Enabling Legislation
Enabling Legislation for Healthcare Sharing Ministries
The ACA enabled Healthcare Sharing Ministries (HCSM) to function exactly as health insurance companies without having to be legally considered insurance because they do not themselves purchase stop-loss (umbrella) policies and as such are not under the control of the Department of Insurance. Instead, they operate under the control of states’ Attorneys General and must adhere to all consumer protection laws, especially those requiring fair dealing with consumers (Members). Altrua Healthshare has consistently proven since 1999 that it maintains sufficient cash reserves from operations to pay all covered claims based on Reference Based Pricing (RBP) that requires it to reimburse hospitals at 125% of the Medicare rate, which it of course does. RBP is gaining traction in the health insurance space because traditional insurance usually reimburses hospitals at an average of 247% of Medicare, obviously much more than RBP. This, together with the fact that HCSMs do not have to accept Members with significant preexisting medical conditions (PreEx), represents substantial savings that is passed on to the Members of HCSMs and is why we are 20-60% less than Obamacare. Please see the quote below from the ACA, and feel free to call us if you have any questions. For a greater understanding of why HCSMs are a very necessary element of American healthcare, why American healthcare is such a mess, and what part billionaire businesses, lobbyists, and corruption play in creating this mess, to read our Healthcare Sharing 101, please click here.
The Patient Protection and Affordable Care Act of 2010 (aka Obamacare or the ACA) in § 5000A(d)(2)(B) Health care sharing ministry formalized the legality of Healthcare Sharing
See the Enabling Legislation for Healthcare Sharing
(i) In general, such term (of exclusion) shall not include any individual for any month if such individual is a member of a
(ii) Health care sharing ministry. The term “health care sharing ministry” means an organization—
(I) which is described in section 501(c)(3) and is exempt from taxation under section 501(a),
(II) members of which share a common set of ethical or religious beliefs and share medical expenses among members in accordance with those beliefs and without regard to the State in which a member resides or is employed,
(III) members of which retain membership even after they develop a medical condition,
(IV) which (or a predecessor of which) has been in existence at all times since December 31, 1999, and medical expenses of its members have been shared continuously and without interruption since at least December 31, 1999, and
(V) which conducts an annual audit which is performed by an independent certified public accounting firm in accordance with generally accepted accounting principles and which is made available to the public upon request.
This is the seminal federal case on Obamacare and refers to Heath Care Sharing Ministries, confirming their legality.
LIBERTY UNIVERSITY, INCORPORATED v. Lew, 733 F. 3d 72
Court of Appeals, 4th Circuit 2013
This dispositive excerpt is from Section A.1., 2nd paragraph of Liberty v. Lew. The Court of Appeal’s summary omits Paragraphs (IV) and (V) of the below enabling legislation from the below summary.
“The "[h]ealth care sharing ministry" exemption applies to a member of a 501(c)(3) organization that "has been in existence at all times since December 31, 1999" (or who has partnered with an organization who has), the "members of which share a common set of ethical or religious beliefs[,] ... share medical expenses among members in accordance with those beliefs," and "retain membership even after they develop a medical condition." Id. § 5000A(d)(2)(B).”
Id refers to the Patient Protection and Affordable Care Act (ACA) of 2010, the Enabling Legislation for Healthcare Ministry Sharing, which also see if desired.