Karen Owsley

May 30, 2018

7 Facts You Should Know About Healthcare Sharing Ministries

Karen Owsley

May 30, 2018

7 Facts that you should know about Healthcare Sharing Ministries

Written by Richard Best

February 11th, 2016

As an alternative to traditional health care insurance, health care sharing ministries (HCSMs) have been in existence for many years; however, they have only recently experienced surges in membership as a result of the implementation of the Affordable Care Act (ACA) that began in 2010. Through its mandate, the ACA has forced many people into buying health insurance. Some have found health insurance to be too expensive, not sufficient to meet their needs or incompatible with their religious beliefs. This has raised the profile of HCSMs, resulting in more media attention and questions from the general public as to what they are all about. The following are seven facts about HCSMs everyone should know.

1. HCSMs Facilitate Medical Cost Sharing

An HCSM is a nonprofit organization that pools together monthly deposits made by members to pay for medical costs incurred by members. Members generally pay their own low medical costs, but when they have large medical expenses, they contact the ministry, which then facilitates the sharing of the costs among members. If the medical bill presented meets the eligibility requirements, and the member has already covered his annual unshared amount, the bill is shared.

2. HCSMs Coverage Is Not Insurance Coverage

HCSMs do not provide insurance coverage. There is no PPO or HMO. Members pick their own medical providers, negotiate their own costs and pay their own medical expenses. The ministry is there to provide financial assistance for covered treatment or procedures after they occur.

3. HCSMs Are Not Bound by Regulation

Because HCSMs do not provide minimal essential coverage as described by the ACA, they are not bound by any state or federal regulations to provide the same level or type of coverage as other health plans. They are not required to offer any guarantee of coverage. In addition, if an HCSM becomes insolvent, members have no recourse for recovering any monetary losses.

4. Eligible HCSMs and Their Members Are Exempt From ACA Requirements

When the ACA was being written, members of Congress had an exemption added under the same principle that allowed the Amish to be exempted from the law’s requirements. The main eligibility requirement for the exemption is an HCSM had to be in operation before Dec. 31, 1999. In addition, an HCSM must meet the following requirements:

• Be a nonprofit organization as described under section 501(c)(3);

• All members must share in a common belief system and share medical costs according to these beliefs;

• Members cannot be disqualified after they develop medical conditions;

• Must submit to an annual audit conducted by an independent certified public accountant (CPA).

Based on these requirements, there are only four HCSMs that have been granted exempt status: Samaritan Ministries, Christian Healthcare Ministries, Medi-Share and Liberty HealthShare.

5. HCSMs Have Strict Rules for Membership Eligibility

Just because you want an alternative to ACA coverage does not make you eligible for membership in an HCSA. HCSA have strict rules and standards that must be met. These include:

• No tobacco or illegal drug use;

• Limited alcohol use;

• No sex outside of marriage;

• No contraception use;

• Regular church attendance.

Generally, HCSMs limit their memberships to people who share their Biblical faith. The success of the HCSM model is predicated on members sharing the core value of taking care of one another as Christians.

6. Preventative Care Costs and Small Expenses Are Not Covered

HCSMs believe their members should be doing everything possible to live healthy lifestyles, so they do not cover preventative care. This includes exams and tests such as colonoscopies. They also do not cover small expenses that fall within a member’s annual unshared amount, which is similar to a deductible. Generally, HCSMs only cover large medical expenses.

7. HCSMs Do Not Have to Cover Pre-Existing Conditions

HCSMs may distinguish between pre-existing conditions in active treatment and maintenance treatment. If you become a member with a pre-existing condition that is being actively treated, any bills related to that treatment are not shared. However, once your treatment becomes maintenance or routine, your medical bills are eligible based on a graduated schedule of treatment. For instance, a bill presented during the first year of maintenance treatment may be eligible for sharing of up to $15,000. That amount increases for three years, and after the third year, the condition is no longer considered pre-existing.

Bills presented for maternity care cannot be shared unless members have due dates at least 300 days after joining the HCSM. Each HCSM offers varying levels of maternity coverage based on the amount the member is willing to contribute in monthly deposits.

Karen Owsley

May 30, 2018

What Pastors Need to Know About Mental Health, Ministry, and Liability

Karen Owsley

May 30, 2018

What Pastors Need to Know About Mental Health, Ministry, and Liability

Written by Samuel Ogles

May 30th, 2017

Mental health is not often a public topic of conversation—or even a private one. That avoidance appears to be just as prevalent, if not more so, in church settings. In recent years, however, a plethora of research has shown that mental health issues are more common than one might think, cutting across gender, ethnicity, and socioeconomic status. According to the Substance Abuse and Mental Health Services Administration, it’s estimated that almost one in five Americans suffer from some form of mental illness each year.

As churches become increasingly aware of the widespread and serious nature of mental illness, church leaders may wonder how they should engage mental health ministry in the church—and what legal risks they may face in doing so.

The most important mental health case to date

Lisa Runquist, an attorney specializing in nonprofit law, has researched the issue of liability for churches that have chosen to counsel individuals with mental health issues.

For Runquist, the most important court case regarding churches and counseling came in 1988 when a lawsuit—Nally v. Grace Community Church of the Valley—was ultimately decided by the Supreme Court of California. An individual, Kenneth Nally, had sought help from counseling through Grace Community Church of the Valley and later committed suicide. Nally’s parents then brought a wrongful death action lawsuit against the church and four church pastors, alleging “clergyman malpractice” (negligence in failing to prevent the suicide).

Karen Owsley

May 30, 2018

More People Turn to Faith-Based Groups for Health Coverage

Karen Owsley

May 30, 2018

More People Turn to Faith Based Groups for Coverage

Written by Stephanie Armour

January 4th, 2018

A growing number of people are turning to health-care ministries to cover their medical expenses instead of buying traditional insurance, a trend that could challenge the stability of the Affordable Care Act.

The ministries, which operate outside the insurance system and aren’t regulated by states, provide a health-care cost-sharing arrangement among people with similarly held beliefs. Their membership growth has been spurred by an Affordable Care Act provision allowing participants in eligible ministries to avoid fines for not buying insurance.

Ministry officials estimate they have about 500,000 members nationwide, more than double the roughly 200,000 members before the law was enacted in 2010.

The membership growth was largely unanticipated by ministry officials when the groups obtained an exception to the law. Only ministries in continuous operation since at least Dec. 31, 1999 are exempt from the ACA. The carve-out was intended to satisfy what at the time were relatively small religious groups that argued that their nonparticipation was a matter of religious freedom.

But now, some insurance commissioners are concerned that the ministries could put consumers at risk if bills aren’t paid. The ministries aren’t overseen by state commissioners, which generally guard against unfair practices and ensure solvency.

Ministry officials say they aren’t offering insurance, don’t guarantee claims will be paid, and don’t need to be regulated. The nonprofits are well managed, according to ministry officials, with third-party audits and a sterling history of sharing members’ claims.

Ministries generally don’t allow members to sue and require disagreements to be settled by arbitration and mediation.

Some ministries say they cost about 30% less than private insurance. Monthly payments, or sharing, may range from about $75 for a single person under age 30 to $500 or so for a family.

State regulators also say health ministries disrupt the insurance market because they tend to attract healthier consumers, siphoning them from commercial plans that can be left with sicker or older customers. Most ministries don’t always share bills for certain pre-existing conditions, whereas the ACA requires insurers to cover anyone regardless of their past or current medical history.

“They [ministries] have the potential to destabilize the market by drawing off the good risk,” said Mike Kreidler, Washington’s state insurance commissioner.

Many of the estimated 50 health-care ministries in the U.S. are small operations of Amish or Mennonite communities, and some churches have their own programs limited to parishioners. There are several large Christian ministries, and at least two other ministries open to people regardless of specific religious faith. For the most part, the largest are operated by not-for-profit ministries.

Members typically must abide by Biblical principles such as not having sex outside of marriage, and may have to sign a statement of religious faith.

Kristine Willington, of Beverly Mass., and her family joined Liberty HealthShare last year. Photo: Shiho Fukada for The Wall Street Journal

Consumers generally pay a set monthly amount that goes into a general account or directly to others who have an eligible medical bill. They can also submit their own eligible bills to be shared by other members. In some ministries, members make contributions directly to others—and tuck gifts, personal cards and get-well wishes into the envelopes. Preventive care in some cases isn’t covered.

Some consumers say they joined ministries to avoid rising deductibles and premiums on the health law’s exchanges, and to be free from the law’s penalty, which starts at $695 next year.

Kristine Willington, 37 years old, of Beverly, Mass., found out that her family’s insurance was almost doubling in 2014 to $2,100 a month with a $5,000 deductible.

Last year, the family of six joined Liberty HealthShare and paid $475 a month, she said, with a $1,500 annual out-of-pocket cost. Her son’s $30,000 hospital bill was taken care of by members, alleviating her concerns about consumer risk.

“It’s a risk we’re willing to take,” she said. “Two of our children are in private school and we couldn’t afford that otherwise.”

Insurance commissioners in some states including Kentucky, Oklahoma and Washington moved to shut down the ministries’ state operations in past years. Their efforts were blocked by state legislatures, which backed the right of ministries to operate without interference. The ministries have gotten support from conservative lawmakers.

Past problems have led to concerns. Former officials of an Ohio ministry were ordered by a jury in 2004 to pay more than $14 million for embezzling member funds. Money for medical bills was instead spent on real estate, vehicles, and the living expenses of an exotic dancer, according to the civil lawsuit brought by the ministry and the Ohio Attorney General.

The group, now called Christian Healthcare Ministries, incorporated a list of financial safeguards since the lawsuit and now protects members with a stringent conflict-of-interest policy for board members and an annual certified audit.

“Our purpose is ministry, not profit,” said the Rev. Howard Russell, chief executive of Christian Healthcare Ministries, who also filed the lawsuit against the former officials.

Rev. Russell said the organization is vastly different than it was then and that when the problems were identified, he brought the matter to the Ohio attorney’s general office and requested their assistance. He said it was important to demonstrate the ministry’s stand against such behavior, and that their internal controls worked.

Separate lawsuits were filed in Montana, Illinois and Oklahoma by ministry members against another cost-sharing ministry, claiming particular medical bills that should have been shared were not. The cases were ultimately settled or resolved through arbitration. The ministry didn’t admit to any wrongdoing in the cases.

Even the ministries are surprised by their recent growth. A self-employed painter launched Samaritan Ministries International from a remodeled chicken coop in his backyard, and members began joining in 1994.

Leaders thought sign-ups would be slow because of subsidized insurance on the exchanges. Instead, the Peoria, Ill.-based organization has moved into three-story headquarters and recently threw a luncheon celebrating 50,000 members.

“None of us imagined it would be this big,” said James Lansberry, executive vice president of Samaritan Ministries International, a health-care sharing group. “The difficulties with narrow networks, high deductibles and premiums on the exchanges were much higher than even we expected. Our growth rate has been higher than ever before.”

Karen Owsley

October 11, 2017

FACT SHEET: FALLS - THE BIGGEST THREAT TO SENIOR HEALTH AND SAFETY

Karen Owsley

October 11, 2017

Falls are, unfortunately, a common occurrence.

Falls are a serious health issue among seniors. While falls in the general population usually come about due to dangerous work or leisure activities, seniors are at greater risk of falling in their day-to-day activities. Medications, vision impairments, and general weakness can combine with environmental factors to put seniors in danger of seriously injuring themselves in any fall.

11: Every 11 seconds, an older adult is treated in the emergency room for a fall

65: According to the National Council on Aging, one in four Americans over the age of 65 falls each year.

7,000,000: In 2014, older Americans experienced 29 million falls, resulting in 7 million injuries.

19: Every 19 minutes, an older adult dies from a fall

For more information on this health issue, click here.