Guidelines - 3.10 Limited Sharing
2026-07-01
Needs for specific conditions might be eligible for limited sharing,
depending on your Unshareable Amount, and other applicable
conditions. Refer to each category below for detailed information.
3.10.1. Maternity and Newborns
3.10.1.1 Due Date Requirements
Maternity Needs are eligible for sharing when your membership
includes the mother and at least one other member who has
been active for at least 12 months before the estimated due
date. For Samaritan Ministries Legacy Members who join REDEEM
HealthShare without membership interruption, this waiting period
begins at your start date in the Legacy program.
If you have been active for 12 months and apply to add your
spouse or future spouse within 30 days before or after your
wedding, sharing of eligible Maternity Needs begins on your
marriage date once the ministry has approved your application.
This includes a pregnancy that occurs on or after the marriage
date.
3.10.1.2 Approved Providers for Delivery
For bills to meet eligibility, a Medical Doctor (M.D.), Doctor of
Osteopathy (D.O.), or a Midwife who is properly licensed, certified,
or registered in the state of birth must deliver your baby.
3.10.1.3 Maternity Services Eligible for Sharing
• Antepartum care
• Labor and delivery
• Postpartum care
• REDEEM Enhanced members should reference section 3.2
REDEEM Enhanced Sharing of Expenses for well-baby visit
eligibility.
3.10.1.4 Adding Newborns to Membership.
You must add your baby to your household membership within
30 days of delivery to ensure your newborn qualifies as a member
from birth.
3.10.1.5 Birth Defects and Conditions.
Any known birth defects or conditions in the baby from a pre-
existing maternity are not eligible for sharing. If birth defects or
conditions are discovered after the mother joins, then—after the
membership meets the Unshareable Amount—those Needs are
eligible for sharing per the program Guidelines. See section 3.8.1
Adoption for eligibility details on pre-existing conditions.
3.10.1.6 Ectopic Pregnancies
Eligible For Sharing
• Procedures related to a ruptured fallopian tube (including
postoperative recovery of the mother, follow-up care, and
treatment of any complications).
• Preoperative tests, consultations, and expenses related to
keeping the mother under medical care while determining care
for the mother and child when doctors diagnose an ectopic
pregnancy before a rupture.
Not Eligible For Sharing
• Procedures like salpingectomy or salpingostomy, or the use of
medications like methotrexate that are directly related to the
termination of a living, unborn child and removal of the living,
unborn child from the mother due to an ectopic pregnancy,
unless the removal of the child from its ectopic location was for
the primary purpose of saving the life of the child or improving
the health of the child.
3.10.2. Prescription Medications
Inpatient Prescriptions. Prescriptions administered as part of
inpatient treatment are shareable. These are subject to the
Unshareable Amount, applicable Co-Share amounts, and annual
maximums.
Outpatient Prescriptions. REDEEM Enhanced members should
reference section 3.2 REDEEM Enhanced Sharing of Expenses
and SeniorSaver Members should reference section 3.3 REDEEM
SeniorSaver Sharing of Expenses for specific outpatient
prescription eligibility.
Exceptions for Outpatient Prescriptions
REDEEM HealthShare may make exceptions for medications for
cancer and transplant recipients. Requirements for exception
consideration include application to a Patient Assistance Program
and other available programs for medication cost when available.
3.10.3. Mental Health
Costs for involuntary commitment up to $50,000 per year are
shareable and subject to the Unshareable Amount.
3.10.4. Therapies
Outpatient therapies delivered are subject to the Unshareable
Amount and must be eligible for sharing per the program
Guidelines. For each of the three eligible therapy categories, there
is a $5,000 cap per category, per household membership per year:
Category A: Hormone Therapies ($5,000 cap per household
membership per year), such as:
• Androgen replacement therapy
• Menopause related conditions
• Pregnancy and maternity support (excluding IVF)
Category B: Injection Therapies ($5,000 cap per household
membership per year), such as:
• Platelet Rich Plasma or Stem Cells therapy
• Prolotherapy
• Steroid and corticosteroid injections
• Allergy shots and serum
• Nerve blocker
• Eye Injections for Macular Degeneration
Category C: Other Therapies ($5,000 cap per household
membership per year):
• Acupuncture or Acupressure
• Cardiac therapy
• Chiropractic care
• Disc decompression
• Dry needling
• Hyperbaric treatments
• Massage therapy
• Occupational therapy
• Physical therapy
• Respiratory therapy
• Softwave or Shockwave therapy
• Speech therapy
• Sublingual Immunotherapy
• Vision therapy
• Home Care includes skilled care by a registered ARNP, LPN, or RN
for at home services for an eligible Need ordered by a qualified
provider for members who are homebound for that Need.
REDEEM HealthShare limits visit sharing to a maximum block of 4
hours.
REDEEM HealthShare may make exceptions in the case of therapies
for cancer treatment and transplant recipients. Requirements
for exception consideration include application to a Patient
Assistance Program and other available programs for medication
cost when available.
3.10.5. Sharing Limits, Waiting Periods, and Pre-existing Conditions
(for joint replacement and other conditions)
See section 3.7 Sharing Limits for waiting periods during the first
12 months of membership and section 3.8 Pre-existing Condition
limitations.
The waiting period and pre-existing conditions requirements
referenced in this subsection do not apply to REDEEM SeniorSaver
members. REDEEM SeniorSaver members, see section 3.3 REDEEM
SeniorSaver Sharing of Expenses.
3.10.6. Motor Vehicle Related
Medical bills incurred for injuries resulting from motorized vehicles
only meet sharing eligibility 1) after any insurance entity or other
liable third party has paid their portion 2) provided you meet
all other Guideline requirements, and 3) if the operator did not
operate the vehicle recklessly. To determine eligibility, report the
motor vehicle related injuries to Member Care.
3.10.7. Medical Transportation
Bills for medically necessary, emergency ground or air
transportation are eligible for sharing. Both types of transportation
are subject to the Unshareable Amount.
3.10.8. Telemedicine
The approved REDEEM HealthShare telehealth provider is free and
available through the Member Center and is not subject to your
Unshareable Amount. Telemedicine from other providers is subject
to your Unshareable Amount.
3.10.9. Hospice Care
Hospice care services are subject to the Annual Sharing
Cap. These services are eligible for sharing for 90 days upon
prescription by a physician or certification that the person is
terminally ill. For continued sharing eligibility, you must submit a
renewed prescription or certification. Note: If you are in the REDEEM
SeniorSaver program, then Medicare must provide your coverage
first before the REDEEM community considers sharing eligible non-
covered portions.
3.10.10. Skilled Nursing Facility
Skilled nursing facility expenses are shareable for up to $10,000
per member per year and are subject to the Unshareable Amount
for a shareable condition requiring rehabilitation or skilled care
following a surgery or injury.
3.10.11. Direct Primary Care
Both “Direct Primary Care” and “Concierge Medicine” are methods
by which you pay a regular fee, usually monthly, to secure more
favorable access to a primary care physician. The monthly fee
for your household (should you use one of these methods) is
shareable, up to $100 for any month you, or someone in your
household consults the physician, or the physician makes a
referral or charges for services.
3.10.12. Medical Care Outside of the United States
You may share bills from medical treatments occurring outside of
the United States. You must include all the bill itemization requirements
listed in section 3.6 Approved Sharing of Bills, and translate
the information into English and convert the price into U.S. dollars.
The international care requirements described in this subsection
do not apply to REDEEM SeniorSaver Members. REDEEM SeniorSaver
members, see section 3.3 REDEEM SeniorSaver Sharing of Expenses.
3.10.13. Immunizations (vaccinations)
REDEEM Enhanced Members see section 3.2.4 Immunizations
(vaccinations) for limited sharing for REDEEM Enhanced members.
REDEEM Essential Members see section 3.1 REDEEM Essential
Sharing of Expenses.