Sharing Eligibility for Pre-Existing Conditions

Introduction 

Use this article as a guide to the below Sharing Guideline sections that address when a pre-existing condition might affect eligibility for sharing.  

Information 

If you have questions about how pre-existing conditions might affect eligibility for sharing, waiting periods, or annual sharing limits, refer to the resources below:

• Members migrating from Samaritan® Classic or Samaritan® Basic programs, see Guidelines – 3.8 Pre-existing Conditions.
• Members enrolled in REDEEM® SeniorSaver, see Guidelines – 3.3 REDEEM SeniorSaver Sharing of Expenses section 3.3.6.
• Members who adopt a child, see Guidelines – 3.8 Pre-existing Conditions section 3.8.1 Adoption. 
  Note: Before requesting to share medical bills, follow the requirements in Guidelines – 5.9 Other Responsible Parties to use any other health benefits.
• Members who qualify for condition-specific exceptions, see Guidelines – 3.8 Pre-existing Conditions, section 3.8.2 Pre-existing condition exceptions.

Additional Sharing Options

Some members might have included FlexShare® add-on to their REDEEM® program which offers additional sharing options for eligible bills related to pre-existing conditions.

FlexShare Add-on is an option that permits the submission of bills associated with pre-existing conditions. FlexShare add-on has its own requirements, waiting periods, and sharing limits, see Guidelines 4 – FlexShare® Add-On.

References

• For information about pre-existing maternity, see Guidelines – 3.10 Limited Sharing | 3.10.1.5 Birth Defects and Conditions.

• For information about pre-existing conditions when restarting your membership, see Guidelines – 5.3 Restart of Membership.

As a member of REDEEM HealthShare reading and understanding the Sharing Guidelines is important.