Insurance for Christian Scientists

Thomas & Associates offers specialized insurance solutions for Christian Scientists. Another option is Serving Christian Scientists Insurance. For more information on the Affordable Care Act (ACA) and what it means for Christian Scientists, click here.

Five Basic Types of Health Insurance Policies

1. Comprehensive
Benefit coverage may include facility care, home nursing, emergency care, and Christian Science practitioners.

2. Medigap or Medicare Supplement
Medigap policies generally base their benefits upon whether a person qualifies for Medicare. If the nursing care qualifies under the specific eligibility criteria for skilled nursing care at a Christian Science nursing facility, the Medigap or Medicare Supplemental insurance policy will generally pay for nursing charges that Medicare doesn’t cover (deductibles, etc.). Some policies stop paying any benefits once Medicare stops paying benefits; others continue to pay for some specific time period beyond Medicare coverage so long as the care required to meet a patient’s nursing need meets the criteria to qualify for Medicare reimbursement.

3. Indemnity
Indemnity policies pay a fixed daily rate for inpatient care. They pay for Christian Science nursing care whether or not Medicare pays.

4. Long Term Care
Long term care insurance is different from other health insurance because it is intended for long term assistance with normal activities of daily living such as eating, bathing, and mobility. Medicare does not pay for this type of care. Most long term care policies do not cover Christian Science nursing care, and those that do may require evaluation of the need by a representative of the company issuing the policy. It is important to ensure that the policy includes written verification or a “rider” confirming coverage for Christian Science nursing care, and to thoroughly understand the company’s requirements for documentation or proof of the need for care. Long term care policies are generally divided into two categories. The “tax qualified” policies may require a physician to certify that a patient will be disabled for at least 90 days before benefits will be paid. Payment of benefits for a “non-tax qualified” policy are generally based upon a person’s inability to perform certain functions of daily living as evaluated by a licensed home health agency or the facility providing the care. If you consider a non-tax qualified policy because of fewer restrictions, be sure to check with the agent as to whether or not the payments from a non-tax qualified policy will be tax free. As of this printing, the IRS has not ruled on this issue.

5. Home Nursing
Home nursing insurance provides financial coverage for nursing care in your home. You need to review the policy carefully for eligibility requirements such as Journal-listed vs. non-Journal listed nursing care, may a friend or relative provide the service, or need written approval of a doctor before benefits will be paid.

Four Important Questions About Health Insurance
Following are four important questions Christian Scientists should ask about health insurance coverage:
1. Will this policy cover nursing care in a Christian Science nursing facility?
(This must be in writing in the policy or in a rider to the policy.)
2. Will this policy cover the services of a Christian Science nurse in my home?
(This must be in writing in the policy or in a rider to the policy.)
3. Will I need to have a physician’s diagnosis before this policy will pay benefits?
(Many long term care policies, especially those whose premiums are tax deductible – so-called “tax qualified” policies – require this.)
4. Will this policy cover the services of a Christian Science practitioner?
(This must be stated in writing in the policy or in a rider to the policy.)

Note: Christian Scientists with insurance coverage or who are exploring it (either private policies or through employment benefits), should find out exactly what Christian Science care expenses are covered. It is important to note that many personnel departments, and even some insurance agents, are not aware until they specifically ask the carrier, of specific benefits that may be available to Christian Scientists. If such benefits are not already available, riders can sometimes be attached to an individual or company policy that provides for Christian Science nursing care. When dealing with someone in a personnel department, it may be necessary to request a written response directly from the insurance carrier.

Other Questions to Ask
Once an individual determines that a policy will cover Christian Science nursing, he or she must determine how much coverage is desired. These are a few of the many variables involved in this decision.

– What type of coverage is desired? Some policies cover only “intensive care,” while others include coverage for “custodial nursing care” (often referred to as “long term care”)
– How soon after the purchase of a policy are benefits available?
– When does the policy begin paying benefits if one is admitted to a facility? (Policies become effective when your application is accepted and payment received, but payment of benefits may not begin on the day of admission.)
– How does the daily benefit compare to current rates?
– Does the policy cover the patient’s charges not covered by Medicare?
– Will premiums for the policy increase periodically over time?
– Review the benefits page that tells if benefits will be reduced at specific ages and whether premiums remain the same.
– Does the policy require a physical exam prior to enrolling?
– What is the deductible of the policy? (the amount you pay out of pocket before the insurance starts to pay)
– What is co-insurance? (the amount the insurance company pays and the amount you pay once the deductible amount is paid by you)
– What is the maximum benefit period? (maximum number of days for which benefits will be paid)
– What is the maximum benefit amount? (the maximum dollar amount that will be paid)
– What is the elimination period? (the period of time you must pay yourself before the insurance starts paying)

Accreditation
Many policies specify that Christian Science nursing care be provided by an accredited Christian Science nursing facility, and specify the accrediting body. Not all accrediting agencies are recognized by the Medicare administration.