Five
Basic Types of Health Insurance Policies
1. Comprehensive
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Benefit coverage may include facility care, home nursing,
emergency care, and Christian Science practitioners.
2. Medigap or Medicare Supplement Back
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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 Back to
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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 Back
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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 Back
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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.)
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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 Back
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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?
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- 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 Back
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Many policies specify that Christian Science nursing care
be provided by an accredited Christian Science nursing facility,
and specify the accrediting body. Broadview and Sunland are
accredited by The Commission for Accreditation
of Christian Science Nursing Organizations/Facilities, Inc.,
an organization recognized by the federal Medicare program.
Additional Information Back
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Health insurance is a very complex subject. The information
presented in this Resource Guide includes only the highlights.
For more information, you are encouraged to consult the publication,
Finding Health Insurance for Christian Scientists in 3 Easy
Steps by Lee Bedient. Copies can be obtained from The
Christian Science Nursing Care Endowment.
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