IV. Conditions of Sharing
A. Family Members Defined
REDEEM HealthShare limits a membership to members of the same nuclear family. Nuclear families include only husband, wife, and children, but can include grandchildren in the circumstances described in 5. Grandchildren.
Children 18 and over must verify that they meet the member’s requirements by signing an application form.
1. Spouse
Spouse means a legally married person. It can be a person’s lawfully married husband or wife. Marriage is defined as being between one biologically born man and one biologically born woman.
2. Adult 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). A disabled child can remain on a family membership after turning 26 if the parents provide more than 50% financial support and claim the child as a dependent on their federal tax return. Contact Member Care before the date your child turns 26 if you wish to apply for this status.
3. Newborn
A newborn, whose addition to the membership may increase the monthly share amount, will be included within the membership retroactive to the date of birth, as long as at least one parent was a member as of the baby’s birth and you notify REDEEM HealthShare to add him or her to the membership no later than 30 days after the birth; otherwise, the effective membership date will be no earlier than the date of notification to REDEEM HealthShare. A member should notify REDEEM HealthShare as soon as possible to add subsequent newborn children to the membership. Section III.F.1 addresses sharing needs for a newborn.
4. Adoption
REDEEM HealthShare considers adopted, unmarried children members of the family the same as biological children.
5. Grandchildren
A REDEEM member may include their grandchildren as part of their membership if the children meet all the following criteria:
- They live permanently with their grandparents (their residence), and
- The grandparents have legal custody, or the grandchild is the child of a minor, and
- They meet the eligibility Guidelines for children, and
- They have no other agency, person, or group responsible for their medical bills.
6. Guardianships
REDEEM HealthShare allows for guardian memberships are allowed. The guardian must be 18 years old or older to manage the membership on behalf of a minor.
B. Inactivation of Membership
1. Voluntary Inactivation
Members can voluntarily inactivate their membership at any time, which shall take effect at the end of any month.
2. Involuntary Inactivation
REDEEM HealthShare will inactivate a membership if:
- The member fails to fully fund their Share Account for 60 days.
- The member fails to resolve Know Your Customer (KYC) issues within 60 days of Notice of Failure.
Notice Periods
- 30 Days' Notice: After 30 days of non-compliance, a member will receive a notice of their ineligibility for sharing until the member resolves the issue. REDEM HealthShare will suspend a membership, which means that members are not eligible to have new bills shared or to participate in membership voting.
- 60 Days' Notice: After 60 days of non-compliance, REDEEM HealthShare will inactivate the membership, effective from the date the member should have funded their Share Account.
C. Restart of Membership
If an existing membership inactivates due to voluntary or involuntary inactivation, a member may apply for a new membership. All membership requirements, waiting periods, and conditions will apply as if the member had no previous membership and include the following requirements:
- Any inactivated membership must pay back-shares, if any, in full before starting a new membership.
- Only eligible bills with dates of service prior to the inactivation date are eligible for sharing.
- Bills for conditions in which known signs, symptoms, testing, treatment (routine or maintenance) diagnosis, or use of medication (routine or maintenance) occurred after inactivation will be considered pre-existing and will not be shared in the new membership until applicable pre-existing waiting periods have lapsed.
D. Changing Programs
A member must meet specific criteria to change between programs or AUA levels.
Members are allowed to change their membership AUA level or program within 30 days of either their anniversary month or a qualifying life event, with the effective date being the first day of the following month.
Qualifying Life Event Changes:
- Change in marital status
- Change in child/dependents
- Birth/Adoption
- Loss of spouse
- Loss of employment
- Dependent turns 26
- Turning 65 and would like to join REDEEM SeniorSaver
The Program Change Request form is available in the Forms section of the Member Center.
Membership Anniversary Changes. Members are allowed to change their AUA level or program each year, effective with the first day of their anniversary month. REDEEM HealthShare will email the Program Change Request form to the primary member 60 days before the membership anniversary date. If you want to change programs, you must submit the Membership Anniversary Program Change Request form at least 30 days in advance of your anniversary month.
Switching Fee and Resetting AUA
- Switching Fee. Changing your program or AUA level requires a switching fee of $100. You can choose the first day of any future month for your switch to occur and the Total Share Amount Due (Member Center) will include the $100 switching fee within one to two months after the switch is effective.
- Resetting AUA. Changing your program or AUA level will reset the AUA.
- You can add or remove members from your membership at any time without incurring a fee.
Switching Between Programs and AUAs
When switching from REDEEM Essential to REDEEM Enhanced OR when switching from a higher AUA to a lower AUA, the 12-month waiting period for the conditions and treatments listed in Sharing Limits (Section III.C.) resets.
E. Member Privacy
Members may share deeply personal prayer requests and detailed health information with one another to allow for support, fellowship, and prayer. Do not post names or details on social media, blogs, or websites without permission, or in any other way misuse the information.
F. Guidelines Govern
These Sharing Guidelines explain the program requirements and govern the sharing of medical bills. The Guidelines in effect at the time you receive service govern the program. The Guidelines are available online at redeemhealthshare.org/guidelines and in your Member Center.
G. Changes to the Guidelines
REDEEM HealthShare can amend the Guidelines at any time subject to approval by the Samaritan Ministries Board of Directors. Members receive notification of the changes, and a history of changes will be available in the Member Center online for two years from the date of the change.
H. Balancing Needs and Shares/Proration
In any month, the funding of Shares across REDEEM HealthShare Ministry may or may not meet the eligible bills submitted for sharing. In that event, the ministry will share eligible medical bills proportionately, which means sharing a percentage of eligible bills within that month and holding back the balance of those bills to share in a subsequent month. If there isn’t enough funding of Shares to meet the eligible bills submitted for sharing over a 60-day period, then REDEEM HealthShare may increase the suggested monthly share amount in sufficient proportion to satisfy the eligible bills. The ministry may take this action temporarily or ongoing. If member sharing cannot fund an eligible bill within 90 days of entering the normal sharing queue, then the ministry removes that bill from the normal sharing queue and shares the amount through the Member Assistance Fund, if possible. REDEEM HeathShare will send any money currently in the bill account to the provider as partial payment.
As allowed by the Samaritan Ministries Board of Directors, to balance expenses and shares calculations, the ministry may share across two or more Samaritan Ministries programs or keep them separate.
I. Other Responsible Parties
If a member has insurance or is eligible for any insurance benefits or other health or welfare benefits, such as an employment related health or welfare plan (except as provided in Section IV.J. below), worker’s compensation insurance, homeowner’s insurance, or fraternal benefits, the member is expected to take all reasonable steps to qualify for such payments and to exhaust benefits available under those resources before submitting a request for sharing. Additionally, any time another individual or entity is or may be responsible for some or all of a medical bill intended to be submitted to REDEEM HealthShare to be shared, whether through litigation, insurance, or otherwise, the member must take all steps necessary to make sure such other individuals or entities pay the amounts applicable to their respective responsibilities before submitting the bill for sharing. The member must pursue his legal remedies unless he demonstrates that doing so would violate his Biblically based conviction against initiating a lawsuit. Medical bill processing can be delayed to allow other responsible parties to pay, and if a third party with responsibility for the issue represented by the need is identified by REDEEM Healthshare, then SMI in its discretion may decline to share the bills related to that third party responsibility. Should any member receive a settlement or reimbursement applicable to medical bills already shared, the member must send those funds back to REDEEM HealthShare or to another member in need as directed. Samaritan Ministries International or REDEEM HealthShare Ministry never requires members to seek assistance from government aid programs and considers it contrary to our understanding of God’s desire for His people. REDEEM SeniorSaver requires participation in Medicare Part A and Part B.
J. Other Sources of Payment
A member may have the right to reimbursement from a Health Reimbursement Arrangement (HRA), Flexible Spending Account (FSA), or Health Savings Account (HSA). There are no requirements for a member to use these fund types to pay for a shareable medical expense. However, the member should consider using this resource to lessen the burden that the community will bear. A member who uses HRA, FSA, or HSA money to pay the expense, can still submit the bill for sharing, but there may be income tax consequences from using reimbursements from these fund types to pay for an expense for which you also received share amounts. Please consult your tax advisor.
Funds raised by crowdfunding for shareable medical expenses must be reported and will be applied to reduce the shareable amount. A member must report funds raised by crowdfunding for shareable medical expenses. REDEEM HealthShare will apply these funds to reduce the shareable amount.
A member of REDEEM HealthShare who simultaneously participates in another health care sharing ministry may not seek shares or payments from multiple ministries that exceed shareable bills. To do so is to obtain assistance beyond that member’s burden.
K. Sharing Appeal
A member who disagrees with a bill-sharing eligibility decision can appeal if the member believes:
- REDEEM HealthShare misread the medical records.
- REDEEM HealthShare misapplied the Guidelines.
- The member’s providers incorrectly recorded their medical history.
- The Guidelines do not address the member’s situation
After a review of the appeal by REDEEM HealthShare, if the member still disagrees with the decision, the member has 90 days to request a review by a member Appeal Panel composed of 7 to 13 REDEEM members. As part of this process, the member may submit a written position statement to the Panel. REDEEM HealthShare will hold a teleconference wherein the panel can ask questions of both the member and REDEEM HealthShare. A simple majority vote will carry the decision whether to share. The panel’s decision will be binding and non-appealable.
A member may appeal to the Institute for Christian Conciliation as explained below when it involves membership requirement issues related to payment of shares or member integrity (with respect to the submission and payment of medical bills). For all other questions concerning membership requirements, a member may appeal to the Samaritan Ministries Board of Directors who make the final, non-appealable decision.
A member must settle any other issue in accordance with the Rules of Procedure for Christian Conciliation™ of the Institute for Christian Conciliation. (Complete text of the Rules is available at www.aorhope.org/rules or by contacting ICC at icc@aorhope.org) However, if both REDEEM HealthShare Ministry and you agree, you may submit the dispute to a randomly selected panel of members instead. In all events, you will have available the same relief as a court could grant. REDEEM HealthShare will pay all the arbitrator’s fees and costs unless the arbitration determines there was no reasonable basis for your complaint, in which case you will be responsible for the fees and costs.
You understand that these sharing appeal methods will be the sole remedy for any civil controversy or claim arising out of your relationship with REDEEM HealthShare and expressly waive your right to file a lawsuit in any civil court against REDEEM HealthShare Ministry, its employees, members, associate members, and directors, for such disputes, except to enforce an arbitration decision obtained under conditions specified herein. This also includes deciding whether the dispute is part of this arbitration agreement or whether it must go through arbitration. Judgment upon an arbitration decision may be entered in any court otherwise having jurisdiction.
Resolving disputes within the Body of Christ is always the command of Scripture and in the interest of all our members (MATT 18:15-20; 1 COR 6). Therefore, even if REDEEM HealthShare or a member participate in a court proceeding about a dispute, neither give up their right to later demand arbitration to resolve the dispute.
For all civil matters of procedure and substance regarding any dispute or claim that comes within these mediation or arbitration requirements, the laws of the State of Illinois, and if applicable of the United States, will govern.
L. Misuse of Trust and Accountability
The funds which members receive from other members are given explicitly and specifically for eligible medical bill amounts. Members receiving these funds are obligated to use these funds for no other purpose. If all or part of a bill that was shared in full is forgiven or paid by other means, the receiving member must contact Member Care for instruction of sending the extra money on to a member with a need yet unpublished.
Members commit to act with integrity. REDEEM HealthShare will involuntarily inactivate a membership if a member presents a falsified need, uses deceptive practices, or participates in another member’s misuse of trust.
Members submitting bills further commit to working with REDEEM HealthShare staff and designated third parties to determine if the bills are shareable, to seek fair and reasonable prices from providers, and to document amounts paid to providers.
When an issue of misuse of trust by a current or inactive member arises, 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 the Guidelines.
M. Sponsorship
There may be circumstances where applicants or current members may not be able to pay the entire Share amount. In certain cases, REDEEM HealthShare may be able to offer temporary reductions in the Share amount to assist a member experiencing financial difficulty. 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, please contact us.