Posted by: Steve | January 30, 2008

Health Care – Enduring Questions (part 2)

Last week I shared why we require our missionaries to have health insurance. As with any issue, it is wise to fully understand the effects of a decision and our missionaries are no exception. Below are the nine most asked questions about this issue here at Fellowship International Mission.

Question 1: Why do I need health insurance at all? I’m young (or at least I feel young) and I’m healthy.

Answer: The reality is that you will not always be young and you may not be healthy as long as you expect. We buy life insurance, hoping we never use it. We wouldn’t drive a car without car insurance, yet many of us have been accident free for years. The aging process or an unexpected health condition will one day render you uninsurable. If you do not have the insurance before you need it, you can’t get it when you do need it. Choosing not to have health insurance presents a multitude of liabilities ranging from unexpected or complicated births to unanticipated early catastrophic illnesses. The associated financial liabilities are unacceptable. Any unexpected or prolonged medical treatment in the US or elsewhere courts financial disaster and could create ministry-ending burdens. FIM would be remiss in its responsibilities if it did not insist on healthcare for its missionaries.

Question 2: I realize I need health insurance, but why can’t I buy an individual plan instead?

Answer: One way FIM keeps health insurance at affordable levels is through its group plan. In order for a personal plan to be affordable, you must be in good health, with no prior conditions that would preclude your being covered. Even seemingly minor health problems can drive up premiums, or cause you to be denied personal coverage completely. The FIM group plan covers new missionaries regardless of their pre-existing conditions. In addition, our agreement with Aetna Global is that all US citizen missionaries who join the Mission after June of 1995 will be required to join the plan. Non-US citizens may join optionally. Foreign nationals who have obtained a “US permanent residency visa” or have become a US citizen, or hold dual citizenship will be considered US citizens for determining health insurance requirements. The premiums were negotiated with this understanding in mind. Though Aetna does not closely monitor this situation to ensure our compliance, our sense of integrity demands that we keep that agreement. Our broker maintains that organizations that exempt personnel from their group policy are doomed to become an aging group with outrageously high premiums. What typically happens in voluntary environments is that young healthy missionaries opt out of the plan and older missionaries or those with health conditions that make them otherwise uninsurable remain in the plan. This scenario drives the premium up prohibitively. If this were to happen, many of our missionaries would be left without health insurance and would need to seek out individual plans rated for their specific health conditions. Administratively, individual plans would create a nightmare of administrative load and cost. For the Mission to responsibly represent to churches that you carry health insurance would require a monthly tracking system and a monthly check for each missionary’s plan. Many mail systems around the world are fraught with theft and general inefficiency. It would be difficult to be sure that everyone’s premiums would arrive in a timely way. Though electronic transfers are increasingly common, transfer costs can be considerable. Should your premium arrive late, you would be at risk for having your insurance coverage terminated just when you might need it most.

Question 3: Why can’t I pay my own premiums to my individual plan?

Answer: If you paid the premiums from income, the amount of the premium would need to be sent to you on the field, subject to Social Security taxes. This would add a tax burden to you, and an even larger burden when you would be in the US, since the premiums would then become subject to federal, state, and local taxes.

Question 4: Why can’t I buy coverage in my country of service? Can I participate in socialized plans provided free or inexpensively to expatriates in my country of service?

Answer: Such a decision would put you at the mercy of the changing financial fortunes of countries that may choose to alter benefits for expatriates, leaving you with reduced benefits or no coverage at all. Though it may prove prudent to participate in such plans as a supplement to other coverage, national plans alone are seldom sufficient for most missionaries. Some national plans do not accept payment from outside the country, or they may require that you make the payment personally. Funds to cover these costs would need to be sent to you, subject to Social Security taxes. Funds you would receive from FIM to cover these costs while you are in the US would also be subject to federal, state, and local taxes. Some national plans may not cover you when you are away from your field of service. You would then need to purchase short-term health insurance for all travel to the US or elsewhere, a service that is extremely expensive considering the typical coverage. Health insurance premiums not paid by FIM are considered personal expense, but they can be considered when you calculate your salary on your Financial Requirements Chart. In addition, should you become seriously ill on the field and need to come back to the US, you likely would be unable to purchase coverage for that condition. Current laws would allow an insurance company to exempt all costs relating to any pre-existing illnesses. Some missionaries do not serve for life. If you were to leave missionary service and return to the US for reasons other than health, you would lose your national plan and need to buy individual coverage at typically higher rates, assuming you could purchase coverage at all.

Question 5: What if the medical system in my country of service is so good that I don’t plan to return to the US for medical attention?

Answer: There is no question that if you have no intention of returning to the US for medical attention, the FIM group plan appears to be wasteful. However, the plan provides worldwide coverage, whereas some other plans, national or otherwise, might not. Experience teaches us that a high percentage of missionaries return to the US for attention to catastrophic medical conditions. Families, churches, and other important people in your life usually advocate your return to the US for life-threatening or terminal conditions. Only in rare circumstances do missionaries opt to remain on the field until death. Purchasing the FIM plan keeps your options open. World conditions could close your chosen field and you could be required to leave the field. If, while on the field, you were to develop health conditions that demand higher premiums with pre-exiting condition exceptions, or even render you uninsurable, purchasing health insurance in the US could become extremely difficult or impossible. It is important to have continuous coverage to protect insurability.

Question 6: What if I’m on Medicare or have permanent healthcare from the military or some other previous employment?

Answer: Those who have documented lifetime coverage from another source may be exempted from our group plan. However, it is important to remember that Medicare only provides services in the US.

Question 7: Is there another group plan that would be cheaper?

Answer: The Board of Directors researched this issue at the time the contract was entered into and believes it found the best plan for the money. As conditions in the health insurance industry change, we seek to be sensitive to other options, but so far, we have found none competitively priced. On-going contacts with other agencies lead us to believe that our plan is a valuable product.

Question 8: Are there any other benefits to being a part of the FIM group plan?

Answer: Several other benefits exist. Newborn children have health insurance from birth, thereby diminishing your financial exposure in the event of the birth of a child with extraordinary health challenges. You are responsible to notify FIM of new births promptly.

Life insurance Benefit: In addition to health insurance, the FIM group plan currently includes term life insurance on all household members, $25,000 on the head of the household, $5,000 on the spouse, and $2,000 on each unmarried child in the family over the age of 13 days up to their 19th birthday. Coverage for dependent children enrolled full-time in school are covered up to their 23rd birthday. These term life insurance benefits are reduced by 50% when the head of household reaches age 65, and terminate at the 70th birthday.

One-year Prescription Benefit: Because of their specialty in international care, Aetna allows you to purchase a year’s supply of prescription medications.

Dismemberment Benefit: In the event you would lose a hand, foot, or eye, Aetna will provide one half of the principal term life insurance amount.

Question 9: Does my being in the group plan benefit others?

Answer: FIM missionaries serving in the US, but outside the Lehigh Valley area, and those serving in the FIM home office do not qualify for the Aetna group plan which is limited to missionaries serving outside the US. Missionaries in the US working or living outside the immediate Lehigh Valley area typically purchase comparable care in their own areas of ministry. Those working in the home office participate in a US-based plan that is roughly 65% more expensive than the Aetna plan. However, some missionaries serving outside the US benefit immensely from the group effort. Your participation in the FIM group plan enables people serving in remote and undeveloped parts of the world to have access to US healthcare when it is needed. Though you may be serving in a place that affords healthcare comparable to that available in the US, others are not so fortunate. Without the FIM group plan, some of our missionaries would struggle to care for their healthcare needs. For some, healthcare would be either unavailable or greatly diminished. For others, having to purchase health insurance as individuals would be costly due to their pre-existing conditions. Unless we are able to provide a group plan, some of our missionaries would not have access to adequate medical care. Your participation makes possible the group coverage that benefits other faithful servants of the Lord.

THe FIM Board of Directors has given much prayerful thought and discussion to this topic.  It has been and continues to be their judgment that the course we follow with respect to health insurance is both biblical in its perspective and prudent financially.



  1. Good info. and reading. I would definitely bookmark you to check for new updates.

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