Churches, ministries & non-profits Health Benefits for Churches, Ministries and Non-Profits

The Quick Answer: Churches, ministries and non-profits can offer health benefits on a fixed budget by giving staff a monthly allowance through a CHOICE Arrangement (formerly ICHRA) or a QSEHRA, adding Direct Primary Care for everyday care, and comparing health sharing for the staff it suits. We help you weigh each option against your budget and your team.

Why benefits look different for mission-driven teams

Most churches, ministries and non-profits share a few realities. Teams are small. Some staff are part-time, seasonal or serve in more than one role. Budgets are set a year at a time by a board, a finance committee or a congregation, and a double-digit increase at renewal has to come from somewhere else in the mission.

That makes predictability as important as price. The options below let you set what you spend each month, rather than finding out at renewal.

Options to consider

• CHOICE Arrangement (formerly ICHRA). Your organization sets a monthly allowance, and staff use it, tax-free, toward individual health insurance they choose and other qualified medical expenses. Employers of any size can offer one, and staff who accept it must enroll in individual coverage or Medicare [1]. You can set different allowances for different groups, such as full-time and part-time staff.
• QSEHRA. Small employers that don't offer group health coverage can reimburse employees' medical expenses, including monthly insurance costs, up to the amount you set [2].
• Direct Primary Care. A flat monthly membership with a primary care practice gives staff direct access to a doctor for visits and routine care. It is not insurance, so it works alongside another layer for larger medical events. See Direct Primary Care.
• Health sharing. Some staff consider a health sharing program. Many programs ask members to affirm a statement of faith; others are built around shared health principles. Health sharing doesn't count as minimum essential coverage, and it isn't regulated as insurance [3]. See Health Sharing.
• A traditional group plan. For some teams, a group plan is still the right fit. We'll show you how it compares, line by line.

Important: Direct Primary Care is a membership arrangement with a doctor for primary care services. It is not insurance and doesn't meet ACA minimum coverage requirements on its own. Health sharing plans are not insurance. Sharing of medical costs among members is voluntary and is not guaranteed the way payment is under an insurance contract.

State availability: Health sharing programs are not available in every state. The program we most often recommend is not currently accepting new members in California, New Mexico, Pennsylvania, Vermont, or Washington. Ask an advisor about options where you live.

Questions to bring to your board

• What can we commit to each month per person, and for how many years?
• Do part-time, seasonal or bi-vocational staff need a different approach from full-time staff?
• Are any staff close to Medicare age, or covered through a spouse?
• How will we explain a new benefit so it feels like care, not a cut?

Compensation and benefits for ministers can have their own tax rules. This is general educational information, not tax or legal advice. Talk with a qualified tax professional about how this applies to your situation.