Healthcare Sharing Ministries, an Alternative to Health Insurance - - PowerPoint PPT Presentation

Healthcare Sharing Ministries, an Alternative to Health Insurance

July 30, 2019

Presented by:

Michelle Berndt OneShare Health, LLC

What is a Healthcare Sharing Ministry?

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Organizations that facilitate sharing of healthcare costs among individual members who have common ethical or religious beliefs. Organizations must be a 501(c)(3) Not for Profit. Members of healthcare sharing ministries are exempt from the individual mandate requirement of the U.S. Patient Protection and Affordable Care Act. The individual shared responsibility provision was repealed in December 2017, effective in 2019. This means members of healthcare sharing ministries are not required to have insurance as outlined in the individual mandate.

30 states have safe harbor laws that distinguish healthcare sharing ministries from health insurance organizations.

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30 st states

State law explicitly exempts healthcare sharing ministries

20 st states

State law does not contain an explicit exemption for healthcare sharing ministries

Source: Commonwealth fund Aug 2018

The Market Landscape

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Why is this one of the fastest growing industries?

• More Affordable
• Choice of Doctors
• Exempt ACA Taxes and Penalties
• Faith Based & Ethics Focused Programs

With over 70% of the U.S population as Christian, Healthcare Sharing Ministries account for over 1.2M members nationwide!

Source: Pew Research Center 2019

Membership requirements

Members must share common ethical or religious beliefs. Must not discriminate membership based on state of residence or employment. Members cannot lose membership due to development of medical condition. Must have existed and been in practice continually since December 31, 1999. Must be subject to an annual audit by an independent CPA which must be publicly available upon request.

We believe in the sanctity and dignity of every human life, and that God created every life for a special meaning and

• purpose. Psalm 139:13-14

We believe that every individual has the constitutional and religious right to worship God in freedom. 2 Corinthians 3:17 We believe and agree in the biblical and ethical principle of sharing with those who are less fortunate and who experience medical needs. Galatians 6:2 We believe and agree that it is our responsibility to God and

• ur fellow members to engage in healthy living, and to avoid

habits and behaviors which are harmful to the body. 1 Corinthians 6:19-20

Common Beliefs: The right to worship God in freedom.

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Members agree to a state of commitment or

• belief. Each Healthcare Sharing Ministry has

their own beliefs such as:

• Believe in biblical teachings
• Live a healthy lifestyle
• Believe in one God
• Salvation is by grace through faith in Christ.
• Share their Christian testimonial by phone
• Believe smoking, illicit drugs and excessive

alcohol is harmful to the body and soul

• Marriage is between man and woman

Sample Statement of Beliefs

Ministr tries and C Charities

You can’t out-give God.

2 Corinthians 9: 8-11 A portion of unrestricted net assets are shared with other charities who demonstrate a financial need or worthy purpose. Healthcare Sharing Ministries believe in giving back and strive to help other charities nominated around the world.

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How Does It Work?

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How Sharing Works

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Member selects Provider Member presents ID card Provider submits medical bill Member receives EOS Portion of monthly contribution designated to sharing account Price negotiated Member Sharebox

Healthcare Sharing Programs act as the facilitator, bringing together processes and providers for the sake of members.

Check sent to Provider

Common Membership Restrictions

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Pre-Existing Conditions:

• A chronic or recurrent medical condition that exists within 24 months prior to Effective Date.
• Eligibility for a pre-existing condition has a 24 month waiting period.
• If available, chronic maintenance can be utilized during the waiting period to keep chronic

conditions stable through PCP, Urgent Care, Labs and Specialist visits. Typical services not eligible for sharing:

• Abortion
• Substance abuse
• Cosmetic surgery
• Self inflicted injury
• Pregnancy out of wedlock
• (STD) Sexually Transmitted Disease
• Emergencies resulting from unbiblical lifestyle

What do they not do?

1. Healthshares do not accept risk or make guarantees. 2. Healthshares do not purchase reinsurance policies on behalf of its members. 3. Healthshares are not governed by the Department of Insurance. 4. Healthshares do not guarantee payment of bill submissions.

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Sharing Services What do programs look like?

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Basic Sharing Services

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Member responsibility varies according to program designs. Preventive Care $0  Primary Care Visits $10 - $50  Specialist Visits $75 - $150

Preventive Care Doctor Visits, Urgent Care, Specialists

Goal: Focus on staying healthy Goal: Management of care

• Adult Screenings
• Women Screenings
• Children Screenings
• Immunizations and Injections
• Annual Visits
• Primary Care
• Urgent Care
• Specialist

Some healthcare sharing ministries believe that medical sharing expenses should be for catastrophic services therefore they do not offer basic services.

Major Sharing Services

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Emergency R Room Su Surgeri ries es Hospit itali lizatio tion Maternity ity Can ance cer Or Organ T n Trans nsplants

What additional type of services may be offered?

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20% - 60% 30% - 60% 15% - 80% 20% - 50%

Dental Prescriptions Hearing

Vision

Membership Discount Program Savings

20% - 40%

Diabetic Care

10% - 80%

Labs Telemedicine Member Concierge

Maximum Sharing

• Individual Sharing Amount
• Out of Pocket Maximum
• Per Incident Maximum
• Lifetime Maximum
• Maternity Maximum
• Cancer Maximum

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Provider Networks

Direct Contracts

• Offer a national or regional network
• Members receive better discounts

No Contracts

• Members self pay providers direct
• Members are allowed to choose any provider

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Affordable monthly contributions

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$120+

Hospitalization Only

$280+

Comprehensive Programs

$190+

Basic Programs

• Pricing depends on your age, members in

your household, and your annual household portion.

• The higher your responsibility the less you

will pay.

• Reported average savings of over $4,000 a

year on healthcare.

$60+

Minor Sharing

The only thing that you need to do is live a healthy lifestyle.

Who joins Healthcare Sharing Ministries?

• Individuals
• Unemployed
• Self Employed
• Part-time employees
• Independent contractors
• Spouse not eligible for Medicare
• Not eligible for healthcare subsidies
• List Bill
• Small Businesses & Churches (3-49 employees)
• Associations & Affinity Groups (unlimited

member enrollment)

• Legal Dependents
• Individuals not in school
• Dependents aging off parent’s program

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Top Member Values

• Enroll 365 days a year
• Next day, effective day
• Freedom to choose doctors
• Open to people of similar faiths
• Preventive eligible from day one
• Lower than traditional insurance
• Programs with unlimited visits available

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Thank you!

21 ONESHARE HEALTH IS NOT AN INSURANCE COMPANY BUT A FACILITATOR OF HEALTH SHARE MEDICAL EXPENSES. This is an ACA exempt program that is not insurance coverage. The sharing membership does not guarantee or promise that medical bills will be paid or shared by the membership.