Carson City, NV - December 13, 2019
Open Enrollment is coming to an end on
Sunday, and some consumers may find themselves pressured to enroll in health
insurance before the deadline, making it easy to fall for misleading marketing
practices from entities mimicking health insurance, such as plans offered by
health care sharing programs or ministries (“HCSM”).
Consumers should be careful of purchasing
plans from HCSMs; they may seem enticing because they may be cheap, look and
sound like they are in compliance with the Affordable Care Act (“ACA”), when in
reality these plans are not even insurance products. These plans are from
organizations whose members share a common set of ethical or religious beliefs
and have shared medical expenses in accordance with those beliefs.
Consumers should be aware of the following
regarding health care sharing programs or ministries:
- They do NOT
comply with the Affordable Care Act (ACA), even if their materials say
they do. If you come across any advertising or statements by a sharing
program or ministry stating that it is ACA-compliant (or similar
language), please report this to the Division of Insurance
- Many sharing
ministries specifically state that they do not guarantee payment
for any health care and the member is ultimately responsible for
anything the ministry does not pay. This language might be buried in the
fine print, but it is an important notification.
- They typically
have restrictions or exclusions on pre-existing conditions, leaving the
member responsible for the health care costs for those conditions.
- Often such
programs do not provide mental health coverage or substance use disorder
- Members may also
be subject to religious or moral restrictions from the sharing ministry,
which may leave members responsible for the full costs of health care that
results from an activity the ministry does not agree with.
- Health care
providers (doctors, hospitals) are under no obligation to accept or honor
discounts from these programs if there is no contract or agreement to do
“There are many legitimate insurance
products to choose from on and off the Exchange that have been reviewed and
approved by the Division that offer full coverage and benefits in accordance
with the ACA,” explained Insurance Commissioner Barbara Richardson. “Consumers
should be aware of what they are purchasing so that they don’t find themselves
without any financial protection during a time of sickness.”
products, there is no guarantee that claims will be paid and HCSMs are exempt
from the ACA and state requirements. Please be aware that these programs are
not regulated insurance products, which means there are no solvency standards
or other regulatory protections.
there is still time to purchase health insurance that covers the ten essential health benefits through Nevada Health Link, the online insurance marketplace operated by the state agency, Silver
State Health Insurance Exchange – and the only place consumers can get
financial assistance (subsidies) to help offset the cost of insurance.
also purchase health insurance off the Exchange, but consumers cannot apply for
any financial assistance. To view plans off the Exchange, please visit http://doi.nv.gov/Health_Insurance_Rates/Rate_Review/. These
rates are displayed by age, county, and are for non-smokers. The search results
are displayed and then sortable by plan name, carrier name, metal tier, and
whether it is offered on or off the Exchange. It provides the full contracts
and schedules of benefits as well.
If you believe someone is trying to sell
you a health care sharing program or ministry by telling you that “it complies
with the ACA,” or “is just as good as ACA plans,” contact the Division to let
us know about these misleading marketing practices. If you're unsure of what
kind of coverage you currently have, whether it is traditional health
insurance, a health care sharing ministry, or something else, contact the
Division to find out what questions to ask. Contact the Division by calling
(775) 687-0700 or (888) 872-3234 or by visiting the website at http://doi.nv.gov/.
Open Enrollment ends December 15, 2019 at
About the Nevada
Division of Insurance
The State of Nevada Division of Insurance,
a Division of the Nevada Department of Business and Industry, protects the
rights of Nevada consumers and regulates Nevada’s $14 billion insurance
industry. The Division of Insurance has offices in Carson City and Las Vegas.
In 2018, the Division investigated more than 3,100 consumer complaints and
recovered over $8.4 million on behalf of consumers. For more information about
the Division of Insurance, visit DOI.NV.GOV.