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? 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 The individual shared responsibility provision was repealed in December 2017, effective in 2019.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. 2

30 states have safe harbor laws that distinguish healthcare sharing ministries from health insurance organizations. 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 3

The Market Landscape Why is this one of the fastest growing industries? o More Affordable o Choice of Doctors o Exempt ACA Taxes and Penalties o 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 4

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. Membership requirements

Common Beliefs: The right to worship God in freedom. Members agree to a state of commitment or Sample Statement of Beliefs belief. Each Healthcare Sharing Ministry has We believe in the sanctity and dignity of every human life, their own beliefs such as: and that God created every life for a special meaning and purpose. Psalm 139:13-14  Believe in biblical teachings We believe that every individual has the constitutional and  Live a healthy lifestyle religious right to worship God in freedom. 2 Corinthians 3:17  Believe in one God We believe and agree in the biblical and ethical principle of  Salvation is by grace through faith in Christ. sharing with those who are less fortunate and who  Share their Christian testimonial by phone experience medical needs. Galatians 6:2  Believe smoking, illicit drugs and excessive We believe and agree that it is our responsibility to God and alcohol is harmful to the body and soul our fellow members to engage in healthy living, and to avoid  Marriage is between man and woman habits and behaviors which are harmful to the body. 1 Corinthians 6:19-20 6

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. 7

How Does It Work? 8

How Sharing Works Member Check sent to Member selects Provider submits Sharebox Provider Provider medical bill Portion of monthly contribution designated to sharing account Price Member presents Member negotiated ID card receives EOS Healthcare Sharing Programs act as the facilitator, bringing together processes and providers for the sake of members. 9

Common Membership Restrictions 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 10

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. 11

Sharing Services What do programs look like? 12

Basic Sharing Services 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  Annual Visits  Women Screenings  Primary Care  Children Screenings  Urgent Care  Immunizations and Injections  Specialist Some healthcare sharing ministries believe that medical sharing expenses should be for catastrophic services therefore they do not offer basic services. 13

Major Sharing Services Emergency R Room Su Surgeri ries es Hospit itali lizatio tion Maternity ity Can ance cer Or Organ T n Trans nsplants 14

What additional type of services 15% - 80% 20% - 50% 20% - 40% may be offered? Diabetic Care Vision Prescriptions Membership Discount Program Savings 20% - 60% 30% - 60% 10% - 80% Telemedicine Member Concierge Dental Hearing Labs 15

Maximum Sharing • Individual Sharing Amount • Out of Pocket Maximum • Per Incident Maximum • Lifetime Maximum • Maternity Maximum • Cancer Maximum 16

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 17

Affordable monthly contributions The only thing that you need to do is live a healthy lifestyle.  Pricing depends on your age, members in $190+ your household, and your annual Basic Programs $120+ household portion. Hospitalization Only  The higher your responsibility the less you will pay. $280+  Reported average savings of over $4,000 a Comprehensive Programs $60+ year on healthcare. Minor Sharing 18

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 19

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 20

Thank you! 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. 21