A. All of the responsibilities of Samaritan members and the requirements for submitting needs as set forth in the “Membership” and “Needs” Guidelines apply similarly to participants except when the Save to Share™ Guidelines specifically provide otherwise.
B. Only needs eligible for sharing in the “Membership” and “Needs” Guidelines will be qualified to be shared in Save to Share™. Also, for needs from a condition that occurred while an SMI member, but before participating in Save to Share™, to be shareable, the condition must meet the same type of symptom and treatment free/time elapse, etc. requirements while a Save to Share™ member, as are found in Section VII “Pre-Existing Conditions” and Section IX.C “Maternity Needs for Pregnancies Beginning Prior to Membership” (e.g. for a pregnancy of a member joining Save to Share™ less than 270 days before the estimated due date, the premature complications of the child would not be shareable under Save to Share™).
It is also necessary to again qualify for the pre-existing exceptions of Section VII, for a condition which developed while a person participated in Save to Share™, if the person later dropped out of Save to Share™ and then rejoined.
Note: Members of SMI who joined Save to Share™ prior to January 1, 2004 are able to have needs shared from conditions that began prior to their Save to Share™ participation but first occurred after they became SMI members.
C. Save to Share™ needs will only be shared in months when there is a qualified need to share.
D. New SMI members who join Save to Share™ at the same time will not be asked to share in Save to Share™ needs until they begin sharing with regular needs.
E. When a member who participates in Save to Share™ has a shareable need that is more than $250,000, the amount of that need that exceeds $250,000 will be eligible for sharing with other Save to Share™ participants. It will only be the amount of the need over $250,000 that is shared even though the ministry may not have shared all of the first $250,000 of the need due to proration.
Although participants in Samaritan Basic have a maximum shareable amount of $236,500, that amount is based on $250,000 of eligible bills (plus the $1,500 initial unshareable amount). Therefore, participants in Samaritan Basic/Save to Share™ are eligible for sharing in Save to Share™ after the $236,500 Samaritan Basic sharing maximum is reached.
Large needs frequently are the result of the reality that most health care providers charge patients without insurance substantially more than insured patients. Therefore, Save to Share™ needs are not shared until satisfactory negotiations with providers toward reductions in bills have occurred.
F. In order to have a Save to Share™ need shared, a participant must have the appropriate amount set aside, must have given to all Save to Share™ needs that have been assigned to him, must be current in sharing with all other SMI needs assigned to him, and must be a member in good standing of SMI. A participant who does not send his share after two notices may be removed from participation and, once removed, will not be eligible for reinstatement.
G. Needs that qualify for sharing will be divided among participating households in proportion to the amounts set aside by participants by year.
Example: If a participant has a shareable need of $450,000 after negotiations and adjusting for the initial unshareable amount and discounts, the first $250,000 would be shared according to the “Needs” Guidelines (including the co-share and implementation of the pro rata provision if necessary). The remaining $200,000 would be shared in Save to Share™. If the total amount set aside by participants for the current year is $20,000,000, then each household would be asked to share 1% ($200,000/$20,000,000) of their current year set-aside amount balance.
So a two-person membership which had not yet shared in Save to Share™ for the current year would be asked to send $266 x .01 = $2.66 in addition to their regular share.
H. If the amount of one need qualifying for sharing in Save to Share™ exceeds half of the funds for the current year held by the participants when the need is shared, only half of these funds will be assigned for sharing. Funds held from the previous years would then be assigned to the remaining unmet portion of the need, up to half of these funds.
Example: There is a need amounting to $3,000,000 (after the first $250,000 was shared under the “Needs” Guidelines).
There is $4,000,000 available in the current year set-aside amount. Only $2,000,000 of the $3,000,000 need will be allocated to the current year to stay within the half limitation mentioned above ($2,000,000/$4,000,000 = 50%).
If the previous years’ set-aside balance is $3,000,000, then those Save to Share™ members with previous years’ set-aside amounts will be asked to share one-third of that balance ($1,000,000/$3,000,000) with the second Save to Share™ need to help with the remaining $1,000,000.
If at any time there are multiple Save to Share™ needs in process, and the order in which they are shared could affect the maximum amount shared for a particular need, then the need given priority for calculating the shareable amount will be the need for which the properly completed form (and all required documentation) first arrived.
I. Giving to Save to Share™ needs is done through the monthly newsletter mailing or eShare notification. The shareable amount of the need is determined and then divided proportionally among all Save to Share™ memberships according to the size of their membership (i.e. one person, two-person family, three or more person family, and single-parent family). The correct Save to Save to Share™ amount is then added to the regular share amount for each of these Save to Share™ households.
The Save to Share™ gifts are added to the total amount of share money available, and then enough of this larger amount is assigned to selected Save to Share™ members to be given to the Save to Share™ need(s). The other Save to Share™ members are directed to send their entire amounts (including the Save to Share™ amount) to regular needs. In this way the members with Save to Share™ needs receive the amount they should receive, but instead of being inundated with a large number of small gifts coming from every Save to Share™ member, they receive a more manageable number of larger gifts.