Is a health care sharing ministry insurance, and what can I do if it does not pay my bill?

Texas keeps a chapter for these groups in its insurance code, and that chapter is where the rules below sit [1]. Here is what makes a group one of them. It must be a faith-based nonprofit that is tax-exempt. It limits who may join to people of a similar faith. It matches participants who have medical bills with participants who can help. The money moves from one participant to another. No one takes on risk and no one promises to pay — not the other participants, and not the ministry itself. It must also send a written monthly statement, disclose its fees and costs, and print on any card that the holder is in a sharing ministry that is not engaging in the business of insurance [1].

The notice is the heart of it. The law writes out the words the group has to give you. It is not an insurance company. Its guidelines are not an insurance policy. Whether anyone helps with your bills is totally voluntary, because no other participant is compelled by law to contribute. And whatever happens, you are always personally responsible for your own medical bills. The same notice names where to complain: the office of the Texas attorney general [2].

That shapes your dispute route. A ministry acting under this chapter is not considered to be engaging in the business of insurance [3]. The chapter names no appeal and no outside review. The one door it does name is the attorney general's office, in the notice itself [2]. Whether your own insurance department will take a complaint about one of these groups — ask that office, because the statute does not say.

The federal tax rule is a separate thing. It has its own list for what counts as a sharing ministry: a 501(c)(3) group, members who share a set of beliefs and share medical costs, members who keep their place even after they get sick, a group that has run without a break since the end of 1999, and a yearly audit by an independent accounting firm whose report is public on request [4]. That list is a test for a tax exemption. It is not a promise that your bill gets paid. Two things the sources do not give: whether a given ministry will pay your bill, and how each other state treats these groups. We do not have either, so we do not say.

Read Tex. Ins. Code §1681.001, §1681.002 and §1681.003 at the links quoted here, then read 26 CFR 1.5000A-3(b) for the federal definition. Check the card you were issued as well: the law says it must state that you are in a sharing ministry that is not engaging in the business of insurance. Whether your own state has the same exemption — Don't know yet. Ask your state insurance department.