Sharing Guidelines

II. Health Care Sharing Programs

REDEEM HealthShare is a nonprofit health care sharing ministry that facilitates direct member-to-member sharing of eligible medical expenses.

A. How Health Care Sharing Works

Health care sharing is a voluntary arrangement that unites individuals and families in the REDEEM community through acts of mutual support and love, reflecting the early Christian church's commitment to caring for one another (Acts 2:44-45). Guided by our shared faith and Biblical principles, we come together to bear each other's burdens and demonstrate the love of Christ in practical ways.

There is no transfer of risk from a member to REDEEM HealthShare or from a member to other members, and there is no contract of indemnity between REDEEM HealthShare and any member or between the members themselves.

REDEEM HealthShare Ministry is not an insurance company. The terminology and processes may be different or unfamiliar to you. REDEEM members do not pay “premiums” and REDEEM HealthShare does not collect money to “cover” medical expenses. Members receive Share notifications each month informing the members who they will be sharing with and the reason for the medical need. Members submit voluntary monthly Shares to assist other members with their eligible medical expenses and to support the administration and program services of the ministry. Members are always responsible for their medical bills and expenses.

Overview: The REDEEM™ HealthShare Sharing Process

Members select a sharing program that aligns with their desired level of medical expense sharing and financial considerations. Each month, members deposit their Total Share amounts into a specific member-owned (not-REDEEM-owned), bank account—called a Share Account—opened by the primary member during the application process with our third-party fiduciary, America’s Christian Credit Union. Medical providers or members submit medical bills to REDEEM HealthShare. Medical bills that are eligible for sharing per the Guidelines are matched, allocated, and published to the membership prior to sharing. REDEEM HealthShare implements a member-to-member approach to sharing which means that members share funds directly with one another. Through a process called Publishing, members matched to share receive a notification about 1) who will receive their funds, and 2) the amount from their Share Account that the member must withdraw for the payment of another member’s assigned bill. The amount shared to each receiving member is transferred to a Virtual Bill Account for the payment of the bill. Once completed, the funds directly transfer to the medical provider as payment for the bill or to the member where applicable.

You can find complete details on the sharing, publishing, and payment process in the REDEEM™ Sharing Platform (see Section V).

All eligible medical bills are subject to an Annual Unshareable Amount (AUA), which is the dollar amount a household membership must pay direct to providers toward their own eligible medical bills during a twelve (12) month period before their eligible medical bills can be published and shared by REDEEM HealthShare. Some REDEEM HealthShare programs have Co-Share amounts and other limits described herein.

REDEEM HealthShare offers three sharing programs which offer different sharing levels and health care sharing support and one optional add-on program providing additional flexible sharing options.

B. Important Membership Terminology

REDEEM HealthShare is defined using certain terms, vocabulary and definitions. A complete list may be found in the Glossary of Terms.

Annual Unshareable Amount (AUA). The Annual Unshareable Amount (AUA) is the dollar amount a household membership must pay toward their own eligible medical bills during a 12-month period before their eligible medical bills can be published and shared by the membership. All eligible medical bills are subject to the AUA unless otherwise specified. The AUA 12-month period begins on your effective date. The AUA resets on the anniversary of your membership date or upon switching between programs or AUA levels after which it resets on the Effective Date Anniversary.

Co-Share Amounts and Limits (REDEEM™ Essential only). In REDEEM Essential only, once the membership household meets their AUA, REDEEM HealthShare shares 80% of eligible medical bills. The member pays the remaining 20% (the Co-Share amount) up to the annual Co-Share limit directly to the provider. There is a $5,000 Co-Share limit per household membership per year. The Co-Share limit will reset on the anniversary of the membership date or on the effective date of any AUA reset occurring during the membership year.

Membership Date. Your membership date is the date that your membership in a REDEEM HealthShare program started. All medical bills with a date of service on or after this date will be determined for eligibility under these Guidelines.

Samaritan Ministries Legacy Member. A member who transfers their participation from a current Samaritan™ Classic or Samaritan™ Basic program without membership interruption to REDEEM. These members have transferred their participation from a current Samaritan Classic or Samaritan Basic program. For Samaritan Ministries Legacy Members who join REDEEM without membership interruption, any waiting period begins at the member's start date in the legacy program.

C. REDEEM™ Essential

REDEEM Essential offers a sharing solution at a low monthly cost and allows the household membership to select the level of sharing participation to determine their monthly share amount and AUA. Members share eligible medical expenses. Members do not share certain preventative screenings, wellness visits, and outpatient prescription costs. REDEEM Essential has a $1 million per household membership cap per year.

D. REDEEM™ Enhanced

REDEEM Enhanced is our most comprehensive sharing program and allows the household membership to select the level of sharing participation to determine the monthly share amount and AUA. Members share eligible medical expenses as well as certain preventative screenings, wellness visits, and prescription costs subject to the AUA as documented herein. REDEEM Enhanced has a $2 million per household membership cap per year and is not subject to a Co-Share.

E. REDEEM™ SeniorSaver

REDEEM SeniorSaver is a program for members 65 years of age and older. The AUA is $500. Only services covered by Medicare Part A, Part B, and if applicable, Medicare Advantage plans are eligible for sharing through REDEEM HealthShare even though a medical expense is eligible for sharing in REDEEM Essential or REDEEM Enhanced. Members are not required to join REDEEM SeniorSaver when they turn 65; they can participate in REDEEM Essential or REDEEM Enhanced for as long as they like.

Additional REDEEM SeniorSaver Requirements

1. Members must have Medicare Part D in order to have eligible prescription bills shared.
2. Members may only participate as an individual. A couple participating in REDEEM SeniorSaver would require two individual memberships. Those wishing to have a couple or family membership will need to participate in REDEEM Essential or REDEEM Enhanced.
3. All other membership requirements in Conditions of Sharing (Section IV) and Foundational Overview (Section I) apply.

F. FlexShare™

FlexShare is an optional add-on sharing service that permits sharing of additional items, such as vision, dental, and supplements. There is no Co-Share or AUA for the FlexShare add-on. The FlexShare add-on provides a per household membership annual allowance for eligible expenses of:

• $1,000 for REDEEM Essential
• $1,500 for REDEEM Enhanced
• $1,000 for REDEEM SeniorSaver

A household membership may submit bills in FlexShare after six months of participation. The annual allowance amount resets on the membership anniversary date or on the effective date, and any unused balance does not carry over to the next year. Participation in FlexShare can be added or removed from your membership at your Membership Anniversary Date.

FlexShare expenses must comply with the Membership Requirements, and bills or receipts must be submitted through the Member Center bill submission portal as a FlexShare expense. This feature is provided as supplementary support and, 1) subject to the annual FlexShare limit, 2) applicable terms and conditions, and 3) the exclusion list of items not eligible for sharing.

FlexShare expenses must comply with the Statement of Faith and Membership Requirements.

See the Appendix for examples of expenses that are eligible for FlexShare.

G. Annual Sharing Caps and Lifetime Limits

H. Liability

Members of REDEEM HealthShare Ministry share one another’s medical expenses. REDEEM HealthShare facilitates this member-to-member sharing by directing members’ shares to those who have eligible expenses. REDEEM HealthShare is not insurance. A division of Samaritan Ministries International, REDEEM HealthShare is a health care sharing ministry, as outlined in the Patient Protection and Affordable Care Act and facilitates the sharing of medical bills and expenses among members, one directly with another, according to these Guidelines, at the discretion of REDEEM HealthShare.

REDEEM HealthShare is not liable for the payment of a member’s medical bill. The REDEEM community of members pays for individual member’s medical expenses through share contributions. Members pay providers from share contributions they receive from other members. Medical bill funding does not come from REDEEM HealthShare itself. Members have no legal obligation to contribute toward another member’s medical bill. It is a sharing community.

REDEEM HealthShare’s programs are not insurance. However, individuals can use REDEEM HealthShare to be exempt from the “Affordable Care Act” federal mandate that became effective January 1, 2014, requiring “applicable individuals” to maintain “minimum essential [insurance] coverage” and also to be exempt from similar mandates in California, New Jersey, Rhode Island, Massachusetts, and the District of Columbia.

These are the only exceptions. Otherwise, members must not certify that REDEEM HealthShare is insurance to avoid purchasing insurance required by law, rule, or regulation, such as worker's compensation insurance, or extended auto coverage in some states, such as Michigan.