Credentialing board launches to certify, oversee health sharing ministries

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Health sharing ministries can now seek accreditation from an independent Healthcare Sharing Accreditation Board, an option that will benefit both the organizations that promote themselves as an alternative to health insurance and their membership, a leading health sharing trade group has said.

The accreditation board comes after one Christian health sharing ministry made the news for a 2021 bankruptcy that left unpaid claims ranging from $50 million to $300 million for its remaining 10,000 members.

Katy Talento, executive director of the Alliance of Health Care Sharing Ministries trade group, welcomed the launch of the accreditation board, which is independent of her organization.

“The board has adopted a set of extensive and rigorous standards that will identify the Health Care Sharing Ministries that stand out as trusted communities for people of faith who are looking for a health care solution that is consistent with their beliefs and their budget,” she said May 26.

Unlike health insurance companies, which pool insurance premiums under company control, health sharing ministries promise members a means to help them share the costs of their qualified medical bills. Many health sharing ministries restrict membership based on religious belief and require pledges to avoid risky behavior. Some ministries’ plans have attracted attention from Catholics for their sensitivities to concerns about excluding coverage for procedures like contraception, sterilization, abortion, and assisted suicide. 

About 1.5 million Americans are members of these kinds of ministries, according to the Alliance of Health Care Sharing. Some $2 billion in medical expenses were shared through this type of ministry in 2020.  There are over 100 health sharing organizations certified by the U.S. Department of Health and Human Services for meeting the federal law’s definition of a health sharing ministry.

The Healthcare Sharing Accreditation Board is accepting applications for health sharing ministries. If accredited, a ministry may publicize this credential for one year before re-applying.

Talento said a list of accredited health sharing ministries will benefit policymakers and other stakeholders. Going forward, she said, the Alliance of Health Care Sharing Ministries will be governed only by ministries which are “committed to undergoing the accreditation process.” The alliance’s members include seven of the nine health sharing organizations with a large, nationwide open membership certified by federal regulators.

The Healthcare Sharing Accreditation Board is an independent, non-profit entity. Its voting board members do not have an affiliation or interest with any health care sharing ministries, according to the Alliance of Health Care Sharing Ministries. Its members include former U.S. Rep. Diane Black, a Tennessee Republican; James Lansberry, former executive vice president of the Peoria, Illinois-headquartered health care sharing group Samaritan Ministries; and Mary Mayhew, president and CEO of the Florida Hospital Association.

The accreditation board will evaluate applicants in various areas, including legal structure and governance; organizational management and compensation; conflicts of interest; external communications and marketing; enrollment processes; members’ written acknowledgments; published sharing guidelines; expense ratio; and audited financial statements.

The board will also evaluate organizations’ financial sharing processes in areas like processing time, dispute resolutions and appeals, and total amounts shared and not shared among members.

Sharity Ministries, a Christian health sharing ministry, went bankrupt last year, leaving tens or even hundreds of millions of dollars in unpaid claims for its members.

Formerly known as Trinity HealthShare, Sharity Ministries had 40,000 members at its peak. But in recent years, the organization had faced class action lawsuits. Regulators in several states said it had been operating as an unauthorized insurance provider. Sharity Ministries blamed its vendor for acting in bad faith. Its vendor, the for-profit Aliera, was found guilty of fraud in 2020.

Sharity Ministries was not part of the Alliance of Health Care Sharing Ministries and several leaders in health sharing ministries backed investigations of the organization.

Among the critics of health sharing ministries is Joann Volk, a research professor at Georgetown University’s Center on Health Insurance Reforms. Volk, joined by other researchers, has co-authored several articles posted to The Commonwealth Fund, a New York-based private foundation that seeks to improve the health care system through independent research and grantmaking. 

Volk has said that while these ministries resemble health insurance and have lower upfront costs, they do not follow the same rules or provide any of the protections as insurance plans. They make no promise that enrollees will be reimbursed at all, even if health claims meet guidelines for payment.

Critics like Volk have faulted health sharing ministries’ exclusions of some drugs and services. Some plans exclude payment for pre-existing conditions or impose a long waiting period. Maternity services, for instance, can be restricted to those enrolled prior to becoming pregnant and only to those who are married.

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The ministries that Volk and other researchers examined excluded maintenance medications required for chronic conditions. They excluded mental health or substance-use disorder treatments except in very limited circumstances.

The Alliance of Health Care Sharing Ministries offered its view of best practices in a December presentation to the National Association of Health Insurance Commissioners’ working group on improper marketing of health insurance. These practices include “robust disclosure” to potential members about how membership differs from health insurance funds.

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