The inaugural entry in the HealthShare Challenge series presents a comparison of maternity services between Zion HealthShare and Samaritan Ministries. These highly-rated companies differ significantly, with Samaritan being a religious HealthShare with a 40-year history, while Zion, a secular HealthShare, has only operated for a few years. Maternity sharing provisions are the central consideration in this comparison.
Zion HealthShare
For the most part, Zion HealthShare treats maternity needs the same as other medical needs. According to the guidelines, “expectant mothers pay a single IUA [Initial Unshareable Amount] for all expenses related to their maternity need request.” Shareable needs may encompass bills related to miscarriage, prenatal care (including routine STD screenings), postnatal care, and delivery. Members must submit maternity needs requests within 30 days of learning about the pregnancy.
Starting January 2022, Zion HealthShare also provides a medical advocacy service wherein members receive help finding providers and scheduling appointments. This allows Zion HealthShare to approve, schedule, and pay for appointments in one phone call and may remove some hassle for pregnant members.
Requirements and exceptions
Pregnancies prior to membership are not eligible for sharing. For non-eligible pregnancies, Zion HealthShare considers any newborn complications or medical conditions present at the time of birth pre-existing. This means that members have a waiting period before Zion shares in these needs. Additionally, pregnancies that begin within the first 60 days of membership are deemed pre-existing.
Key points
- Needs unrelated to routine care for a newborn are separate from the mother’s shareable need. With that said, a baby’s needs are fully shareable, even if the baby is premature.
- Expenses for any pregnancy or birth-related complications are part of the mother’s need.
- If a maternity provider offers a discount for prepayment, Zion HealthShare will consider sharing the need before delivery.
- If a member plans a home birth under the care of a licensed provider, Zion HealthShare may lower the required IUA (the cost of care is usually lower than giving birth in a hospital).
- A newborn must be added to a Zion HealthShare membership within 30 days of birth.
- Routine newborn immunizations are eligible for sharing with certain memberships
- Circumcisions are not eligible for sharing.
- Adoption fees are not eligible for sharing.
Samaritan Ministries
Maternity needs are typically treated like other medical needs and may include bills for prenatal care, delivery, postnatal care, congenital conditions, and miscarriage. Bills from doulas (up to $500), midwives, doctors, nurse practitioners, and other licensed medical professionals are shareable.
Requirements and exceptions
Samaritan’s eligibility requirements for pregnancy costs are stringent. Maternity needs are shareable when the doctor’s estimated due date is 260 days or more after the mother’s membership began. Samaritan also requires a two-person household membership for the bills to be shareable, with both members on the same plan. Maternity costs for single members are not shareable except as a Special Prayer Need, which allows other members to donate to costs as they wish, OR if the single member pays as much as a two-person membership monthly. Other limitations and exceptions can be found in their guidelines here.
Key points
- Bills for all pregnancy and birth-related complications of the mother will be shared as part of the maternity need. Any pre-birth and routine postnatal needs of the child are also included in the maternity need.
- Post-birth needs beyond routine care are considered the child’s need and separate from the mother’s maternity need.
- For some plans, Samaritan will also consider sharing prior to delivery with an estimate from the provider and a needs sharing form. This may help lower costs.
- Adoption fees are not shareable.
- Samaritan has two plan levels that offer maternity care. Samaritan Basic has a $1,500 Initial Unshareable Amount (IUA), with a 10% co-share (90% sharing percentage) and a $5,000 Initial Maternity Sharing Limit. The Classic membership has a $400 IUA, but the guidelines do not mention any other differences.
The best HealthShare for maternity care
A comparison based on information from membership guidelines shows that Zion HealthShare outperforms Samaritan Ministries in maternity sharing. The restrictions for maternity sharing are far less complex with Zion HealthShare, making it the more accessible option. Despite its longevity, Samaritan Ministries offers less comprehensive maternity sharing. The intricacies of Samaritan’s plans raise concerns that some members would not qualify for their maternity sharing. Additionally, expectant members facing unique complications may not receive adequate financial support from their membership.
Given these factors, Zion HealthShare emerges as the clear choice in this comparison. As the HealthShare industry continues to grow and evolve, Samaritan might choose to enhance its maternity sharing guidelines.
