As a minister in your church, you wear many hats. You tend to the members of your congregation at their births, weddings, and funerals. You visit them when illness confines them to their homes or a hospital bed. And with weekly sermon preparation, prayer, and contemplation, you have a lot on your plate.
To add to it, you’re often also the head of your church’s administration. You need to be able to answer questions about payroll and benefits — including church health care insurance for your staff.
In this article, you’ll get on the inside track for learning what a pastor needs to know about administering church health care for their ministry.
If you prefer to jump right to a section, just click on the link below.
- Faith-based vs. traditional health insurance
- HMO or PPO?
- Additional health insurance benefits
- Out-of-pocket costs
- Claim denials
- Covering Expenses
- Selecting the right health insurance for your ministry
Faith-based health care vs. traditional health insurance
One of the questions you are likely to receive is about using a faith-based health care plan. On the surface, these look good. But once you dig deeper, there are major concerns.
Christian healthcare/health-sharing ministries often provide lower costs than traditional insurance with faith-based sponsors, however, they aren't insurance companies.
You’ll have less legal protection, more coverage restrictions, and no guarantees. These programs have strict rules about what they will and won't cover — often resulting in excluding preventative care and pre-existing conditions.
Know the facts first. For a deeper dive into the pros and cons between health share ministries and traditional insurance, check out this article.
HMO, PPO, or… something else?
Traditional health insurance is most often delivered through a Health Maintenance Organization (HMO) or a Preferred Provider Organization(PPO). Some of the major differences are listed below.
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HMO plans have lower monthly fees and costs but require a doctor to manage your care and refer you to specialists within a set network.
PPO plans cost more each month but offers more freedom. You can see specialists without referrals — and while it's cheaper to use doctors in the network, you're still covered when seeing doctors outside of it.]
At Reformed Benefits Associations, our plans fit in the PPO category, with one exception. We also offer a plan from Surest, which has defined costs within its own network of providers. So, what does this mean for you and your staff members? You’re free to shop around within that network, and you’ll always know how much you have to pay.
To make it easy to compare different plans, we’ve created a health insurance comparison guide. With this, you will be able to see the differences between any plan on the market and all of the RBA plans. It’s a great way to simplify and organize what can feel like a lot of information. Download your free comparison guide.
Your plan should provide more than health insurance.
Your provider should send you a benefits guide and other resources before you sign up. If they haven’t, and you’d like to see what one looks like, you can download ours.
In addition to traditional health services, insurers offer other benefits. These include access to gym memberships, help with diabetes and weight management, and online mental health services.
These benefits are designed to help you live a healthier life and reduce the risk of medical issues.
Your health insurer may also offer the opportunity to receive prescription coverage, dental, vision, and supplemental insurance as well. Understanding everything you get for the premium you pay can be a pleasant surprise.
What are out-of-pocket costs?
An insurance premium is the recurring cost of staying in the plan. Sometimes, the church pays some or even all of this fee. A PPO plan will also have other fees, known as out-of-pocket costs.
Here are a few other terms that may be helpful to know when looking through your insurance costs:
- Co-Pay: For certain services, you may have to pay a set fee and your insurance provider picks up the rest.
- Deductible: This is the amount you must pay for covered medical services. After this point, your insurance begins to share the costs with you.
- Maximum out-of-pocket expenses: Each plan has a threshold for the most you'll have to pay for covered medical services in a year. From that point on, your insurance plan pays 100% of covered costs. Most co-pays and deductibles count toward this number.
You can learn more about out-of-pocket costs by following this link.
Why do claim denials happen?
Around 15% of all health insurance claims are denied by the insurance company. However, in nearly half of those cases, appeals are successful. Understanding the common causes of claim denials and the appeals process is helpful when your staff comes to you for advice.
Claim denials often result in frustration and anxiety. And while you won’t be able to take on the appeal yourself, you can be a helpful resource for anyone unsure of their next steps.
The majority of problems with an insurance claim arise from simple administrative mistakes. Each insurance provider will also have a system to process an appeal through customer support.
Read our guide to learn the ins and outs of health insurance claim denials to gain a better understanding of why they happen and how to appeal.
Making expenses easier to cover
After the Affordable Care Act went into effect, two important tools emerged to help offset healthcare costs. They are known as Health Savings Accounts (HSA) and Health Reimbursement Accounts (HRA).
An HSA functions like a personal savings account. Individuals (and optionally employers) contribute tax-free funds for healthcare expenses.
An HRA is an employer-funded account that reimburses employees for qualified medical expenses after payment is complete.
If you wish to explore these options in greater detail, follow this link to read more.
Finding the right health insurance benefits partner
As a minister managing health insurance responsibilities, you don't need to navigate this alone. RBA only works with faith-based organizations, and we understand the challenges of your calling:
- Access to high-quality group insurance plans, including PPO options and Surest's defined-cost network
- Expert guidance for choosing the right church health care plan for your ministry
- Comprehensive benefits guides and resources
- Support for answering staff questions about coverage and benefits
Visit our resources page to find detailed plan information, benefit guides, and many other support materials. We want you to feel prepared to make informed decisions about your church's healthcare needs.
You don't need to become an insurance expert. With RBA's support, you’ll be confident whether you’re working with your own benefits or answering questions from church staff.
The information contained in this blog is for educational purposes only. Please seek professional advice before acting on the information you have read above.