Janiva Answers: Does My Policy Cover CS Benefits?

Janiva Toler

Janiva Toler
Executive Director
Answers Your Questions on Healthcare

Question: How can I tell if my current insurance policy covers Christian Science benefits? Or if a policy that I am researching has CS benefits?

Answer: This is such a great question. Over the years I have seen so many folks who have paid premiums on healthcare policies that they “think” have CS benefits when they do not. So how can you tell if your policy covers CS benefits?

  • What kind of policy do you have? If you don’t know, then check your statements or ask for a copy – you need to know what kind of policy it is. If you have a Medigap policy, then payment for CS benefits will be based on an inpatient stay at a Christian Science nursing facility that is a Medicare provider – also called a RNHCI (religious nonmedical healthcare institution). In general you do not need to be concerned about CS language in a Medigap policy.
  • For every other type of insurance policy there are a couple of questions that will help you make that initial determination about CS coverage.
    • Is there anything in writing – either in a Rider to the policy or in the policy itself referring to coverage of CS nursing or practitioners?
    • Is there anything in the policy that would exclude coverage of CS nursing, CS nursing facilities or Christian Science practitioners?

If there is coverage for CS benefits in your policy, it most likely will show up in the definitions page. Skim the definitions page for “CS care facility”, “CS nursing facility” or “CS nurse”. There are a few policies that will specifically define these benefits. More likely, if there are CS benefits you will find them included in the definitions for “hospital”, “nursing home”, “assisted living” and/or “nurse”.

There needs to be “in writing” a definition for any CS coverage that you expect to receive. Some policies will mention accreditation by The Commission for Accreditation of Christian Science Nursing Organizations/Facilities, Inc. and Christian Science Journal listing for CS nurses.

The second question – and really more important — Is there exclusionary language in the policy?

I have talked to so many insurance brokers and agents who are sure that their policies will cover CS benefits, but they have exclusionary language which they have never thought about. For instance:

Hospital – licensed as a Hospital by the state authority or accredited as a Hospital by the Joint Commission on Accreditation of Hospitals
Since only a few CS care facilities are licensed by their state and none accredited by the Joint Commission, this would exclude CS benefits.

Registered Nurse – (RN) means a duly licensed registered graduate professional nurse acting within the scope of his or her license
This obviously refers only to a medical nurse.

Nursing home – provides 24-hour per day skilled, intermediate or custodial nursing care under the supervision of an RN or Physician
Even if there is CS benefits language in this definition it is overridden by the RN & Physician provision.

Unless you get in writing something that overrides that exclusionary language, most likely your claims will be denied if you ever file a claim. Often the agent who was sure that the policy would cover CS benefits is no longer working for the company and neither are the people in the department that assured him/her of the CS coverage.

In summary: Get it in writing. Be sure you have language that covers CS benefits and no exclusions that deny coverage for CS benefits.

7 Responses to Janiva Answers: Does My Policy Cover CS Benefits?

  1. Thomas J. Killeen says:

    Dear Janiva,

    I just glanced at this because it said “insurance.” Well researched and well presented. Crisp and to the point. Read your policy, understand exclusions as well as exceptions to exclusions. If you don’t like what you see get it changed through endorsement. Your agent should be as pro-active as with any of your religious beliefs that may conflict with average policy language.

    Best Regards

  2. Marion Harvey says:

    Since it is a question I’d been wondering, this month’s column is the first one in this series that I have opened and read! I was involved with care arrangements for four CS family members – 3 in the late eighties and early nineties and one in the early 2000s. Glad to have it spelled out just how things work now and specific ways we can determine what benefits we have. May we assume that the policies of organizations carrying insurance specifically for Christian Scientists (e.g. SCS) do not contain these any wording pitfalls? Or is that a naive assumption? Thanks so much for providing this regular feature – so helpful in this period of confusing change regarding coverage, government mandates, and so forth.

    • Janiva says:

      Dear Marion,
      Thanks for the question about SCS (Serving Christian Scientists). Yes, you should assume that SCS policies with Christian Science riders do cover CS benefits and do not have “wording pitfalls”. Where I see the most problems are with policies that do not have CS riders and do not mention CS benefits but where insurance agents assure the policy holder that the policy will certainly cover CS benefits.

  3. manuel says:

    dear. janiva

    thanks for the reply here and love someone with a lot of admiration in his excellent performance in the sea of christian science.thanks. always

  4. Margi Griffith says:

    I have had a long-term care policy for 9 years and now that I read it more carefully I see the exclusionary language you mention. Can you suggest wording for a letter to request CS coverage. I have a home health care option in my plan that does NOT appear to exclude CS nurses except that the nurses are to be licensed in the state and I’m not sure CS nurses are.

    I do not live close to any CS nursing facility now, nor do I expect to in the future, but it seems wise to attempt to obtain coverage NOW rather than trying to make the case if care becomes needed.

    I appreciate any assistance you can give. This website has been wonderful to learn more about Medicare and these long-term care issues.

    Thank you!

Leave a Reply

Your email address will not be published. Required fields are marked *