please call your Member Services team if you have any questions regarding the application of these Guidelines. Also, see Section XI regarding Advisory and Binding opinions.

    A. Physical Conditions for Which Expenses are Shared

    Expenses for all types of physical conditions are generally publishable with special provisions for some conditions as explained below:

    1. Asthma—Publishable. During the first three years of membership, the statement described in VII.D may be required.
    2. Back Problems—Publishable. During the first five years of membership, the statement described in VII.D may be required.
    3. Bunions—Publishable. During the first three years of membership, the statement described in VII.D may be required.
    4. Cancer—Publishable, 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 VII.D may be required.
    5. Carpal Tunnel Syndrome—Publishable. During the first three years of membership, the statement described in VII.D may be required.
    6. Complications from Maternity—Bills for complications to the mother are considered part of the maternity need. See Sections IX.A.2 and IX.C for details.
    7. Complications Following Non-publishable Medical Procedures—If complications arise from a medical procedure that is not publishable (e.g. a routine colonoscopy and most cosmetic surgery—see Section VIII.B), expenses for treating the complications are publishable unless the procedure that was the cause was not publishable due to moral reasons (e.g. Abortion—Section VIII.D.1), or the complication itself is not publishable (e.g. a routine dental problem arising from the treatment of a routine dental problem).
    8. Dental Problems
      1. We publish the treatment of the breaking or injury of natural teeth and caps (but not repairs to dentures or partial plates) by accidents (other than from dental care, when eating, and certain motor vehicle accidents) subject to the $300 initial unpublishable amount. See Section VIII.C.
      2. We publish non-routine dental treatments, such as any treatment that involves surgery on the bones (not teeth) in the mouth, including when surgery on the bones is a necessary part of otherwise routine dental work (not including the cost of implants) such as listed in paragraph c, after an initial unpublishable amount of 5 times the amount of the family share (5 X $495 = $2,475).
      3. We do not publish routine dental work such as (but not limited to): check-ups, cleanings (including deep cleanings), fillings, crowns, root canals, implants, removal of wisdom or infected teeth, dentures, bridges, anesthesia for routine dental care, or treatment of periodontal disease, except when these routine treatments are necessarily a part of surgery on the bones or other non-routine treatments.

        So, for example, if you have an infected tooth removed, that will normally not be publishable. But if the infection went into the jaw bone and required removal of some of the bone, then the entire procedure would be publishable. Implants are not included because they always involve “surgery on the bone,” and there usually are less expensive alternatives.
    9. Diabetes—Publishable, 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 VII.D may be required. Publication of the cost of prescriptions for medication or supplements to treat diabetes is subject to a 120-day supply limit.
    10. Foot Disorders—Publishable. During the first three years of membership, the statement described in VII.D may be required.
    11. Genetic Defects—Publishable 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.
    12. Heart Conditions—Publishable 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 VII.D may be required.
    13. Hemorrhoids—Publishable. During the first three years of membership, the statement described in VII.D may be required.
    14. Hereditary Diseases—Publishable under the same conditions as Genetic Defects.
    15. Hernia—Publishable. During the first three years of membership, the statement described in VII.D may be required.
    16. 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 publishable. It also qualifies for one 120-day period for publication of prescription expenses (see VIII.B.27), as long as you were not previously on medication. Medication thereafter for treating a chronic condition is not publishable. See Section VII.C.3.
    17. Pregnancy/Maternity—See Section IX for the special provisions.
    18. Prostate Conditions—Publishable. During the first three years of membership, the statement described in VII.D may be required.
    19. Sexually Transmitted Diseases (STDs)— HIV, AIDS, or other STDs contracted innocently (e.g. blood transfusions or medical procedures) will be published. We do not publish for sexually transmitted diseases, including the HIV virus and/or AIDS, when contracted sexually outside of marriage, or through irresponsible behavior such as sharing hypodermic needles for legal or illegal drugs. It is the member’s responsibility to demonstrate that the disease was contracted innocently.
    20. Sleep Apnea—Publishable. During the first three years of membership, the statement described in VII.D may be required.
    21. Temporomandibular Joint Dysfunction— Publishable. During the first three years of membership, the statement described in VII.D may be required.

    B. Medical Expenses for Which Sharing is Limited

    Visits to licensed medical providers, emergency rooms, hospitals, testing facilities, and outpatient surgery for lawfully-prescribed treatments by a licensed medical professional for injuries and illnesses are generally publishable. “Licensed medical provider” may include for example: osteopaths, naturopaths, chiropractors, and various credentialed levels of nurses, for which we will generally publish the expense for what they may lawfully diagnose and/or treat under the license of their juris- diction. Such lawfully-prescribed treatments will be publishable if provided by one licensed or certified to provide that treatment within the limits of these guidelines. Treatments provided by non-medical personnel, e.g. acupuncture and massage must be lawfully prescribed by a medical professional and documentation of the prescription may be required. A “Doctor of Acupuncture” or “Doctor of Oriental Medicine” is not considered a “medical provider” for these purposes. Expenses for services rendered in any part of the world are publishable as long as the documentation meets the requirements of Section X.L. There are special rules and limitations for some services, and some services are not publishable as explained in this Section B:

    1. Alternative Medical Practices (or nonconventional treatments)—An “alternative medical practice” or “treatment” is a treatment proposed by a member for a condition lawfully diagnosed by a licensed, medical professional, but not prescribed by the member’s provider. The member must present the request in writing, describing in detail the proposed treatment, the length of time envisioned for the treatment, their source of information about the treatment, and why it is not being prescribed by their provider. Alternative treatments may be published with prior written approval from Samaritan Ministries. Approval is based upon factors such as the less invasive nature of the proposed treatment, demonstration that such treatment will prevent more costly conventional treatments, consistency of the treatment with what a licensed medical provider would prescribe for illness or injury, and the member’s acceptance of appropriate preconditions for publishing the expenses.
    2. Ambulance—Ambulance transportation and life flights are publishable when medically or otherwise necessary or when prescribed by your health care provider for transport between medical facilities.
    3. Audiological—Surgery to correct hearing issues due to illness, accident, or congenital defect is publishable. Hearing aids or any related examination or fitting, are not publishable unless for hearing loss caused by accident or disease (e.g. not publishable 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 publishable if a physician has provided written verification that the hearing loss cannot be addressed by non-surgical means.
    4. Biofeedback Therapy—Will be published 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 global therapy session limit. See Section VIII.B.36.
    5. Chiropractic—Services are publishable, including ancillary items, such as prescribed nutritional supplements for up to 120 days and X-rays. Each office visit where adjustments, manipulations, or other therapy occurs counts towards one of the 40 total therapy-type visits allowed for any one need. See Section VIII.B.36. To be publishable, billings for each treatment must indicate the condition being treated. Maintenance treatments are not publishable.
    6. Colonoscopy—A colonoscopy will be publishable when prescribed due to symptoms for a condition not evident prior to your membership, or when it results in the discovery of a publishable condition. Regular tests and checkups (see #35) are not publishable.
    7. Concierge Medicine—See “Direct Primary Care” (#10).
    8. Cosmetic Surgery—Cosmetic surgery for disfiguration caused by amputation, disease (excluding acne), accident, and breast reconstruction following a mastectomy is publishable. All other elective cosmetic surgery done primarily for non-health reasons, including breast reduction or enhancement operations, is not publishable. See Section VIII.A.11 for cosmetic surgery related to a genetic defect.
    9. Dental—See “Dental Problems” (Section VIII.A.8).
    10. 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 (or his allocable share of a family fee) is publishable, within the limit for tests and checkups (Section VIII.B.35), as part of a publishable 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.
    11. Fertility—Fertility treatment or testing is not publishable. However, medical expenses for an embryo adoption and implantation will be eligible for sharing as a Special Prayer Need.
    12. Homeopathic—Homeopathic prescriptions and treatments will be published as long as within the allowed practice of a licensed provider. 

      Note: While many licensed providers use homeopathic methods, no U.S. state licenses homeopaths as such. So treatment from an unlicensed person who has a private certification as a homeopath is only publishable as an Alternative treatment. See VIII.B.1.
    13. Hormone and Intravenous Therapy— Publishable if prescribed to treat a specific condition, and a treatment plan signed by the provider is submitted. There may be a limitation placed on the number of sessions and maintenance treatments are not publishable.
    14. Hospice Care—Hospice care services will be published for 90 days upon prescription by a physician or certification that the person is terminally ill. Additional 90-day periods will be published with a renewed prescription/certification subject to the per-need dollar maximum.
    15. Hyperbaric Therapy—Publishable if prescribed for treatment of a specific injury or illness. Outpatient sessions will be included in the 40 total outpatient therapy sessions allowed for any particular need. See Section VIII.B.36.
    16. (Therapeutic) Massage—Therapeutic Massage sessions are publishable if lawfully prescribed by a licensed medical provider to treat a specific medical condition. Outpatient massage sessions will count toward the 40 total of all therapy-type sessions limit for any one need. See Section VIII.B.36. To be publishable, billings for each treatment must indicate the condition being treated. Maintenance treatments are not publishable.
    17. Medical Equipment–Rental/Purchase— Equipment necessary to treat a publishable condition, or assist the member to perform normal life functions due to a publishable condition, is publishable within the following limits:
      1. Publishable Up to 10 Times the Monthly Family Share Amount—Currently $4,950 ($495 x 10), for any one need if a documented prescription is provided.
        1. Rentals—After one month, the additional rental cost of an item is publishable only by providing the cost of purchasing the item.
        2. Maximum for an Item—Any one item costing over three times the family share amount, currently $1,485 ($495 x 3), requires written preapproval and publishing may be subject to conditions including limits on the amount publishable. The purchase price of an item will be the maximum total amount publishable for that item whether rented or purchased.
        3. Maximum for Therapy Replacement— If an item being purchased is replacing therapy sessions, the maximum amount published will be 40 times the cost of the therapy, less the cost of any therapy already published.
        4. Additional Amounts—An additional amount over $4,950 may be published if preapproved in writing and 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 publishable.
      3. Publishing of Supplies for Equipment—Is subject to the 120-day Guideline limit for medical supplies. See Section VIII.B.18.
    18. Medical Supplies—Medical supplies related to treating a qualifying medical condition are publishable 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 publishable. Subsequent publication for maintenance of the same condition will occur only when there is a new need. See Section VI.A.6.
    19. 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” (#38) for more details.
    20. Naturopathic—Naturopathic adjustments, manipulations, and similar treatments are subject to the same 40 office visit limits as other therapy (see VIII.B.36). Other treatments lawfully provided by a licensed Doctor of Naturopathy that meet all other requirements will be publishable.
    21. Newborn Care—See the Maternity and Newborn Guidelines (Section IX).
    22. Nutritionists—Services of nutritionists, dietary consultants or herbalists, and nutritional products are not eligible for sharing unless they are licensed or certified to provide the service, and the service is prescribed by a licensed medical professional or, if the member is hospitalized, prescribed by a member of the hospital staff. Prescribed nutritional products are publishable for the customary cost of a 120-day supply, not including inpatient hospital stays. The Guidelines for “Alternative Medical Practices” may also apply in some cases (Section VIII.B.1). See also “Supplements” and the special provisions for treating cancer (Section VIII.B.34). Exceptions: The cost of prescriptions of nutritional products for maintenance treatments of chronic or recurring conditions (e.g. diabetes, eczema, blood pressure control) is not eligible for sharing beyond a one-time, 120-day period. Subsequent sharing for nutritional products for the same condition will occur only when there is a new need (Section VI.A.6). 

      The cost of nutritional education and educational materials is not publishable.
    23. Optical—Expenses related to cataracts, glaucoma, and other diseases or injury (including cornea replacement due to disease or injury) are publishable. Vision therapy is publishable, and outpatient therapy will be included in the 40 total outpatient therapy sessions allowed for any particular need. See Section VIII.B.36. 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 reasons unrelated to disease or injury are not publishable.
    24. Organ Transplants—The costs to the member recipient of a routine (not experimental) organ transplant (including costs of the donor) are publishable, 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 publishable only if the recipient is a member.
    25. Osteopathic—Adjustments and manipulations, etc., are subject to the same 40 office visit limits as other therapy (see VIII.B.36). Other treatments that a licensed osteopath lawfully prescribes and that meet all other requirements will be publishable.
    26. Physical Therapy—Publishable for injury or illness related physical therapy received while you are in the hospital and for up to 40 sessions for outpatient therapy. Outpatient sessions will be included in the 40 total outpatient therapy sessions allowed for any particular need. See Section VIII.B.36.
    27. Prescriptions—We publish 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), anti-rejection drugs, and sublingual immunotherapy (a curative treatment for allergies) are not subject to this limitation. All medication, prescribed or not, administered during inpatient hospital stays will be publishable. 

      Note: We do not publish 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 publication of a prescription for maintenance of the same condition will occur only when there is a new need. See Section VI.A.6.) We do not publish expenses for psychotropic medications for chemical imbalances unless they are verified by laboratory tests.
    28. 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 generally publishable.
      1. Certain Prosthetics Limited—Prosthetics for hair, teeth, and breasts are generally not publishable with certain exceptions for accidents and disease (see Section VIII.A.8 “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 publishable. During the first five years of membership, the statement described in 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 publishable 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; 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 publishable after a five-year, maintenance-free period if there was no indication (besides the lapse of time) at the time of joining that replacement might be necessary in the next 12 months. The five-year period can run both before and after joining.
    29. Psychiatric Care—Inpatient psychiatric care due to involuntary commitment, and psychiatric treatment for changes in the brain due to injury or physical illness are publishable 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 publishable except for the situations described above. No other type of psychiatric care or services is publishable.
    30. Psychological Services—Psychological services including psychophysiology are not publishable.
    31. Sexual Dysfunction—Treatments for sexual dysfunction are not publishable unless due to injury or disease.
    32. Speech Therapy—Therapy needs for treatment of speech problems related to an illness or accident (e.g. stroke) are publishable and subject to the 40 outpatient therapy session limit per need, but developmental related speech therapy is not publishable. See Section VIII.B.36.
    33. Sterilization—Elective sterilization such as tubal ligation and vasectomy, or the reversal of the same, is not publishable. But, reversals may be publishable as Special Prayer Needs. See Section V.A. Procedures that result in sterilization are publishable if the reason for them is to treat a medical condition.
    34. Supplements—We normally publish up to a 120-day supply of any licensed medical provider-prescribed nutritional supplement, to treat a specific injury or illness, purchased within 120 days of the date of the first such prescription purchased for a need. A Supplement Treatment Plan form is required to be submitted, and can be obtained from the Member Services dept. 

      The 120-day supply limitation does not apply for the term of a pregnancy, nor when prescribed as a treatment (whether primary or secondary) for a diagnosed and continuing cancer condition; however, an updated Supplement Treatment Plan may be required periodically. Once the cancer is in remission, the 120-day supply limit will begin to apply.
    35. Tests and Checkups—Tests are publishable 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 more than one year after an illness or injury is stabilized after treatment, in remission, or cured are not publishable.
    36. Therapy—Publishable for biofeedback, hyperbaric, physical, occupational, speech, vision, chiropractic/naturopathic/osteopathic adjustments/manipulations, and analogous external therapies only if related to treatment of injury or disease (but not for developmental issues), and received while you are in the hospital, plus up to 40 additional sessions of outpatient therapy of all kinds combined—provided for any one need, if lawfully prescribed by a medical professional. Documentation of the prescription may be required. Some therapies have unique limitations. Check for entries under the specific therapy within Section VIII.B. A single visit to a health care provider will only be considered as one therapy session even if multiple types of therapy are provided during that session. Psychological therapies are not publishable.
    37. Transplants—See “Organ Transplants.”
    38. Travel Expenses—Travel expenses (transportation, meals, and lodging) are not normally shared (Section VIII.D.21). However, where it can be demonstrated that a substantial savings in medical expenses resulted from the travel, reasonable expenses will be shared.
    39. Visiting Nurses—We will publish up to 45 days of prescribed visiting nursing care after you are released from a hospital. The days need not be consecutive.

    C. Injuries Involving Motor Vehicles

    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 publication. See Section VI.B.1 “Others Obligated to Pay.”

    1. Publishable. 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 publishable for the amount of the need that is not the responsibility of any insurance or liable party.
    2. Publishable 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, four-wheel ATVs, tractors, farm implements, construction equipment, six-wheel ATVs, golf carts, personal moving devices, motorized watercraft of all kinds, and all aircraft, will be publishable 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 public highways, or were lawfully on the highway, and
      2. were not engaged in formal racing or stunt competition, and
      3. were not operating the vehicle recklessly, or under the influence of alcohol or any illegal substance as defined by the applicable law.
    3. Not Publishable. Expenses from injuries related to accidents involving three-wheel ATVs, even if local law allows them to travel on public roads.

    D. Miscellaneous Items Not Shared

    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 publishable 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.

    1. Abortion—Expenses for abortion of a living, unborn baby will not be publishable. 
    2. Abuse of Drugs or Alcohol—Injuries that result from a member abusing drugs or alcohol will not be publishable.
    3. Accidents to Teeth While Eating—The breaking or injury of natural teeth by accident when eating is not publishable.
    4. 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 are not publishable.
    5. Aging “Reversals”—Treatments and devices for the normal, natural slow decline in bodily functions are usually not publishable 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 publishable subject to all other guideline limitations.
    6. 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 publishable.
    7. Contraceptives—Items prescribed or used primarily for contraception are not publishable.
    8. Donations of Tissues and Organs—Not publishable unless to be used for another SMI member. Complications from the donation would be publishable, but only if not the responsibility of the donee or the providers involved.
    9. Ectopic Pregnancies—Expenses related to the termination of the life of an unborn child are not publishable. 

      The removal of a living unborn child from the mother which results in the death of the child is a “termination of the life of the child” unless the removal was one for the primary purpose of saving the life of the child, or improving the health of the child. 

      This means that the removal from the mother of an unborn child due to an ectopic pregnancy (outside the normal location in the uterus) is not publishable unless the member states they believed the child was not alive before the procedure. Considerations of the health or life of the mother does not change that the removal of a living unborn child from the mother may be a termination of life.
    10. Infertility Expenses—Bills for prescriptions, tests, treatment, in vitro fertilization, or other procedures primarily to address infertility are not publishable. However, medical expenses for an embryo adoption and implantation will be eligible for sharing as a Special Prayer Need.
    11. Injuries from Certain Acts—Injuries or illness from participation in a riot, criminal act, assisted suicide, or euthanasia will not be publishable.
    12. Interest/Late Charges—Costs incurred for late payment or interest charges from any care provider are not publishable. Interest or finance charges from a credit card or lending institution that a member borrows from to pay medical bills are also not publishable unless it results in a substantial savings for early payment (30+ percent), and is limited to three months.
    13. Long-Term Care—Nursing home and other long-term care is not publishable. Separately charged, non-routine medical services while in long-term care are publishable.
    14. 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 publishable.
    15. Non-Medical Expenses—Phone calls, cots and/or meals for visitors, and other expenses not directly related to provided medical services are normally not publishable.
    16. Products such as herbs, teas, vitamins, supplements, etc., are not publishable unless prescribed by a member of a hospital staff for a hospitalized patient, or lawfully prescribed by a licensed medical provider. See Sections VIII.B.22 and 34 for sharing limitations. The Guidelines for “Alternative Medical Practices” may also apply in some cases (Section VIII.B.1).
    17. Routine Medical Care such as routine physicals, checkups, vaccinations, flu shots, long-term maintenance prescriptions, and other routine medical expenses are not publishable.
    18. Self-Inflicted Injuries—Self-inflicted, non-accidental incidents for members over 12 years old are not publishable.
    19. Sterilization—Procedures for sterilization, and not primarily to treat a medical condition, are not publishable.
    20. Surrogacy—Expenses related to a surrogate pregnancy, whether or not the surrogate is a member, are not publishable.
    21. Travel Expenses—Travel expenses and lodging expenses are normally not publishable. Reasonable travel, transportation, meals, and lodging will be considered for publication if a substantial savings will result (Section VIII.B.38).
    22. Weight Reduction—Weight reduction programs, diet centers, and clinics are not publishable. Staples in the stomach, balloons inserted in the stomach, jaw wiring, or any other surgical procedures done primarily for weight reduction are not publishable.

     


  • 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 publishable (Section A) and the initial unpublished amount (Section B). Expenses related to pregnancies and complications of birth of the mother and child where the pregnancy began before membership will be shared as a Special Prayer Need (Section C).

    A. Maternity Needs that are Publishable

    1. General Rule—Publishable maternity needs include bills for prenatal care, delivery, postnatal care, miscarriage, and congenital conditions. Publishable services include those of doulas (up to $500), midwives, doctors, nurse practitioners, and other licensed medical professionals. There are special criteria for publishing needs of the child from genetic defects and hereditary diseases. See Section VIII.A.
    2. Separate Needs—Bills for all pregnancy and birth-related complications of the mother will be published 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. 

      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.
    3. Adopted Child—Medical expenses of the birth mother and an adopted child, for which the adopting parents are liable and which are not from a “condition existing before membership” (see Section II.E), are publishable the same as other maternity needs, less any credit amount to 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.
    4. Early Publication—If a maternity care provider will reduce the normal charges if a member prepays some or all of the bill, we will consider publishing 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. If the resulting bills are less than the prepaid amount, the member must contact Member Services who will advise where to send the surplus. 

    B. Initial Unpublishable Amount/Proration

    1. Like any other need, only the portion of a maternity need that exceeds $300 will be eligible for publication. See VI.A.1 and 2.
    2. Home Births—Home births have the initial unpublishable $300 waived and are not subject to prorating (see VI.D) because they reduce overall maternity costs.
    3. The initial unpublishable $300 is waived for a vaginal birth after cesarean (VBAC).

    C. Maternity Needs for Pregnancies Beginning Prior to Membership

    Expenses related to pregnancies and complications of birth of the mother and child where the pregnancy began before membership will be shared as a Special Prayer Need (Section V.A). A pregnancy will be considered to have begun before membership if the doctor’s estimated due date is less than 250 days after the mother’s membership began.


  • Qualified expenses will be shared for all who are included in a household (see Section II) that meets the membership requirements (see Section I) when the expense occurs. For a need to be published, a household must be current with the annual membership continuation verification and all shares, through the time he was a member, even if he is no longer a member when the need is published.

    Please carefully follow these instructions for submitting your medical needs.

    A. First verify that your medical need meets the publishable needs Guidelines (Sections VI–IX). Next, call Samaritan Ministries toll-free at 877-764-2426. You will be directed to your Member Services team who will mail you a Need Processing packet. Read the instructions in the Need Processing packet mailed to you and follow them carefully.

    B. If you prefer to submit your bills online instead, you can use your Samaritan Dashboard. Go go your Dashboard apps, click the Needs app, and then follow the online instructions. 

    C. Along with your Need Processing Form, you must submit itemized bills to Samaritan Ministries. Ask your health care provider to itemize all bills, and make copies to keep for your own records. If you are submitting your need online, you will need to have electronic versions of your itemized bills, to upload them when prompted. 

    D. An itemized bill will contain the following information:

    1. Name, address, and phone number of the provider
    2. Name of the patient
    3. Date(s) of services provided
    4. Cost
    5. Description of the services or item
    6. Account number if available

    The most common need processing delays are caused by bills that do not provide specific and complete information about the services you received. Bills that merely give amounts or codes may not be accepted. Overbilling and errors are common in health care, and detailed bills allow you and Samaritan Ministries to verify that you are being billed correctly.

    E. Read the “Common Questions” on the sheet included in your Need Processing packet, and seek reductions on your bills, using as a guide the “Suggestions for Negotiating Reductions” section. Reductions may decrease the $300 unpublishable amount for your need, and reductions help reduce the burden for all members.

    F. On the “Bill List,” list the amounts you have been billed. Also list any payments by other agencies and discounts from the health care provider. These reductions will not be published.

    G. Total the columns on the “Bill List” and number your bills according to the list.

    H. Fill out the Member Questionnaire section. Your need will not be published without it.

    I. Include a letter or note explaining the incident so we can better understand your need. Describe how we may pray for you or give praise for how God is already working in the situation. A short summary of your condition will be included in the monthly Prayer Guide and in the assignment sheet sent to the members who will be sharing with you.

    J. Mail your need to Samaritan Ministries in the need envelope provided (or submit it online via your Samaritan Dashboard). Correctly submitted needs are generally published in 30-60 days, helping you to pay the medical bills in a timely fashion.

    K. If additional bills for the same need arrive after you have submitted your need, call for an Add-on Form designated for your need, to submit the additional bills (or submit them online via your Samaritan Dashboard).

    L. If you are treated for an illness or medical condition in another country, the entire itemized billing statement must be written or translated in English, and the cost must be converted to U.S. dollars.

    M. 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 (either by mail using the Need Processing Form, or online via your Samaritan Dashboard) as soon as possible. Ordinarily, bills submitted more than one year after the service was provided will not be published.

    N. Negotiations for Reductions

    One of the reasons that the monthly share is kept low is the substantial reductions from original billings that members and our negotiators are able to obtain. We encourage members to seek discounts even on small bills, but depending on the situation, often our negotiators are able to save even more. When you submit your need you are committing to cooperate with SMI staff and agents to seek equitable prices from providers and to document amounts you have paid to providers if needed.

     

     


  • A. Only members of SMI through the Christian Health Care Newsletter (CHCN) are eligible to participate in the Save to Share™ ministry.

    B. Each household must participate in Save to Share™ with the same level of membership (one person, two-person family, three or more person family, or widowed/divorced with children) as they have in CHCN

    C. In addition to the annual administrative share, each participating household must set aside funds that will be dedicated for use in the Save to Share™ program. As of February 2017, the current annual household amount required to be set aside is $133 for one person, $266 for a two-person membership and widowed/divorced parents with children, and $399 for a three or more person family.

    Voting—Set-aside amounts can only be raised by a vote of the Save to Share™ participants with a 60 percent majority of the weighted votes cast required for approval.

    D. Any unused funds remaining at the end of a year’s participation are to be held for future needs if the household continues participation, and the household will be asked to set aside an additional full year’s amount for the new year. (A household will not be asked to add any amount that brings the total set aside to more than three times the current annual set-aside amount.)

    E. An annual administrative share (currently $15) will be required from each participating household. This share is separate from the set-aside amount and is paid to SMI.

    F. The funds set aside are the property of the member and will be used at the member’s voluntary discretion. If the member ceases participation in the Save to Share™ ministry, unused funds will remain the property of the member

    G. Financial Difficulties—If your financial situation changes and you believe you will not be able to continue giving through Save to Share™, please contact your Member Services team immediately so that future Save to Share™ needs will not be assigned to you.


  • A. All of the responsibilities of members and the requirements for submitting needs as set forth in the CHCN Guidelines apply similarly to Save to Share™ participants except when the Save to Share™ Guidelines specifically provide otherwise.

    B. Only needs eligible for publication in CHCN will be qualified to be published in Save to Share™. The only CHCN publishable needs that would not qualify for publication in Save to Share™ are needs resulting from:

    1. Type 1 diabetes that existed prior to joining Save to Share™; or
    2. Any other condition that developed before or while a person was a member of SMI, but before they joined (or rejoined) Save to Share™, and
      1. a 12-month period without symptoms, treatment, or medication had not elapsed (five years for genetic defects, hereditary diseases, cases of related cancers, and heart conditions); or
      2. the condition fits the special exception described in Section VII.B of the basic Guidelines, for Conditions Stabilized and Five Years Symptom Free. Those newly joining Save to Share™ with such a condition should consider documenting the status of that condition at the time of joining. 

        It is also necessary to fit within the exceptions of a. or b. above, for a condition which developed while a person participated in Save to Share™, if the person later dropped out of Save to Share™ and then rejoined.

    Note: Members of SMI who joined Save to Share™ prior to January 1, 2004 are able to have published needs from conditions that began prior to their Save to Share™ participation but first occurred after they became SMI members.

    C. Save to Share™ needs will only be published in months when there is a qualified need to share.

    D. New SMI members who join Save to Share™ at the same time as they join CHCN will not be asked to share in Save to Share™ needs until they begin sharing with regular needs.

    E. When a member who participates in Save to Share™ has a publishable need that is more than $250,000, the amount of that need that exceeds $250,000 will be eligible for publication to other Save to Share™ participants. It will only be the amount of the need over $250,000 that is published even though the CHCN Guidelines may not have published all of the first $250,000 of the need due to proration or a special limit. See Section IX.

    Large needs frequently are the result of the reality that most health care providers charge patients without insurance substantially more than insured patients. Therefore, Save to Share™ needs are not published until satisfactory negotiations with providers toward reductions in bills have occurred.

    F. In order to have a Save to Share™ need published, a Save to Share™ participant must have the appropriate amount set aside, must have given to all Save to Share™ needs that have been assigned to him, must be current in sharing with all CHCN needs assigned to him, and must be a member in good standing of SMI. A Save to Share™ participant who does not send his share after two notices may be removed from participation and, once removed, will not be eligible for reinstatement.

    G. Needs that qualify for publication will be divided among participating households in proportion to the amounts set aside by Save to Share™ participants by year.

    Example: If a Save to Share™ participant has a publishable need of $350,000 after negotiations, the first $250,000 would be published in CHCN according to those Guidelines (including implementation of the pro rata provision if necessary). The remaining $100,000 would be published in Save to Share™. If the total amount set aside by participants for the current year is $500,000, then each household would be asked to share 20 percent ($100,000/$500,000) of their current year set-aside amount balance.

    So a two-person membership which had not yet shared for the current year would be asked to share $266 x .20 = $53.20.

    H. If the amount of one need qualifying for publication in Save to Share™ exceeds half of the funds for the current year held by the participants at the time of publication, only half of these funds will be assigned for sharing. Funds held from the previous years would then be assigned to the remaining unmet portion of the need, up to half of these funds.

    Example: After the example in item G above, there is another need amounting to $300,000 (after the first $250,000 was published under the CHCN Guidelines).

    There is $400,000 available in the current year set-aside amount after publishing the need in the item G example above. Only $200,000 of the $300,000 need will be allocated to the current year to stay within the half limitation mentioned above ($200,000/$400,000 = 50 percent). So the two-person membership that now has remaining $212.80 set aside for the current year ($266 minus $53.20 sent to the item G example need above), will be asked to share 50 percent of the balance, i.e. $212.80 x .50 = $106.40 with the second need.

    If the previous years’ set-aside balance is $300,000, then those Save to Share™ members with previous years’ set-aside amounts will be asked to share one-third of that balance ($100,000/$300,000) with the second Save to Share™ need to help with the remaining $100,000.

    If at any time there are multiple Save to Share™ needs in process, and the order in which they are published could affect the maximum amount published for a particular need, then the need given priority for calculating the publishable amount will be the need for which the properly completed form (and all required documentation) first arrived.

    I. Giving to Save to Share™ needs is done through the monthly newsletter mailing. The publishable amount of the Save to Share™ need is determined and then divided proportionally among all Save to Share™ member households according to their level of membership (i.e. one person, two-person family, three or more person family, widowed/divorced with children). The correct Save to Share™ amount is then added to the regular share amount for each of these Save to Share™ households.

    The Save to Share™ gifts are added to the total amount of share money available, and then enough of this larger amount is assigned to selected Save to Share™ members to be given to the Save to Share™ need(s). The other Save to Share™ members are directed to send their entire amounts (including the Save to Share™ amount) to regular needs. In this way the members with Save to Share™ needs receive the amount they should receive, but instead of being inundated with a large number of small gifts coming from every Save to Share™ member, they receive a more manageable number of larger gifts.


  • A. These Guidelines may be amended by the Samaritan Ministries Board of Directors. The Board has the option of taking an advisory vote of the Save to Share™ participants.

    B. If a member disagrees with a determination made by the Samaritan Ministries staff regarding a need, they may ask for the matter to be submitted to a panel of seven to 13 randomly chosen Save to Share™ participants.

    C. Any disputes remaining after this resolution process will be handled using the mediation/ arbitration procedures specified in the CHCN Guidelines, Section XII.B and C.

Membership


  • To become a member you must meet all the requirements of this section and submit an application, including a pastor’s verification. As long as you continue to meet these requirements and fulfill all membership duties as determined by the Board of Directors, your membership will continue. If at any time you no longer meet all these membership requirements, you must notify SMI immediately, and your membership and all privileges will be suspended unless otherwise indicated.

    Your health status has no effect on your eligibility for membership. However, there are limitations on the sharing of needs for some conditions that existed before membership. Other needs in which members share have specific requirements. For a detailed explanation of the types of needs that are publishable or not publishable to the members, see the publishable needs Guidelines (Sections VI-IX).

    To be eligible to have a need shared, a member must be meeting all of the requirements of membership including being current with all shares, and the need must not be caused by conduct inconsistent with membership requirements.

    We believe the following membership requirements benefit all members by being Scriptural, and also by minimizing medical risks and costs, ensuring proper accountability, and encouraging good health practices:

    A. Be a professing Christian according to Biblical principles. Romans 10:9-10, John 3:3

    B. Be in agreement with the following member statement of faith:

    • I believe in the triune God of the Bible. He is one God Who is revealed in three distinct Persons—God the Father, God the Son, and God the Holy Spirit.
    • I believe Jesus Christ was God in the flesh—fully God and fully man. He was born of a virgin, lived a sinless life, died on the cross to pay the penalty for our sins, was bodily resurrected on the third day, and now is seated in the heavens at the right hand of God, the Father.
    • I believe that all people are born with a sinful nature and can be saved from eternal death only by trusting in Christ’s atoning death and resurrection to save us from our sins and give us eternal life.

    C. Attend a Christian church regularly (at least three out of four weeks per month that your health or weather permits). Hebrews 10:25 If it is not possible for you to attend a Christian church, please submit a letter giving the details.

    D. Believe that you are to bear one another’s burdens as taught in the Bible. Galatians 6:2; Philippians 2:4

    E. Agree to: not abuse any legal or prescribed substance, abstain totally from illegal drugs and recreational use of marijuana, and abstain from tobacco use (a rare celebratory cigar or pipe, e.g. at the birth of a baby, is an allowed exception). Romans 13:1; I Corinthians 6:12

    F. Choose option one or two regarding the use of alcohol. Ephesians 5:18 

    1.  Abstain totally from all beverages containing alcohol (wine used for communion only is an approved exception). 
    2. Limit consumption of alcohol to moderate amounts so as to never drink to drunkenness.

    G. Abstain from any sexual activity outside of traditional Biblical marriage as designed by God between one man and one woman. Genesis 2:24, Matthew 19:5, I Corinthians 6:18

    H. Agree to practice good health measures in accordance with the principle that your body is the temple of the Holy Spirit. I Corinthians 6:19-20

    I. Keep your membership active and current by promptly sending your monthly share to all regular needs assigned to you in the monthly newsletter mailing. Luke 16:10 Members who are not current in sending their monthly shares will not be eligible to have needs published, and will be choosing not to continue their membership if the failure is not corrected after notice has been given. If financial need is the cause of these problems, assistance may be available through the Sponsorship Program (Section V.C).

    J. Be in agreement that when you have a dispute with a fellow Christian, and your fellow Christian is willing to submit that dispute to fellow believers for resolution, you are not to sue each other in the civil courts or other government agency I Corinthians 6:1-8 (Section XII). A person initiating a governmental proceeding against SMI to become a member would disqualify himself from membership.

    K. Sign and send to us your Membership Continuation Form each year confirming that you are meeting the above requirements. Proverbs 10:9

    L. Have your pastor or Christian church leader sign a statement confirming that you meet the above requirements. Hebrews 13:17

    M. You will be required to complete an application form agreeing to these requirements and providing background information including your date of birth. Annually, you will need to confirm that you meet these requirements


  • There are four primary levels of household participation for SMI membership: one person; two persons (two members of the same nuclear family); three or more person family; and widowed, divorced, or legally separated with children. Nuclear family includes only husband, wife, and children, and can include grandchildren in the circumstances described in II.F. 

    Any unmarried children age 17 and under, and unmarried children age 18 and over who meet the requirements of paragraph A, may be included as a child in a family membership and may submit medical needs for publication if they meet the member requirements in Section I and are listed on the Membership Application/ Continuation Form. Children 18 and over must verify that they meet the member requirements by signing an application form. 

    A. Children Age 18 and Over 

    Your single children from age 18 up to and including age 25 may be on your membership if they are living at home (which includes while away at school full time). 

    Single children age 26 and over may be on your membership if they are still living in your home and have an annual adjusted gross income (AGI) for federal tax purposes of less than 80 times the standard one-person membership monthly share. 

    Example: For the current standard one-person monthly share of $220, the AGI limit is $220 x 80, or $17,600. 

    Additionally, if your child’s AGI exceeds $17,600, in special circumstances (e.g. a handicapped child) there is administrative leeway for your child to remain on your family membership. Contact your Member Services team if you wish to apply for this status. 

    B. Marriage 

    When your children are married, they must have their own membership even if they qualify as your dependent, or are under age 26. The spouse will not be a part of the new membership until they submit an application. 

    C. Thirty Day Transition Allowance 

    1. Children who become ineligible to be on their parents’ membership—as described in Section II.A and B above, will have a 30-day grace period to obtain their own membership after which they will no longer be considered part of their parents’ membership. It is the child’s obligation to be aware when he is responsible for his own membership. 

    2. Gap Time—Any incidents which occur from the time a child leaves his parents’ membership to the date he begins his own, will not be published. 

    D. Newborn 

    A newborn, whose addition to the household membership will increase the monthly share amount, will be included within the household membership retroactive to the date of birth as long as you notify SMI to add him to the membership no later than 30 days after birth; otherwise, the effective membership date will be no earlier than the date of notification to SMI. SMI should be notified as soon as possible to add subsequent newborn children to the membership. Please be aware that there are specific Guidelines addressing publishing needs for a newborn (Section IX). 

    E. Adoption 

    Adopted, unmarried children are considered members of the household the same as biological children. 

    F. Grandchildren 

    Grandchildren may be included as part of their grandparents’ membership if they meet all of the following criteria: 

    1. they live permanently with their grandparents (their residence), and 

    2. the grandparents have legal custody, or the grandchild is the child of a minor, and 

    3. they meet the eligibility Guidelines for children, and 

    4. they have no other agency, person, or group responsible for their medical bills


  • Please familiarize yourself with the following duties so we can minister to each other more efficiently and effectively. Your faithful participation directly ministers to other members.

    A. Check Your Mail—Each member should faithfully check the mail (or email if you have chosen that option) for the newsletter and promptly call the office to request the newsletter and your monthly share assignment if you have not received them by the 10th of the month.

    B. New Members—To begin a membership, each new member sends a start-up administrative fee to the SMI office, along with their share for the first month. The start-up administrative fee is currently $200. New members will also normally be assigned to send their shares for the second and third months to the office, although some may be directed to send to a member need to maintain basic amounts of share money for needs.

    C. Sending Shares—After the first three months of membership, the next nine months you will send your share to a member in need. Then, on your anniversary month of becoming a member, you will send your share to the office, and the following 11 months you will again send your monthly share to another member with a medical need. Eleven months of shares to a member, then one to the office, will then continue as long as you remain a member.

    D. Monthly Share—The assignment sheet in each month’s email or newsletter mailing will tell where the monthly share should be sent. The amount you send depends on your household’s membership level.

    If your share check does not have your individual name on it, please make sure your name is on the memo line or other location so proper credit will be given to you. The share must be sent in U.S. currency.

    As of February 2017, the monthly share amounts for the four primary levels of household participation are as follows: a one-person membership shares $220; a two-person membership shares $440 (two members of the same nuclear family); a three or more persons family membership shares $495; and a widowed or divorced parent with children shares $305.

    The monthly share is reduced for heads of household age 25 or younger. Those amounts are as follows: a one-person membership shares $180; a two-person membership shares $360 (two members of the same nuclear family); a three or more persons family membership shares $445; and a widowed or divorced parent with children shares $255.

    If you need assistance with your share amount, see Section V.C. “Sponsorship.”

    E. Overseas Members—Must have a stateside contact through which to send monthly shares and to receive shares sent to help with a need in a timely manner. The Member Services department can waive the need for a contact, if the member demonstrates that requirements are met by other means.

    F. Sending Notes—Along with your monthly share, send a note of encouragement to the member with the medical need to which you are assigned. Also pray for this member and for other members listed in the Prayer Guide included with each newsletter.

    G. Respect the Privacy of Other Members— Members share deeply personal prayer requests and detailed health information with one another to allow for specific prayer. While it is expected this information may be shared with family and prayer partners, please be sensitive: Do not post names or details on social media, blogs, or websites without permission, or in any other way misuse the information.

    H. Misuse of Trust and Accountability—At all times act with integrity and avoid the appearance of evil. Members presenting a falsified need, using deceptive practices, or participating in another member’s misuse of trust will be dropped from membership.

    When a need is submitted requesting other members share financially to relieve the burden of a medical expense, the member submitting the need is committing that those medical expenses will be paid immediately, if not already paid, to the extent of the sharing received.

    Members submitting needs further commit to work with SMI staff and agents to seek equitable prices from providers and to document amounts paid to providers.

    If a member receives more share money than the amount of his financial need, as a result of discounts or other changes (see FAQ 25), he will be directed to forward any extra share money to another member with a need or to the administrative office to assist with the cost of negotiating reductions in SMI members’ medical bills.

    When an issue of possible misuse of trust by a member arises (whether or not still active or currently a member), the administrative office may seek the assistance of the member’s Christian church and provide it with the necessary information to address the issue and hold the member accountable. The member may request resolution of the question through the mediation and arbitration provisions of Section XII of the Guidelines.

    I. Ending Membership—If you wish to end your membership, SMI must have received notice from you no later than the 15th day of the month that you want to be the last month for which you share, so that a member with a need will not be relying on receiving your share. (E.g., if you want your last sharing month to be for the share that is due to be sent by March 15, you must notify SMI by February 15.) After the 15th of the month, SMI will be preparing share slips to send the following month, counting on the share you have pledged to help meet the needs of our brothers and sisters.

    J. Modifying Membership—If you are continuing your membership, but removing from the membership a spouse, or otherwise lowering the level of household participation, SMI must have received notice from you no later than the 15th day of the month that you want to be the last month for which you share the higher amount, so that a member with a need will not be relying on receiving the higher share amount. (E.g., if you want your monthly share to be modified for the share that is due to be sent by March 15, you must notify SMI by February 15.)

    Additionally, if a spouse is being removed from the membership, the notice is not effective until written approval of the change signed by the removed spouse is received by SMI.

    K. Restarting a Membership After 30 Days

    1. And a Need has Occurred—If you have a need occur (whether new or related to a prior need) after the date that your membership has ended, and you seek to restart your membership more than 30 days after the membership ended:
      1. It will be treated as a new membership so all existing health conditions will be subject to the pre-existing conditions sharing limits discussed in Section VII, and
      2. You may be required to pay a start-up fee.
    2. And No Need has Occurred—If you seek to restart your membership and no need has occurred since your membership ended:
      1. If you notify Member Services within 60 days after the membership ended and you catch up on any missed shares, your membership will be treated as if it never ended.
      2. If you notify MS more than 60 days after your membership ended it will be treated as a new membership so all existing health conditions will be subject to the pre-existing conditions sharing limits discussed in Section VII, and you may be required to pay a start-up fee.

    L. Restarting a Membership After One Year—If you seek to restart a membership more than a year after it ended, it will be treated as a brand new membership requiring a new application and start-up fee, and subject to the pre-existing health conditions sharing limits of Section VII as if you had never been a member.


  • A. Nominations and Elections

    From SMI’s inception, members have participated in determining how the ministry functions. Members continue to participate in important decisions by voting. Each household receives one ballot. Three or more person family ballots count for 3 votes, widowed or divorced parents with children: 2.5 votes, two persons: 2 votes, and one person: 1 vote.

    1. For Board Members—The SMI Board consists of nine members of SMI. Six Board members are elected by the membership to staggered three-year terms. Members nominate candidates and vote by mail. Elections are announced in the newsletter and held each fall. The qualifications for Board members are available upon request. Samaritan Ministries founder and international president, Ted Pittenger, is a permanent Board member and will appoint the other two Board members.

    If the elected positions are contested, the two candidates receiving the most votes are elected. A candidate only receiving a plurality will be the winner unless the Board determines that a runoff should occur between the highest candidates. If there is only one candidate for each position, members will be provided with a “Yes/No” ballot, and each candidate must receive a simple majority of the weighted votes cast to be elected.

    To be eligible for Board membership, nominees must agree with the following Board member Statement of Faith

    • I believe the Bible alone is the inspired Word of God; therefore it is the final and only source of absolute spiritual authority. 
    • I believe in the triune God of the Bible. He is one God Who is revealed in three distinct Persons—God the Father, God the Son, and God the Holy Spirit. 
    • I believe Jesus Christ was God in the flesh—fully God and fully man. He was born of a virgin, lived a sinless life, died on the cross to pay the penalty for our sins, was bodily resurrected on the third day, and now is seated in the heavens at the right hand of God, the Father. 
    • I believe that all people are born with a sinful nature and can be saved from eternal death only by grace alone, through faith alone, trusting only in Christ’s atoning death and resurrection to save us from our sins and give us eternal life. 
    • I believe in the bodily resurrection of all who have put their faith in Jesus Christ, and the bodily resurrection to judgment of all who have not. 
    • All I believe and do should be for the glory of God alone.

    2. For Share Increases—If needs submitted are greater than shares available and “prorating” of needs occurs for three consecutive months, members will be provided an opportunity to vote on whether they want to increase the monthly share, although voting may be limited to those members whose share amount will be directly affected by the outcome. A month will not be considered to be part of three consecutive prorated months if all the needs for that month have been met through a surplus of shares the following month or by extra giving of members for prorated needs (see Section V.B). The Board may propose share increases to the members at other appropriate times, such as when it believes that the occurrence of prorating demonstrates the inadequacy of the share amounts to meet all the needs which members have agreed to publish.

    For a proposal to increase the basic share amount to pass, it must receive a three-fifths majority of the weighted votes of the members cast. The discounts for young adults may only be changed by majority vote of the SMI Board.

    3. For Advisory Input on Other Issues—The Board may seek an advisory vote of the members on any issue, e.g. whether to make changes in the Guidelines concerning what medical needs should be published.

    B. Communicating With Each Other

    At SMI we believe all members of the body of Christ should give input for the mutual edification of the whole body. We encourage members to communicate with staff about all issues of health care. Your input can help us be more aware of ways to improve the ministry. You may know about new and effective medical treatments. You may know of ways to negotiate discounts or use alternate treatments to keep costs down. You may know of specific medical, spiritual, or financial needs. You may know of ways the staff can better serve our members and encourage a spirit of community. Input offered in a spirit of love is highly valued, and we welcome it. Our staff and members should always communicate with these scriptural admonitions in mind: “But the fruit of the Spirit is ... kindness ... gentleness” Galatians 5:22-23a and, “Let your speech always be gracious ... ” Colossians 4:6 (ESV)


  • Although Samaritan Ministries staff are trained to be forthright in phone conversations, routine responses to emails, and oral opinions offered by the staff do not constitute binding decisions. Members who call to inform us of their circumstances in order to discover if the need qualifies for publishing will be given an opinion—not a binding decision. Inquiries by members in writing explaining circumstances and medical procedures involved and specifically seeking a binding, written ruling from SMI Leadership will be answered in writing and will explicitly indicate if it is a decision that will bind SMI. The routine submission of bills to SMI followed by SMI’s standard “Need Status Letter” will not be considered such an inquiry or binding ruling.

     


  • Samaritan Ministries is a community of Christians and its members, as followers of Christ, believe that the Bible commands them to make every effort to live at peace and to resolve disputes with each other in private or within the Christian church (see Matthew 18:15-20; 1 Corinthians 6:1-8). A member who chooses to violate this command of Scripture and his covenant with his SMI brethren, and takes a dispute to court, destroys our fellowship and has chosen to be as if he had never been a Samaritan Ministries member, and to not have his needs shared with the membership.

    Therefore, in becoming a member or reaffirming your membership, you agree that any claim or dispute you have with, or against SMI, its employees, directors, members and associate members, that is related to SMI and its ministries in any way, shall be settled by Biblically-based mediation and, if necessary, legally binding arbitration. And SMI agrees similarly with respect to any matter SMI might have against you. The procedure to be used depends upon the nature of the issue as explained in paragraphs A and B.

    A. Questions Regarding Whether a Need is Publishable

    Nearly all needs can be determined to be publishable or not publishable according to the Guidelines. In matters where the Guidelines may not provide absolute clarity, Samaritan Ministries can usually determine whether the need should be published according to procedure and precedent. If Samaritan Ministries cannot determine whether the need is publishable, or if you believe we are misinterpreting the Guidelines or your circumstances, upon your written request explaining why you believe the bills in question are publishable under the Guidelines, the need will be submitted to a panel of seven to 13 randomly chosen members who will review the need to determine whether it is publishable. The panel’s decision will be binding on both SMI and the member. Your written request must be postmarked, or received by Samaritan Ministries International, no later than 90 days after you received the staff’s response to your last internal appeal.

    B. Resolution of All Other Issues

    Any issue not included under paragraph A to be resolved by the member panel, shall be settled in accordance with the Rules of Procedure for Christian Conciliation of the Institute for Christian Conciliation (Peacemaker Ministries). See www.peacemaker.net. However, if both SMI and the member agree, the dispute may be submitted to a randomly selected panel of members instead. In all events a member will have available the same relief as a court could grant. SMI will pay all of the arbitrator’s fees and costs unless the arbitration determines there was no reasonable basis for the member’s complaint.

    C. You and SMI Agree Not to Go to Court

    You understand that these methods shall be the sole remedy for any controversy or claim arising out of your relationship with SMI and expressly waive your right to file a lawsuit in any civil court against SMI, its employees, members, associate members and directors, for such disputes, except to enforce an arbitration decision obtained under paragraphs A or B. This also includes any determinations as to whether the matter in dispute comes within this arbitration agreement or can be required to be arbitrated. If an arbitration decision has been made, and anyone is failing to follow that decision, then in order to enforce the arbitration award under either paragraphs A or B, the decision may be entered only in the Circuit Court of Peoria County, Illinois.

    Resolving disputes within the Body of Christ is always the command of Scripture and in the interest of all our members (Matthew 18:15-20, I Corinthians 6). Therefore, even if SMI or a member participates to some extent in a court proceeding regarding a matter in dispute, this participation will not be forfeiting the ability to later demand that the dispute be resolved by these arbitration procedures.

    D. Applicable Law

    For all matters of procedure and substance regarding any dispute or claim that comes within these mediation/arbitration requirements, the laws of the State of Illinois, and if applicable of the United States, shall govern.

     


  • A. Procedures. These Guidelines may be amended by the Samaritan Ministries Board of Directors. The Board has the option of first taking an advisory vote of the members.

    B. Effective Date. Amendments to the Guidelines will go into effect as soon as administratively practical or as designated by the Board. If you have a need which began before the change was adopted, the publishing of bills related to that need will be determined by the Guidelines as they existed on the date the bills were incurred. However, bills related to a member’s need that would have been publishable under the Guidelines in effect when a need began, will remain publishable regardless of subsequent Guideline changes.

    C. Notice of Amendments. Members will be notified of changes to the Guidelines in the monthly newsletter, through postings on the ministry Web site, or by provision of updated Guidelines booklets when they are notified that their Membership Continuation Form is coming due.