Guidelines - 3.8 Pre-existing Conditions

This section does not apply to REDEEM SeniorSaver members 
because each program includes its own specific requirements 
regarding pre-existing conditions. REDEEM SeniorSaver members 
see section 3.3 REDEEM SeniorSaver Sharing of Expenses.

A pre-existing medical condition refers to conditions in 
which known signs, symptoms, testing, treatment (routine or 
maintenance), diagnosis, or use of medication (routine or 
maintenance) occurred within 36 months prior to your Member 
Start Date. Any pre-existing condition known to exist at your 
Member Start Date has a three-year waiting period from your 
Member Start Date for bill sharing. After this waiting period, 
sharing towards pre-existing conditions is up to $125,000 per 
member, per year. In the sixth year of your membership, and every 
year thereafter, this limit increases to $500,000. Note: REDEEM 
HealthShare does not count testing, for the purpose of monitoring 
a prior resolved condition, as pre-existing, so long as the tests 
indicate the continued resolution of the issue.

For Samaritan Ministries Legacy Members who join REDEEM 
HealthShare without membership interruption, this waiting 
period begins based on your start date in the Legacy program. 
Conditions and treatments that were eligible for sharing according 
to the pre-existing conditions in the Guidelines for Health Care 
Sharing in Samaritan® Classic and Basic are eligible for sharing.

3.8.1. Adoption 

For adoption, a pre-existing condition refers to any physical 
condition the child has that the adopting parents either knew 
of or had reason to know of prior to their legal responsibility for 
the child’s expenses, or prior to the child’s effective date within 
your membership. See section 5.9 Other Responsible Parties for 
expectations related to exhausting other health benefits before 
submitting a request for sharing. 

3.8.2. Pre-existing condition exceptions:

3.8.2.1 Type 1 diabetes. 

Bills for pre-existing Type 1 diabetes are not eligible for sharing.

3.8.2.2 Heart and cancer conditions. 

Bills for pre-existing heart and cancer conditions are subject to a 
five-year waiting period from the start of your membership. After 
this waiting period, the sharing limits in section 3.7 Sharing Limits
will apply. This waiting period will not apply to a new heart or 
cancer condition that occurs after your membership begins.

3.8.2.3 High blood pressure. 

Bills for pre-existing high blood pressure are eligible for sharing 
provided you have not received hospital treatment for high blood 
pressure in the last five years, and medication or diet control the 
condition. 

3.8.2.4 Elevated cholesterol. 

Bills for elevated cholesterol are eligible for sharing, even when 
a provider prescribes a statin. However, REDEEM HealthShare 
does consider elevated cholesterol a pre-existing condition 
when a provider prescribes a statin to treat a diagnosis like 
arteriosclerosis.