Michigan Court of Appeals; Docket #356739; Published
Judges Ronayne Krause, Kelly, and Yates; Authored
Official Michigan Reporter Citation: Forthcoming; Link to Opinion
STATUTORY INDEXING:
Coordination with Other Health and Accident Medical Insurance [§500.3109a]
TOPICAL INDEXING:
Not Applicable
SUMMARY:
In this unanimous, published decision authored by Judge Yates, the Court of Appeals affirmed the trial court’s summary disposition order dismissing Plaintiff Meemic Insurance Company’s (“Meemic”) reimbursement action against Defendant Christian Care Ministry, Inc. (“CCM”). The Court of Appeals held that CCM, a voluntary health care sharing ministry under Michigan law, did not provide Vanderlinden, its participant/Meemic’s insured, with “other health and accident coverage” for purposes of MCL 500.3109a, and thus was not subject to the coordination provision in Vanderlinden’s no-fault policy.
At the time of the subject crash, Josephus Vanderlinden was covered under a Meemic no-fault policy which was coordinated as to Vanderlinden’s medical expenses. Meemic paid Vanderlinden’s crash-related medical expenses at first, but stopped upon discovering that Vanderlinden was also a participant in Medi-Share, a program administered by CCM, a health care sharing ministry under the Health Care Sharing Ministries Freedom to Share Act, MCL 550.1876. A health care sharing ministry is a “faith-based arrangement that involves ‘matching its participants who have financial or medical needs with participants who have the ability to assist in meeting those needs according to criteria established for the ministry by the eligible entry.’ ” Thus, Medi-Share is funded entirely by a “voluntary system of payments to meet financial or medical needs of its participants”—e.g., Vanderlinden—and any participant in Medi-Share ‘remains personally responsible for the payment of all his or her medical bills and other obligations incurred in meeting his or her financial or medical needs.’ Upon discovering Vanderlinden’s participation in Medi-Share, Meemic sought reimbursement from CCM for the more than $685,000 it paid in no-fault allowable expense PIP benefits to him, arguing that CCM was primarily responsible for Vanderlinden’s medical expenses given the coordination of benefits provision in Vanderlinden’s no-fault policy. CCM, in turn, moved for summary disposition, arguing that it did not provide “other health and accident coverage” for purposes of MCL 500.3109a, and thus was not subject to the coordination of benefits provision in Meemic’s policy. The trial court agreed and granted CCM’s motion.
The Court of Appeals affirmed the trial court’s summary disposition order, holding that health care sharing ministries such as CCM do not provide “other health and accident coverage” as that term is understood in MCL 500.3109a. The Court of Appeals noted that, far from qualifying as “other health and accident coverage,” the arrangement between Medi-Share and its participants—in which the participants remain personally responsible for their medical expenses—was the “antithesis of coverage, which by its very nature provides protection against personal financial responsibility.” Moreover, the Court noted that, unlike coverage provided by actual insurers, CCM’s ability to cover its participants’ medical expenses depended solely on the generosity of others, and, lastly, that CCM could not be regarded “as something akin to self-insurance because no participant indemnifies himself or herself to satisfy medical expenses.”
“Despite the long line of cases fitting a wide variety of benefit programs into the term ‘other health and accident coverage’ to provide for coordination of coverage under MCL 500.3109a, we conclude that allowing coordination of coverage with what a health care sharing ministry provides is a bridge too far. To determine whether what a health care sharing ministry provides should be characterized as ‘other health and accident coverage,’ we must consider ‘whether the coverage is typically provided by an insurance company.’ Jarrad, 472 Mich at 217. Under MCL 550.1867, which prescribes the requirements for a health care sharing ministry, ‘[w]hether any participant in the ministry chooses to assist another participant who has financial or medical needs is totally voluntary.’ MCL 550.1867(g). Needless to say, no coverage ‘typically provided by an insurance company’ depends solely on the generosity of others. See Jarrad, 472 Mich at 217. Beyond that, MCL 550.1867(g) expressly mandates that each participant in a health care sharing ministry ‘who receives assistance from the ministry for his or her financial or medical needs remains personally responsible for the payment of all of his or her medical bills and other obligations incurred in meeting his or her financial or medical needs.’ This arrangement is the antithesis of coverage, which by its very nature provides protection against personal financial responsibility. Finally, what a health care sharing ministry offers to its participants cannot even be regarded as something akin to self-insurance because no participant indemnifies himself or herself to satisfy medical expenses. See Jarrad, 472 Mich at 219. In sum, we can find no basis to characterize what a health care sharing ministry provides to its participants as ‘other health and accident coverage’ for purposes of coordination of coverage under the no-fault act, MCL 500.3109a. Our Legislature placed its imprimatur upon health care sharing ministries operating entirely outside the insurance system and providing assistance to the participants on a purely voluntary basis. Therefore, it should come as no surprise that health care sharing ministries do not furnish ‘other health and accident coverage’ within the contemplation of the no-fault act for purposes of coordination of coverage under MCL 500.3019a.”
Notably, the Court acknowledged that Vanderlinden would experience what Meemic described as an “indefensible windfall” by virtue of his choosing to coordinate his no-fault coverage—thereby resulting in a lower premium—with “other health and accident coverage” he did not actually have. The Court reasoned that “CCM Cannot be blamed for that result if Michigan law excuses CCM from coordination of coverage under the no-fault act,” and went on to state in Footnote 4:
“We cannot necessarily ascribe impure motives to Josephus Vanderlinden because he might have thought he had coverage through Medi-Share that could be coordinated with his no-fault insurance. But the Medi-Share program guidelines distributed to actual and prospective members make clear that members have no right to anything, that they are ‘solely responsible for the payment of’ their medical bills, and that ‘no Member may or shall be compelled to make sharing contributions’ to aid them.”
