Health Care Sharing Ministries

The West Virginia Offices of the Insurance Commissioner (OIC) issued this Consumer Alert on April 29, 2024, in connection with House Bill 4809 (2024), which enacts the Health Care Sharing Ministries Freedom to Share Act, effective May 26, 2024. The alert explains that Health Care Sharing Ministries (HCSMs) are organizations whose members share a common set of ethical or religious beliefs and pool contributions to cover members' medical expenses. The Act expressly provides that HCSMs are not health insurance and are not considered to be engaged in the business of insurance for purposes of OIC regulation. The alert identifies several ways HCSMs differ from ACA-compliant health insurance. HCSMs are not required to follow ACA coverage or consumer protection mandates; they may exclude preventive care, limit or exclude coverage for pre-existing conditions, and exclude mental, behavioral health, or substance use disorder services. Members may be subject to medical screening, higher membership rates based on health status, denial of membership based on health status, or behavioral eligibility requirements such as abstaining from tobacco or alcohol use. HCSMs are generally not legally obligated to pay claims, and members have no guaranteed right to payment. In months where aggregate need exceeds available sharing funds, members may receive only a prorated amount. HCSMs may impose monthly, annual, or lifetime caps, and members may be responsible for bills exceeding any applicable limit. HCSMs may or may not maintain provider networks with negotiated rates. Effective May 26, 2024, any HCSM must include a written disclaimer on or accompanying all applications and guideline materials stating that the organization is not an insurance company, that participation by other members in paying a member's bills is entirely voluntary, that participation is not insurance, and that the member remains personally responsible for all medical bills regardless of whether any payment is received. The disclaimer must also direct complaints to the state Attorney General. The OIC states it does not regulate HCSMs and cannot resolve HCSM-related complaints. Consumers with HCSM complaints are directed to the West Virginia Attorney General's Office. The OIC retains jurisdiction over licensed health insurance products, including employer-sponsored plans, directly purchased plans, and ACA marketplace plans.