Are health insurance companies the reason why health care costs are so overwhelming? Will targeting them alone revamp the health care system? What level of premium will citizens have to pay if everyone is forced to buy coverage and no one can be denied coverage for a pre-existing condition? If our experience with a self-funded plan, a plan in which we provide our own health coverage, is any indication, insurance companies are only a small contributor to the high medical costs. Citizens may very well be in for some profound “sticker shock” when it comes time to ante up for their monthly premium.
What has been our experience?
Village Missions saves money for our churches with a self-funded plan and can tailor our coverage to minister more effectively to our missionaries. However, the premium we need to charge to remain in the black ($950 per month per missionary family) is high. Our premium is out of reach for some of our poorest churches, and we supply financial resources to help them. The Congress will have to do a lot more than demonize insurance companies to bring down costs.
The premium is broken down into several components. The bulk amount covers medical and pharmacy costs. We also pay for life and disability insurance. An ever-increasing piece is stop-loss insurance for large medical claims. The stop-loss trigger was once $60,000. We have raised the level to $160,000 in an effort to lower the premium. However, that means we absorb the first $160,000 of medical expenses. Stop-loss insurance accounts for our biggest single cost (average $14,000 per month) other than actual medical and pharmacy payments. We pay a company to administer the medical bills (T.P.A.) and a consultant to advise us on structuring our plan. All the above are part of the needed pieces to maintain a working health plan.
In managing our plan, we have four main goals. First, we want to provide the best coverage possible to our missionaries. Of course, we balance this goal against our second goal of reducing the premium to the lowest possible level for our churches. Our third goal is to do as much as possible to encourage healthy lifestyles and engage in preventative medicine. Our fourth goal is to provide health care that contributes to our purpose of developing spiritually vital churches in rural North America.
What do we do to support these four goals?
First, under the tireless leadership of Dr. Larry Malewiski, our Benefit Board tries to develop coverage that meets missionary needs. We can’t do everything given the cost but we do everything we can. When a missionary experiences a serious health problem, managed care starts. We have hired a company (MRC) that guides the missionary through the health care maze and makes sure he or a family member receives the best treatment. If warranted, missionaries will receive expert care at Centers of Excellence throughout the country. Often Dr. Larry personally intervenes to provide direction and support.
But we also must manage costs. The Benefit Board, sometimes in anguish, balances premium costs versus deductibles, out-of pocket expenses, and covered procedures. Fortunately, we have a Helping Fund that provides additional support for missionaries burdened by medical or other emergency expenses. Our health care consultant, B.C.N.W., has worked hard to enroll all our missionaries in health networks (P.P.O.) that negotiate reduced costs for medical care. It has been a huge undertaking to find P.P.O.’s in many of the rural areas we serve. The Board examines overall costs to look for savings. For example, they changed our Pharmacy provider to save money and improve service.
We also work to fulfill our third goal of preventing illness. All preventative care such as an annual physical is covered at 100%. At our staff conferences, we have conducted blood screening as well as encouraging a healthy lifestyle. I benefited personally from a blood screening that discovered a high PSA level. We will try to continue such programs, if we are able to resume staff conferences. We encourage missionaries to take responsibility for their own health.
Fourth, we must advance our goal of developing spiritually vital churches. Currently, without our plan missionaries with pre-existing conditions could not obtain coverage or would have to do so at much higher rates. In addition, families with a large number of children (we have several) would be forced to pay much higher rates. Even the Christian plans, Medi-Share and Samaritan Ministries, for example, do not accept people with pre-existing conditions. Simply put, we could not supply anywhere close to the number of Village Missionaries without having a plan that covers every missionary.
A few years ago, we noticed that the poorest churches, the ones most in need of our help, could not afford our plan. We developed a way that these churches could have leadership without putting a huge drain on our resources. We call it the “Sliding Scale.” Churches initially do not have to pay the entire premium based on their General Fund offering. Then as offerings increase with effective leadership, the amount the church pays increases according to a scale. The Sliding Scale enables us to continue keeping country churches alive.
Village Missions has one of the few successful self-funded plans among Christian organizations. Besides the provision of God, this is due to the cooperation of the churches we serve, our missionaries, and the tireless work of our Benefit Board. Some churches perhaps could find a lower premium for health insurance based on whom they have as a missionary but they recognize they are helping provide coverage for the entire missionary family. Their generous spirit enables us to continue this plan.
The Benefit Board will monitor changes made by the Congress. Whatever changes are made, we will make sure that our Village Missionaries in the United States have the best coverage possible. We have experienced difficult challenges in providing health coverage for Village Missionaries. I hope that Congress doesn’t make the situation even worse.