Aliera, Unity, Trinity “Health Care Sharing Ministries” Kentucky Class Action

When is insurance not insurance? This class action brings suit against the Aliera Companies, Inc., Trinity Healthshare, Inc. and OneShare Health, which formerly did business as Unity Healthshare, LLC for selling healthcare plans that the companies claim are not health insurance. It alleges that, while there are indeed things known as “Health Care Sharing Ministries (HCSMs),” the above companies do not meet the requirements and are insurance companies that must be licensed and regulated as such in Kentucky.

The class for this action is all persons who, while Kentucky residents, bought or were covered by a plan from Aliera and Unity or Trinity HealthShare that purported to be a “health care sharing ministry.”

Aliera creates, sells, and administers health plans for Trinity and Unity. But none of them “holds or has held a certificate of authority from the Kentucky Department of Insurance” and none of them “has at any time been authorized to transact insurance” in Kentucky, the complaint says, although “Aliera has been licensed as an agent to sell life and health insurance” in that state since September 2017.

When the Patient Protection and Affordable Care Act (ACA) passed, it required that all individuals be covered by health insurance. An exception to this rule was made for those who are members of an HCSM.

But HCSMs had to meet certain requirements: (1) They had to be 501(c)(3) corporations. (2) The members had to “share a common set of ethical or religious beliefs and share medical expenses among members according to those beliefs[.]” (3) They must have existed “at all times since December 31, 1999 and medical expenses of [their] members [must] have been shared continuously and without interruption since at least December 31, 1999.”

The complaint flatly states, “At no time has for-profit Aliera ever met the definition of an HCSM.” Instead, the complaint alleges that Aliera set up first, in 2016, Unity as an HCSM under “Anabaptist” (an actual HCSM) and then Trinity, in 2018. Neither of these entities had been in existence since December 31, 1999, and Trinity did not require members to share any ethical or religious beliefs.

Nevertheless, Aliera sold health plans that it claimed came from HCSMs. The complaint alleges that the plans did not comply with the minimum requirements under federal law. Kentucky customers are thus “(1) paying for an illegal contract, and (2) being denied coverage for medical care required by law to be provided.” The complaint alleges that the companies have made “exorbitant profits.”

Statements that the plans would provide “meaningful medical coverage[,]” the complaint says, “were fraudulent, misleading, unfair, and/or deceptive in violation of the unfair competition provision of Kentucky’s Insurance Code, False Advertising Law, and Unfair Claims Settlement Practices Act.” They did not even provide “the medical coverage that was represented.”

Article Type:
Topic: Insurance, Permits and Authorizations and So On

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