HARTFORD, CT – Connecticut Insurance Commissioner Andrew Mais told two companies Tuesday that they need to stop selling their product in Connecticut.
That’s because the product they are selling is not health insurance. Instead, they’re selling a health care sharing ministry.
Mais filed cease-and-desist orders Tuesday against Aliera Companies, Inc. and Trinity Healthshare, Inc., accusing the companies of marketing their products as health insurance.
Aliera has been administering and marketing health coverage on behalf of Trinity Healthshare, according to Connecticut insurance regulators. Trinity represents itself as a healthcare sharing ministry whose members share a common set of ethical or religious beliefs. Health care sharing ministries are not illegal in Connecticut, but they are not considered to be health insurance, either.
“Connecticut has some of the highest health insurance premiums rates in the country, so it’s deeply disappointing to see state regulators working to deny residents access to a more affordable alternative offered by our health share ministry partner,” a statement from the company says. “We will utilize all available opportunities to address the false claims being made about the support services we provide to Trinity Healthshare and other health care ministries we represent, and we’re confident the health care sharing ministries will defend the right of their members to exercise their religious convictions in making health care choices.”
The Connecticut Insurance Department issued the cease-and-desists after receiving complaints from one particular consumer alleging nearly $300,000 in unpaid claims and concerns over how the policies were marketed and sold to them. This consumer met the $10,000 plan deductible, paying out of pocket for diagnostic tests including several MRIs, and the company subsequently refused to pay the $280,000 surgical and physician bills, citing a pre-existing condition.
Until their claims were denied, according to the Insurance Department, some consumers believed they were buying traditional health insurance and did not know the plans were offered by a health care sharing ministry, which would be exempt from state insurance regulations.
“We are seeing entities in the marketplace misleading consumers and trying to avoid insurance regulation,” Mais said. “Consumers need protections from these practices, which is what the CID is empowered to do. It is important for consumers to reach out to the department when they have questions or concerns, and be cautious when they purchase health coverage.”
Connecticut is the fifth state to take some type of action against the two companies.
Similar actions have been taken by Washington, Colorado, Texas, and New Hampshire.
Aliera told NPR in November that they planned to appeal a cease-and-desist in New Hampshire.
“Aliera will continue to vigorously defend against false claims made about the administrative, marketing, and other support services we provide to health care sharing ministries (HCSMs), and we’re confident the HCSMs we support will defend the right of their members to exercise their religious convictions in making health care choices,” the company wrote in a statement.
New Hampshire Insurance Commissioner John Elias said that “there are legitimate health care sharing ministries that offer coverage for their members, but Aliera and Trinity are not one of them.”
The Connecticut Insurance Department said the companies “market their plans to Connecticut consumers through licensed insurance producers and collect fixed monthly payments from their members, calculated on the basis of the coverage chosen, which vary in accordance with the type of plan applied for, the level of coverage, the number of family members enrolled and the underwriting characteristics of each member.” However, they “have not applied for or received an insurance license from the Commissioner authorizing the Respondents to make or propose to make, as insurers, insurance contracts or to conduct in Connecticut.”
Health sharing ministries have been around for two decades and have grown in popularity as monthly health insurance premiums have increased year after year.
According to the Alliance of Health Care Sharing Ministries, there are 104 sharing ministries that cover nearly 1 million people across the country. Four years ago that number covered was 160,000.
“We commend the Insurance Department for taking this swift action to protect consumers,” Healthcare Advocate Ted Doolittle said. “Today’s cease and desist order will protect Connecticut residents from Aliera’s deceptive marketing and unfair claims adjudication practices that include pre-existing condition exclusions, lifestyle choices, and other reasons that ordinarily would be prohibited under the ACA.”
Editor’s note: This story was updated on Dec. 9 with comment from Aliera.