Health Insurance

Christian Science nursing organizations do not give advice concerning health insurance coverage or advocate for or against individuals purchasing insurance policies. Whether to insure, and to what extent, are very individual matters, and each should reach his or her own conclusions through earnest prayer. In addition, the options available and laws governing insurance are constantly changing.

Following are some questions and considerations that might be useful to Christian Scientists who are considering whether to purchase health insurance, researching possible purchase of a new policy, or examining an existing policy.

There are three forms of health insurance coverage:

  • Individual health insurance policies
  • Group health insurance policies (usually provided by employers)
  • Health maintenance organizations (HMOs – see previous section)

Few policies include coverage for Christian Science practitioner fees or home nursing care. It is important to know exactly what an insurance policy provides and have the terms spelled out in writing, not just as described by an insurance agent or personnel office contact. For example, some insurance policies will pay only when other insurance coverage has been exhausted, and your agent or personnel office contact may not be aware of benefits available to Christian Scientists.

Five Basic Types of Health Insurance Policies

Comprehensive

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

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 as long as the care required to meet a patient’s nursing need meets the criteria to qualify for Medicare reimbursement (see section on Eligibility for Medicare Reimbursement of Christian Science Nursing Care).

Indemnity

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

Long Term Care

Long term care insurance is different from other health insurance because it is intended for long tern 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’ 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 the whether or not the payments from a non-tax qualified policy will be tax free. As of this writing, the IRS has not ruled on this issue.

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 Scientist 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.)
  1. 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.)
  1. 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)
  1. Will this policy cover the services of a Christian Science practitioner? (This must be 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 human resources 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. Arden Wood, Broadview, Fern Lodge, Olive Glen, and Sunland are accredited by The Commission for Accreditation of Christian Science Nursing Organizations / Facilities, Inc., an organization recognized by the federal Medicare program.