Guidelines - 3.2 REDEEM Enhanced Sharing of Expenses
2026-07-01
As a REDEEM Enhanced member, you share eligible Needs as well
as certain preventative screenings, wellness visits, immunizations,
and prescription costs subject to the Unshareable Amount as
documented herein. Eligible Needs under REDEEM Enhanced are
shareable up to a $2 million per household membership cap per
year and is not subject to a Co-Share.
Additional Eligible Needs with REDEEM Enhanced:
3.2.1. Routine and Wellness Visits.
• Each member of your household is eligible for annual routine
wellness services up to $300 per member, per year.
• Eligible expenses include any wellness service provided during
the wellness visit. For example, the wellness office visit, school
physical, labs, immunizations, and wellness related exams.
• The cost of eligible wellness services up to the $300 cap is
not subject to the Unshareable Amount. During a wellness
visit, however unrelated eligible medical treatment, such as
treatment for an acute illness, is subject to the Unshareable
Amount.
• Waiting periods from section 3.7.1 First 90 days of membership
apply. However, this waiting period does not apply to Samaritan
Ministries Legacy Members.
3.2.2. Gynecology.
• Women are also eligible for annual gynecological wellness visits
up to $300 per member per year, including Pap tests.
• The cost of eligible gynecological wellness services up to the
$300 cap is not subject to the Unshareable Amount.
• Waiting periods from section 3.7.1 First 90 days of membership
apply. However, this waiting period does not apply to Samaritan
Ministries Legacy Members.
3.2.3. Maternity Well Baby Visits
Well-baby visits are eligible for sharing for three years following an
eligible Maternity Need. See 3.10.1 Maternity and Newborns for more
information about Maternity eligibility. Well-baby services are not
subject to the Unshareable Amount.
3.2.4. Immunizations (vaccination).
• Immunizations and the associated office visit are eligible for
sharing for children from birth until 2 years of age. See 3.2.1
Routine and Wellness Visits for immunization eligibility after the
age of two.
• The cost of eligible immunization is not subject to the
Unshareable Amount.
• Waiting periods from section 3.7.1 First 90 days of membership
apply. However, this waiting period does not apply to Samaritan
Ministries Legacy Members.
3.2.5. Preventative Screenings.
The following preventative screenings are eligible for sharing
after the first six months from your Member Start Date in REDEEM
HealthShare and are not subject to the Unshareable Amount.
Mammogram
• Women are eligible for an annual mammogram or a breast
ultrasound beginning at age 45.
Prostate-Specific Antigen Test (PSA)
• Men are eligible for one PSA test per year beginning at age 45.
Colonoscopy
• Each adult in the household is eligible for one colonoscopy every
five years or every two years if you are high-risk (as determined
by your physician), beginning at age 45.
• Cologuard (or equivalent testing) is an acceptable substitution
for a scheduled colonoscopy if desired.
• Required treatment during the procedure such as
polypectomies and pathology are eligible for sharing when part
of the original preventative screening.
• You might need to have your bill re-processed if your provider
bills the additional treatment separately.
• If your test shows a medical issue, then follow-up procedures,
testing, or treatment will be subject to and apply toward your
Unshareable Amount. If you have already met your Unshareable
Amount, then your bill is eligible for sharing through the usual
process.
3.2.6. Outpatient Prescriptions.
• There is an annual cap of $1,000 per household membership,
per year.
• The cost of outpatient prescriptions are not subject to the
Unshareable Amount.
• Waiting periods from section 3.7.1 First 90 days of membership
apply. However, this waiting period does not apply to Samaritan
Ministries Legacy Members