State of Washington
Office of the Insurance Commissioner
Legal Affairs Division
Investigations Unit

Final Investigative Report
Cover Page Synopsis
OIC Case #: 1589861
Related Cases: None

Final Report Date: 04/08/2019
Date Complaint Received: 09/11/2018

Name of Person or Entity under Investigation: (1) Aliera Healthcare, 5901 Peachtree

Dunwoody Rd., Ste. 200, Atlanta, GA 30328. (2) Trinity Healthshare, 5901 Peachtree
Dunwoody Rd., Ste 160, Atlanta, GA 30328
WAOIC License Number and Status: None

(1a) Aliera: Reba Leonard, Vice
President Compliance and Regulatory Affairs (rleonard@alierahealthcare.com / 404-618-0602),
15301 Dallas Parkway, Ste 920, Addison, TX 75001; (1b) Aliera: Dwight Francis (Sheppard,
Mullin, Richter & Hampton LLP), 2200 Ross Ave, Ste. 2400, Dallas, TX 75201; 430-391-7400,
dfrancis@sheppardmullin.com; (2) Trinity: J. Joseph Guilkey (BakerHostetler), 200 Civic Center
Drive, Ste. 1200, Colombus, OH 43215; 614-462-2697, jguilkey@bakerlaw.com
Representative for Person or Entity under Investigation:

Complainant: Zack Snyder, Director of Government Affairs at Cambia Health Solutions; 1800

9th Ave, Seattle, WA 98101 (zach.snyder@cambiahealth.com, 206-332-5060).
Name of Insured (if different from complainant): N/A
Relationship to Insured: N/A
Allegation(s): (1) Trinity Healthshare does not meet the statutory definition of a HCSM under

RCW 48.43.009 and Federal statute. If proven true, Trinity may be acting as an unauthorized
insurer, in violation of RCW 48.05.030. (2) Aliera Healthcare's various advertisements on behalf
of Trinity are deceptive and have the capacity and tendency to mislead or deceive consumers to
believe they are purchasing insurance rather than a HCSM membership. If proven true, these
could be violations of RCW 48.30.040, WAC 284-50-050 and 284-50-060.
____________________________________________________________________________

Investigative Findings: Substantiated
Potential RCW’s or WAC’s Violated: RCW 48.05.030, RCW 48.30.040, WAC 284-50-050

and WAC 284-50-060

 State of Washington
Office of Insurance Commissioner
Legal Affairs Division
Regulatory Investigations Unit

Final Investigative Report
Executive Summary
This investigation determined the following:
1. The allegation that Trinity Healthshare (“Trinity”) does not meet the statutory
definition of a HCSM under RCW and Federal statute is substantiated. Trinity is
therefore acting as an unauthorized insurer, in violation of RCW 48.05.030.
2. The allegation that Aliera Healthcare’s (“Aliera”) various advertisements on behalf
of Trinity are deceptive and have the capacity and tendency to mislead or deceive
consumers to believe they are purchasing insurance rather than a HCSM
membership, in violation of RCW 48.30.040, WAC 284-50-050 and 284-50-060, is
substantiated.
RIU opened the investigation based on a complaint from an insurer, which forwarded an
Aliera Healthcare (“Aliera”) solicitation it obtained which sought to recruit agents to sell
“healthcare” products. From previous RIU investigations, OIC is aware Aliera has acted
as a marketer for health care sharing ministries (“HCSM”). A HCSM is an organization
that is exempt from insurance regulation in Washington State (see RCW 48.43.009, which
defers to 26 USC §5000A(d)(2)(B)(ii)) and exists to facilitate medical cost sharing
between members in accordance with a specific set of religious and/or ethical beliefs.
During the course of the investigation the RIU gathered information regarding Aliera,
Trinity and three other legal entities with a nexus to the Trinity-Aliera relationship. Based
on this information, the RIU concluded:
1. The evidence indicates Trinity does not meet the definition of a HCSM because (1)
its representations about the nature of its religious convictions to consumers, State

OIC Case: 1589861

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 and Federal regulators are contradictory and in conflict with its own bylaws, (2) it
has not been operating as a 501(c)(3) legal entity and sharing member medical
needs continuously since December 31, 1999, and (3) evidence indicates Trinity
was formed in 2018 for the express purpose of entering into a marketing
agreement with Aliera.
Because the evidence indicates Trinity is not a HCSM, as defined by RCW and Federal
statute, the laws concerning advertising for disability insurance likely apply to Trinity’s
HCSM products. Regardless of this finding, because these HCSM products mirror
disability policies in their function (not the legal structure of the entity offering them), it is
prudent to use disability advertising statutes to determine whether Trinity and Aliera are
providing misleading or deceptive advertisements regarding HCSM products. Therefore,
RIU determined the following:
2. The evidence indicates Aliera (1) failed to represent Trinity’s actual Statement of
Faith, as defined by Trinity’s bylaws, (2) provided misleading training to
prospective agents about the nature of the HCSM products, and (3) provided
misleading advertisements to the general public and potential consumers that have
the capacity or tendency to mislead or deceive consumers, based on the overall
impression that these advertisements may be reasonably expected to create upon
a person of average education.

OIC Case: 1589861

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 State of Washington
Office of Insurance Commissioner
Legal Affairs Division
Regulatory Investigations Unit

Final Investigative Report
Investigative Findings
1. ALLEGATION
The Regulatory Investigations Unit (“RIU”), Office of the Insurance Commissioner (“OIC”)
opened this investigation after receiving a communication from Cambia Health Solutions
“(Cambia”) which expressed concerns that Aliera Healthcare (“Aliera”) may be
misrepresenting its products as insurance (Exhibit 1). Cambia provided a copy of a
communication Aliera sent to prospective brokers, which read (in part):
This is an excellent opportunity for Aliera Healthcare to develop long‐term,
mutually‐beneficial relationships with new brokers and agencies in the state of
Washington and to build a strong Aliera presence in both the Group and Individual
markets ... Aliera makes affordable quality healthcare accessible to those who are
priced out of the current markets. Whether you’re a business looking for affordable
ACA‐compliant plans, or an individual looking for ACA alternatives, Aliera
Healthcare puts the power of choice back in your hands.
From previous RIU investigations, OIC is aware Aliera has acted as a marketer for health
care sharing ministries (“HCSM”). A HCSM is an organization that is exempt from
insurance regulation in Washington State (see RCW 48.43.009) and exists to facilitate
medical cost sharing between members in accordance with a specific set of religious
and/or ethical beliefs. The Washington State insurance code defers to the Federal statute
to define a HCSM [see RCW 48.43.009; cf. 26 USC §5000A(d)(2)(B)(ii)]. The Federal
statue lists five criteria:
-

the term “health care sharing ministry” means an organization—
o (I) which is described in section 501(c)(3) and is exempt from taxation under
section 501(a),

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 o (II) members of which share a common set of ethical or religious beliefs and
share medical expenses among members in accordance with those beliefs
and without regard to the State in which a member resides or is employed,
o (III) members of which retain membership even after they develop a medical
condition,
o (IV) which (or a predecessor of which) has been in existence at all times
since December 31, 1999, and medical expenses of its members have been
shared continuously and without interruption since at least December 31,
1999, and
o (V) which conducts an annual audit which is performed by an independent
certified public accounting firm in accordance with generally accepted
accounting principles and which is made available to the public upon
request.
The OIC opened an investigation into both (1) Trinity Healthshare (“Trinity”), the HCSM
behind many of Aliera’s products, and (2) Aliera, Trinity’s marketer. This investigation had
two objectives:
-

Does Trinity meets the statutory definition of a HCSM under WA law (RCW
48.43.009)? If it does not, it may be operating as an unauthorized insurer in
violation of RCW 48.05.030.

-

Do Aliera’s various advertisements on behalf of Trinity mislead consumers to
believe they are purchasing insurance, rather than a HCSM membership? If
proven to be true, this could be a violation of RCW 48.30.040 and WAC 284-50050 and 284-50-060.

The case was assigned to Investigator (“INV”) Tyler Robbins.
2. LICENSING REVIEW
INV Robbins conducted a licensing check on Aliera through the National Association of
Insurance Commissioners (“NAIC”), which disclosed Aliera has active producer’s licenses
in 36 states. It does not have a license in Washington (Exhibit 2). Trinity is not licensed
with the NAIC or the OIC, because it purports to be a HCSM exempt from insurance
regulation.

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 3. NOTIFICATION OF INVESTIGATION
On 10/01/2018, INV Robbins sent formal notices of investigation to both Aliera and Trinity,
requesting a response to the allegations (Exhibit 3a). Throughout the course of the
investigation, INV Robbins sent a follow-up notices to both Trinity (Exhibits 3b – 3c) and
Aliera (Exhibit 3d), requesting further information.
4. INVESTIGATION OF AND RESPONSE FROM PARTIES
During the course of this investigation, RIU gathered information regarding five entities;
Aliera, Trinity, Anabaptist Healthshare, Unity Healthshare and HealthPass USA. The
relationship between these entities and a relevant timeline is below:

Unity Healthshare

Trinity Healthshare

HCSM formed by
Anabaptist to partner
w/Aliera

Anabaptist
Healthshare

parent HCSM for Unity

OIC Case # 1589861

new HCSM partner to
replace Unity

Aliera

Administrator
and Marketer

HealthPass USA

predecessor to Aliera

Page 3 of 35

 a. ALIERA HEALTHCARE
i. Background
The entity known as Aliera appears to have begun as a domestic stock corporation in the
State of Delaware on 09/29/11 as an entity called, “OnSite Health Management, Inc.”
(Exhibit 7b). Approximately 14 months later, it filed an amendment and changed its name
to Aliera Healthcare, Inc. (Exhibit 7b, pg. 4). This Aliera entity (“Aliera #2”) appears to
remain an active business entity in Delaware (Exhibit 7c), and has never registered in
Georgia.
The Aliera entity that is the focus of this investigation (“Aliera”) was incorporated in the
State of Delaware on 12/18/15 (Exhibits 4a and 4b) by Shelley Steele (Exhibit 4b, pg. 7).
Its scope of business was “to engage in the business of providing all models of Health
Care to the general public” and “to cultivate, generate or otherwise engage in the
development of ideas or other businesses. To buy, own or acquire other businesses, to
market and in any way improve the commercial application to the betterment and
pecuniary gain of the corporation and its stockholders …” (Exhibit 4b, pg. 8). In 2017, the
most recent year Delaware has on file, a man named Chase Moses appears on record
as a director of the corporation (Exhibit 4b, pg. 9).
Aliera registered as a foreign corporation in the State of Georgia approximately four
months later, on 04/28/16, with Shelley Steele as the CFO and CEO (Exhibit 4c). The
business remains active in Georgia, where it maintains its offices (Exhibits 4d – 4e). In
addition, an entity named “Aliera Healthcare of Georgia” registered as a domestic LLC in
that state on 03/13/17 (Exhibit 4f) and remains active (Exhibit 4g). Shelley Steele was
also the CEO of this entity.
On 07/25/17, a domestic Georgia entity named HealthPassUSA, LLC (“HealthPass”)
merged with Aliera, which remained the surviving corporation (Exhibit 4h). HealthPass
was organized as a domestic LLC on 05/14/15 by Shelley Steele (Exhibit 6a), the same
individual who founded both Aliera entities (above). HealthPass also occupied the very
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 same address as Aliera later did throughout 2016 and 2017, until its merger (Exhibits 6b
– 6c; compare to address in Exhibit 4b). 1
ii. Agent Training
The Federal exemption for HCSMs is religious in nature. Indeed, the exemption is under
a heading marked “religious exemptions.”2 However, Aliera’s promotional material for
consumers and its training material for new and prospective brokers fails to emphasize
this point. The majority of the material never mentions the religious motivations that the
Federal HCSM statute envisions prospective consumers would have. This potentially
misleads both consumers and the prospective brokers who will market, solicit and sell the
products to the religiously-motivated individuals whom the Federal statute envisions to be
the HCSM’s intended market.
1. Advertisements for prospective agents:
Aliera’s advertisements for recruiting prospective agents to sell the HCSM products offer
them the opportunity to sell “the next generation of Healthcare products” and suggests
they can offer employers “a healthcare plan that saves money,” (Exhibit 4i). The terms
“healthcare” and “health plan” are insurance-specific terminology, defined by statute (see
RCW 48.43.005 [26]). Moreover, the advertisement does not mention a religious or ethical
component for the consumers.
Aliera’s agent training portal3 requires prospective agents to watch a series of three
training videos, then take an assessment (Exhibit 4j). INV Robbins obtained both mp3
and mp4 copies of each video from the portal:

1. The address is 5901 Peachtree Dunwoody Road, Building B, Suite 200, Atlanta, GA, 30328.
2. See 26 USC 5000A(d)(2).
3. At the time of this report, the prospective agent portal was located at
https://www.alierahealthcare.com/training-center/brokers-agents/ and accessed using the password
“aliera2017.”
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 2. Video #1:
The first video, entitled “Training Modules Aliera,” is linked on the training site and hosted
in an unlisted status on YouTube. 4 It consists of a narrator explaining four different plans;
AlieraCare, PrimaCare, InterimCare and CarePlus, accompanied by informational charts.
However, as Aliera disclosed (see response Exhibit 5a, below), each of these plans are
Trinity HCSM products. However, this training video never mentions a religious motivation
or caveat to agents-in-training (Exhibits 4k and 4l).
3. Video #2
The second video, entitled “Aliera Healthcare – Your ACA Solution,” 5 is just over four
minutes long and is an advertisement oriented to consumers, even though it is an agent
training tool. The narrator asks, “what if there was a way to get healthcare coverage that
was affordable, and provides actual health care that you can use, without the added cost
of co-pays, deductibles, and the high cost of insurance?” The narrator said “you bet there
is!” and proclaimed, “Welcome to HealthPassUSA, from Aliera Healthcare!” It explains it’s
a “nationwide healthcare membership that provides you the minimum essential coverage
required by the affordable care act,” (Exhibits 4m and 4n, 00:10 – 00:45).
There is no mention of a religious component or motivation associated with the product.
Indeed, the video specifically refers to the product as “HealthPassUSA,” which is the nonHCSM entity Aliera acquired in 2017 (see Exhibit 4h). The narrator frames the product as
a lower-cost alternative. He provides a hypothetical consumer named “Joe,” who “can’t
afford traditional health insurance, but he needs healthcare for himself and his family,”
(Exhibit 4m, 1:40 – 1:50). The term “healthcare” is insurance language defined by statute.

4. The video is hosted at https://www.youtube.com/watch?v=ecEmZffiR-M/. If a video is “unlisted,” it means
it cannot be found unless the viewer has the link. This process is often used by video creators who want
a video to remain confidential, disclosed only to certain viewers.
5. This video is also available at the Aliera training portal (see footnote #3, above), and on YouTube at
https://www.youtube.com/watch?v=BaL1SH5jQ30.
OIC Case # 1589861

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 4. Video #3:
The third video, entitled “Aliera Healthcare – How to Use Your Membership,”6 is geared
to consumers, not agents, even though it is an agent training tool. The narrator explains
what “your myHealthPass membership” will cover, and explains how to decipher “your
myHealthPass membership card.” Again, this refers to a non-HCSM company Aliera
acquired in 2017 (see Exhibit 4h). The narrator explains the card provides access to
“healthcare services,” and assures the viewer Aliera is his first stop for “your healthcare
needs,” (Exhibits 4o and 4p). Again, this is insurance language defined by statute.
5. Video #4:
The fourth video, entitled “How to Activate Your Membership,” explains to a consumer
how to activate his HealthPass membership. 7 Once again, this video is training for
prospective agents on how to market, solicit and sell an HCSM product, yet Aliera brands
the product after a non-HCSM company it acquired in 2017 (Exhibits 4q and 4r).
6. Assessment:
The Aliera agent training assessment, which all prospective brokers must successfully
pass, asks a series of detailed questions about various Trinity HCSM products – none of
which mention a religious motivation (Exhibit 4s). There is text at the end of the
assessment, just above the “submit assessment” button, which expresses Trinity’s five
faith statements. The producer must attest he will be held responsible for communicating
to consumers that the Trinity products are not insurance. However, the assessment does
not require the producer to explain or advise the consumer of the alleged religious
motivations behind the HCSM product.

6. This video is available at Aliera’s prospective agent training portal (see footnote #3, above) or on Vimeo
at https://vimeo.com/177624500.
7. This video is also available at the Aliera training portal, or on Vimeo at https://vimeo.com/177625744.
OIC Case # 1589861

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 7. Prospective Agent Training Video:
On 10/25/18, an unidentified Aliera trainer conducted a video seminar for prospective
agents. The trainer apparently conducted this seminar for a marketer named America’s
Health Care Plan (“AHCP”), 8 which then posted the video to YouTube on 10/29/18 with
the title “Aliera Healthcare Product Overview.” 9 INV Robbins obtained mp3 and mp4
copies of this video (Exhibits 4t and 4u).
The trainer explained Aliera fills a need, because the market “doesn’t really have anything
that’s affordable, and truly comprehensive. Our plans are very similar to what was in effect
before the ACA came around. And so, all we did is take that wheel, make it a little bit
better, and we put that back out in the market,” (Exhibits 4t and 4u, 1:32 – 1:48).
The narrator discussed various group coverage options, then transitioned to the
“individual alternative market,” which he described as “our bread and butter” which
accounted for over 70% of Aliera’s sales. Each of the branded plans in this category
(below) are actually HCSM plans which Aliera markets on behalf of Trinity. 10

8. See AHCP’s website at http://www.ahcpsales.com/about-us/.
9. See the video at https://youtu.be/OjI5Ff1l2Ck.
10. See the signed agreement between Trinity and Aliera (Exhibit 5g, pgs. 3-18) and Aliera’s response to
the OIC (Exhibit 5a), discussed below.
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 The narrator said Aliera’s “comprehensive plans” (which are HCSM products marketed
by Aliera) “not only mirrors traditional insurance, but truly provide comprehensive
healthcare for an individual,” (Exhibits 4t and 4u, 8:20 – 8:33). The trainer referred to
“InterimCare” as “our short-term medical plan,” (Exhibits 4t and 4u, 10:50 – 11:05). The
following graphic from the video (see Exhibit 4t, 08:36) captures the ambiguity in Aliera’s
representations:

The term “healthcare” is insurance language defined by statute, and the terms
“comprehensive coverage,” “short-term medical” and “individual market” are colloquial
insurance terms widely used in the disability market and discussed in that context during
Washington producer licensing training.
The graphic below, from the AHCP video, confirms this investigative report has now
summarized the entire training pipeline for prospective Aliera agents who market, solicit
and sell Trinity’s HCSM plans to consumers. At no time during the entire training process
for prospective agents is a religious motivation, ethic or caveat emphasized:

OIC Case # 1589861

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 8. “Back Office” Enrollment Training for Agents
On 11/01/18, an unidentified Aliera trainer conducted a seminar for new or prospective
agents about the “back office” functions of Aliera’s agent portal. AHCP posted this video
on YouTube the same day, with the title “Aliera Healthcare Enrollment Process.” 11 INV
Robbins obtained both mp3 and mp4 copies of this video (Exhibits 4v – 4w).
The trainer walks the viewer through how to enroll a new customer for an Aliera product,
and eventually comes to a series of questions the agent must ask before completing the
application. The trainer explains (Exhibits 4v and 4w, 11:45 – 12:05).
Then, of course, there's going to be questions. Now, it’s guaranteed issue, so these
questions are not knockout questions. They're not going to at all make it where
you're not possible to, you know, become a member of the plan. So, there's no
worries about that. Make sure to let the members know that.
The consumer must respond positively to each question, and the first includes Trinity’s
statement of faith:

11. The video is available at https://youtu.be/PiwoaXt8Z78.
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 The trainer explains to the viewer what this means (Exhibits 4v and 4w, 12:25 – 13:25):
Just to give you a general overall synopsis of what it's saying … It basically is
saying that you believe in a higher power. It doesn't necessarily have to be a
Christian God, or a Buddhist God, or a Jewish God. It doesn't … it doesn't matter
as long as we all believe that there is a higher power and we're all living our life
that the best way that we possibly can. We're maintaining a healthy lifestyle. We're
trying to avoid those types of foods, behaviors, habits - things that, you know,
cause us illness that are in our control.
As long as we're doing those types of things, we're all like-minded individuals. So
if you feel that way, and you are a like-minded individual, that's all we're trying to
find out. And, if you are, you're gonna say, “Yes,” you believe in the five same
statement of beliefs that we all do.
This is at odds with the Statement of Faith Trinity requires members to abide by, according
to its own bylaws (see discussion, below).
iii. Marketing
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 1. Consumer Video
On 09/19/18, Aliera published a short promotional video on YouTube entitled, “Aliera
Healthcare – A New Era in Healthcare Choices.” 12 The video encourages the viewer to
consider Aliera as a substitute for traditional medical insurance. The narrator explains
Aliera is “redefining the healthcare experience” by “putting the power of choice back in
your hands.” The narrator never mentions a religious motivation, prerequisite or caveat in
the advertisement. The video description reads, “Aliera is committed to redefining the
healthcare experience for individuals, families, and employers, with innovative services
and solutions that simplify the complexities of healthcare and unlock the freedom and
power of choice.” INV Robbins obtained both mp3 and mp4 copies of the video (Exhibits
4x and 4y).
2. “The Balancing Act”
On 10/01/18, Aliera published a video of an appearance its Executive Vice President,
Chase Moses (“Moses”), made on a Lifetime morning television program called The
Balancing Act. 13 INV Robbins obtained mp3 and mp4 copies of the video (Exhibits 4z and
4aa). Moses explains, “Aliera has thrived in creating simple, affordable, quality healthcare
solutions for anyone and everyone. And, whether you're an individual, whether you're
family, or whether you're an employer, and we’ve done that through innovation,” (Exhibits
4z and 4aa, 1:05 – 1:20). Moses went on to briefly describe each Trinity HCSM plan, and
never mentioned the religious motivation or emphasis in the interview. He demonstrated
the ease with which consumers can sign up for “individual plans” (i.e. HCSM plans) on
the website.
3. Literature:

12. The video is available at https://youtu.be/q8FyZmOla6c.
13. According to its website, The Balancing Act is “a daily morning show that brings cutting-edge ideas to
today’s on-the-go, modern woman to help balance and enrich her life every day,” (retrieved from
https://thebalancingact.com/about/). The video is available at https://youtu.be/I7aobwe3kZ4.
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 INV Robbins obtained brochures from Aliera’s website regarding the various Trinity
HCSM plans which Aliera offers (Exhibits 4ab – 4ae). Each brochure features a disclaimer
which reads “This is NOT Insurance.” A representative first paragraph, below, describes
the nature of the plans (Exhibit 4ab, pg. 1):

The brochure also explains the following (Exhibit 4ab, pgs. 3, 11):

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 The “short-term healthcare” plan apparently mirrors “short-term medical” plans available
in the disability market in certain jurisdictions. Aliera’s literature describes it as “a shortterm comprehensive healthcare plan” (Exhibit 4ad, pg. 1) and does not mention a
religious/ethical conviction. The dental and vision plan “gives you exactly what you need
to maintain your overall dental health, whatever your budget or lifestyle” (Exhibit 4ae) and
likewise does not mention a religious/ethical ethos. Aliera’s informational brochure for the
CarePlus Advantage product explains it is “a catastrophic health plan that offers
assistance with the cost of major medical expenses,” (Exhibit 4ac, pg. 1). It, too, does not
mention a religious or ethical conviction. Each brochure contains legal disclaimers at the
end which explain these are not insurance products; “[o]ur role is to enable self-pay
patients to help fellow Americans through voluntary financial gifts.”
iv. Responses from Aliera:
On 10/22/2018, Aliera responded to the OIC on behalf of itself and Trinity (Exhibit 5a).
The company explained (pg. 1):
Aliera is not a health care sharing ministry. Aliera is best described as an innovative
healthcare organization offering members a comprehensive model of care. Aliera
has entered into an exclusive agreement with Trinity Healthshare, Inc. to provide
operational and marketing support in order that Trinity might grow to include people
of faith from throughout the United States. Trinity’s board directs the activities of
the sharing ministry through the issuance of sharing guidelines and through
oversight of the servicing that Aliera provides to the sharing members on their
behalf.
The company related (Exhibit 5a, pg. 5):
Aliera provides exclusive operational and marketing support for Trinity. Trinity
directs the activities of Aliera through the administration of the signed agreement,
as well as the spiritual guidance for the ministry and its members.
Aliera provided a copy of Trinity’s 501(c)(3) certificate, showing it is a non-profit entity
(Exhibit 5b). It provided a list of five statements “that members must attest they agree with
before they can be enrolled in a health care sharing plan offered by Aliera on behalf of
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 Trinity.” Aliera explained consumers must attest they share in these beliefs, either in a
recorded verification call or by electronic signature as part of the application process
(Exhibit 5a, pg. 2). 14
Regarding the WA state requirement that a HCSM must have been in continuous
existence and sharing expenses since December 31, 1999, Aliera stated it disagreed with
an interpretation that understood this language literally. The company explained (Exhibit
5a, pg. 3):
it seems reasonable that the [Washington state] definition would be applied in the
same context as the U.S. Code, in that the five (5) elements described in the Code
as the definition for Minimum Essential Coverage and the Individual Shared
Responsibility Payment, not for the existence of the health care sharing ministry
outside of that context, or to negate the fact that health care sharing ministry plans
do not meet the definition of insurance.
However, Aliera went on to state (Exhibit 5a, pg. 3):
Trinity derives its existence from the Baptist association of churches which have
been in existence and continually sharing since the 1600 … The health care needs
of the members of Trinity Healthshare, Inc., through its historical predecessor
church association, have been shared for years ahead of the statutory demarcation
point of December 31, 1999.
The OIC asked for documents to support the contention that Trinity, or a predecessor
organization, had been sharing expenses as a HCSM since at least December 31, 1999.
Aliera replied, “Neither Aliera nor Trinity have access to predecessor Baptist association
records, but the role of the Baptist church and its association of churches in assisting
members has been documented historically since the 1600’s,” (Exhibit 5a, pg. 4).
Aliera explained that, in addition to the HCSM component it administers for Trinity, “Aliera
also manages small employer self-funded health benefit plans,” (Exhibit 5a, pg. 5). Aliera

14. See this process explained by a trainer in Exhibits 4v and 4w (discussed above).
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 bundles several non-insurance products with the HCSM elements to form different
plans: 15
Trinity product

Aliera product

AlieraCare

+

PrimaCare

+

InterimCare

+

CarePlus

+

Telemedicine, discount prescription drugs, concierge services to
locate “in-network” providers
Telemedicine, discount prescription drugs, concierge services to
locate “in-network” providers
Telemedicine, discount prescription drugs, concierge services to
locate “in-network” providers
Telemedicine, discount prescription drugs, concierge services to
locate “in-network” providers

The OIC inquired about Unity Healthshare (“Unity”), a HCSM for which Aliera had
previously acted as a marketer and administrator. Aliera explained the Unity board
“exercised its rights to terminate the administrative agreement with Aliera and transition
their membership to another administrator,” (Exhibit 5a, pg. 5).
The OIC asked Aliera to explain references to “in-network” in its plan materials, and the
company explained it uses a MultiPlan network. “The MultiPlan PHCS network is
managed by MultiPlan, and Trinity members who are seeking medical services are
requested to utilize in-network providers in an attempt to manage the cost of health care
expenses that will be requested for sharing,” (Exhibit 5a, pg. 6). Aliera also provided
copies of member guidelines for the four plans it offers (Exhibits 5c – 5f).
v. Agreement Between Trinity and Aliera
On 11/16/18, Aliera provided a copy of the signed agreement between itself and Trinity
(Exhibit 5g) dated effective 08/13/18, which is approximately six weeks after Trinity
incorporated as a domestic corporation in the State of Delaware. The agreement was
signed by Moses (Aliera’s Executive Vice President) and Trinity’s CEO. The agreement
explains (Exhibit 5g, §2-3):

15. The OIC created the following table from a written description Aliera provided.
OIC Case # 1589861

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 The agreement states Trinity had filed to become a 501(c)(3) entity, and wanted Aliera to
offer its HCSM plans (Exhibit 5g, pg. 3). Aliera was granted “exclusive license to develop,
market and sell the HCSM plans to individuals in the public markets who will
acknowledge the standard of beliefs and other requirements as deemed necessary by
Trinity, and agreed upon by Aliera,” (Exhibit 5g, pg. 4, §1a). 16 In addition, Aliera will
“provide enrollment and other administrative services relating to the HCSM and to market
the Plans, which Plans will not include insurance products and cannot be bundled with
insurance,” (Exhibit 5g, pg. 1).
The agreement also noted, “Trinity currently has no members in its HCSM, and the Parties
intend that the members who enroll in the Plans become ‘customers’ of Aliera, and that
Aliera maintain ownership over the ‘Membership Roster,’” (Exhibit 5g, pg. 1; see also pg.
4, 1d). Aliera “may only accept subscriptions from members who will acknowledge the
standard of beliefs and other requirements as deemed necessary by Trinity and agreed
upon by Aliera,” (Exhibit 5g, pg. 4, 1d).
Trinity delegates all financial accounting functions to Aliera (Exhibit 5g, pg. 5, 1h). No
more than one-third of Trinity’s board may be affiliated with Aliera (Exhibit 5g, pg. 5, 1k).
In addition to the normal apportionment of fees, Trinity receives $25 for each application
(Exhibit 5g, pg. 7, 3a). Aliera forwards all allotted fees to Trinity monthly, and controls a
bank account established for that purpose (Exhibit 5g, pg. 7, §3c-d).

16. Emphasis mine.
OIC Case # 1589861

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 The fee schedule shows Trinity retains virtually no funds; they largely return to Aliera for
various purposes. One representative example follows (Exhibit 5g, pg. 16):

Aliera retains 65% of all fees outright, and Trinity receives the remaining 35%. However,
as the example above makes clear, Trinity repays from its 35% (i.e. “from such amount”)
54.2% of this total to Aliera for various reimbursements. The remaining 44.3% of the 35%
Trinity received is placed into a reserve account for member medical expenses (Exhibit
8e, pgs. 7-8). In practical terms, the arrangement looks like this with a figurative total of
$100:

Money received from consumer
Less 65% to Aliera
Less 54.2% of the remaining
35% reimbursed to Aliera
Less 44.3% of the remaining
35% placed in member expense
reserve

OIC Case # 1589861

Less

Total
100.00
- 65 = 35.00
- 18.97 = 16.03
- 16.03

=

0.00

Page 18 of 35

 Trinity has a similar arrangement for its CarePlus, PrimaCare and dental and vision plans
(Exhibit 5g, pgs. 16-18).
b. TRINITY HEALTHSHARE:
i. Background:
Trinity Healthshare registered as a domestic corporation in the State of Delaware on
06/27/18 (Exhibit 8a). Approximately four months later, on 10/26/18, Trinity registered as
a foreign corporation in the State of Georgia, with William Thead as the CEO and David
Thead as the CFO and Secretary (Exhibit 8b). Trinity provided an address that was nearly
identical to that of Aliera, at 5901b Peachtree Dunwoody Road, Atlanta, GA 30328. 17
However, the address is likely false, as the RIU sent correspondence to it in November
2018 (mere weeks after Trinity incorporated in Georgia) which was returned as
undeliverable (Exhibit 8c).
ii. Responses:
1. First Response
On 12/07/18, in response to the OICs notice (Exhibit 3b), Trinity replied (Exhibit 8d) via
its attorney, J. Joseph Guilkey (“Attorney Guilkey”), who provided a letter written by
Trinity’s CEO, William Thead (“Thead”). In his letter, Thead explained “we are confident
that Trinity meets the criteria listed in 26 USC § 5000A to be considered a health care
sharing ministry.” He explained Trinity was seeking a determination letter from the U.S.
Department of Health and Human Services to that end, and believed such a letter would
settle the matter (Exhibit 8d, pg. 1). 18 Thead explained that, regardless, Trinity does meet
the definition of an insurer “because Trinity's operations do not shift risk to Trinity,” (Exhibit

17. Only the suite number is different. Aliera is Suite 200 (Exhibit 4b), whereas Trinity is Suite 160c (Exhibit
8b).
18. HHS has informed the OIC it stopped issuing such determinations several years ago.
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 8d, pg. 2). Thus, Thead concluded, statutes regarding insurers are not applicable to
Trinity.
Regarding whether Trinity had been operating continuously sharing member medical
needs since at least 12/31/99, Thead stated his response was “contingent” on a
determination from HHS. However, as HHS has told OIC, it has not provided such
certifications for several years. RIU asked for more specifics about the history of any
Trinity predecessor organization, as follows:
In its own response to the OIC, Aliera stated, "Trinity derives its existence from the
Baptist association of churches which have been in existence and continually
sharing since the 1600's." As you are likely aware, there is no single, monolithic
"association of Baptist churches." This is in marked contrast to, for example, the
Roman Catholic Church. Baptist churches exist in the free church tradition, which
is marked by a quest for autonomy from the State and, to greater or lesser extent,
from ecclesiastical bureaucracy in general. The context for this ecclesiology is the
principle of soul liberty; more specifically Baptists own struggles against State
churches in Europe and America during and after the Protestant Reformation. The
Baptist tradition does not express itself as a monolithic denomination, but rather
as a multi-layered patchwork of local, regional, national and inter-national
cooperative networks (i.e. "associations") of independent churches, many of which
(at all levels) are aloof from and do not maintain formal ecclesiastical ties with each
other. Even beyond the association level, there are many independent Baptist
churches worldwide which remain detached from all associations, and view them
as infringing on the autonomy of a local church.
In light of this context, please (1) provide more clarification on Aliera's
representations … and (2) please explain how this representation satisfies the
language of 26 USC §5000A.
Trinity replied that it believed its forthcoming certification from HHS would address the
issue, then remarked, “[w]e have concerns that interpreting the language of 26 USC
§5000A too narrowly based on how one religion has historically organized itself could
unintentionally discriminate against other religions,” (Exhibit 8d, pg. 3). It explained
(Exhibit 8d, pg. 4):

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 The Baptist association of churches, formally in existence since the early 1600's,
has provided for the health care needs of association members as a predecessor
of Trinity. Thus, Trinity's predecessor church association does not have a rigid
corporate form.
Trinity also provided OIC a copy of the letter it sent to HHS, seeking official status as a
HCSM. The letter explained why Trinity meets all five criteria of the Federal HCSM statute
and, regarding the 12/31/1999 date, it largely echoed what it already provided to the RIU
(Exhibit 8d, pg. 26):
Baptists and many other Christian denominations have been sharing in each
other's medical expenses since the sixteenth century. They have not only shared
medical expenses since before 1999, they have shared medical expenses since
the 1600’s. The Baptist association of churches has formally been in existence
since the early 1600’s.
In the letter, Thead also stated that Trinity “seeks to provide no-cost or low-cost health
care sharing for missionaries, volunteers, employees of nonprofit faith-based ministries,
and other individuals who share in our Statement of Beliefs. It coordinates sharing support
from within the Baptist community to make this possible,” (Exhibit 8d, pg. 23).
2. Second Response
On 03/11/19, in response to OICs follow-up request (Exhibit 3c), Trinity responded to the
OIC (Exhibit 8e). Trinity denied it was created for the express purpose of entering into a
corresponding marketing agreement with Aliera. Instead, it was created to share member
medical needs in accordance with its Christian beliefs. It acknowledged it had no HCSM
members at the time of its signed agreement with Aliera (Exhibit 8e, pg. 4).
Trinity also acknowledged that, at the time of its signed agreement with Aliera, it intended
that all HCSM members become Aliera customers and that Aliera retain ownership of the
membership roster. In fact, Aliera has exclusive ownership rights to the membership
roster, and Trinity cannot contact HCSM members unless Aliera grants permission. Even

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 if Trinity’s agreement with Aliera is terminated, Aliera will continue to service these HCSM
members (Exhibit 8e, pgs. 4-5).
Trinity acknowledged Aliera is contracted to perform all development, sales and
marketing responsibilities, and that Aliera must communicate Trinity’s faith and lifestyle
requirements to potential HCSM consumers (Exhibit 8e, pgs. 5-6).
Trinity acknowledged Aliera is contracted to perform billing, collection and accounts
payable services. Aliera collects member contributions and enrollment fees, makes
required distributions to a Trinity bank account, and is a signatory on Trinity’s bank
accounts (Exhibit 8e, pg. 6).
Trinity explained one of its purposes was to remain faithful to its statement of faith.
However, Trinity provided a copy of its bylaws (Exhibit 8e, pgs. 11-16), which contain an
explicitly Protestant statement that would be considered a conservative, evangelical
expression of the Christian faith and message (see bylaws, Art. II.4, in Exhibit 8e, pg. 4).
However, this statement of faith is quite different from the more generic faith statements
Trinity members must agree to in order to join the HCSM:
Statement of Faith

1
2

3

4

from bylaws
We believe the Bible alone is the inspired
Word of God; therefore it is the final and only
source of absolute spiritual authority.
We believe in the triune God of the Bible. He
is one God who is revealed in three distinct
Persons – God, the Father; God, the Son;
and God, the Holy Spirit.
We believe in Jesus Christ was God in the
flesh – fully God and fully man. He was born
of a virgin, lived a sinless life, died on the
cross to pay the penalty for our sins, was
bodily resurrected on the third day, and now
is seated in the heavens at the right hand of
God, the Father.
We believe that all people are born with a
sinful nature and can be saved from eternal
death only by grace alone, through faith
alone, trusting only in Christ’s atoning death
and resurrection to save us from our sins
and give us eternal life.

OIC Case # 1589861

Faith Statements

vs.

from marketing and plan
We believe that our personal rights and
liberties originate from God and are bestowed
on us by God.

vs.

We believe every individual has a fundamental
religious right to worship God in his or her own
way.

vs.

We believe it is our moral and ethical obligation
to assist our fellow man when they are in need
per our available resources and opportunity.

vs.

We believe it is our spiritual duty to God, and
our ethical duty to others to maintain a healthy
lifestyle and avoid foods, behaviors, or habits
that produce sickness or disease to ourselves
or others.

Page 22 of 35

 5

We believe in the bodily resurrection of all
who have put their faith in Jesus Christ.
All we believe and do is for the glory of God
alone.

vs.

We believe it is our fundamental right of
conscience to direct our own healthcare in
consultation with physicians, family, or other
valued advisors.

As a result of Trinity’s representation that it “coordinates sharing support from within the
Baptist community” 19 to carry out its mission, the RIU asked Trinity whether it “intends
to restrict membership to members of self-identified Baptist religious communities.” Trinity
explained the Federal HCSM statute does not require HCSM members “to rigidly adhere
to a particular, in Trinity’s case Christian, denomination.” Indeed, Trinity stated
“[f]undamentally, Trinity’s Statement of Beliefs require members to believe in God,”
(Exhibit 8e, pg. 8).
This is incorrect; there are numerous self-identified Christian groups which could not sign
Trinity’s Statement of Faith from its bylaws. Rather, Trinity’s Statement of Faith is an
explicitly Protestant expression of the Christian faith and its bylaws state all HCSM
members must adhere to it (see bylaws, Art. III.1; in Exhibit 8e, pg. 12):

However, the faith statements it actually asks members to agree to in its marketing
materials and solicitations bears little resemblance to the Protestant Statement of Faith
in its bylaws (see the table, above). Specifically, Trinity’s conservative Statement of Faith
from its bylaws expresses the following:
1. The statement affirms a Protestant understanding of the Bible as the “final and
only source of absolute spiritual authority.” This position is at odds with other
19. Emphasis mine.
OIC Case # 1589861

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 Christian traditions which see the role of tradition, through the precedent of the
teaching magisterium of the church, as a legitimate source of authority to interpret
the Bible for the people.
2. The statement affirms God is triune, which identifies the God whom Trinity believes
in to be an explicitly monotheistic, Trinitarian God. This position is at odds with
other self-identified Christian groups or renewal movements which explicitly deny
the doctrine of the Trinity, such as the Jehovah’s Witnesses, the Church of Jesus
Christ of Latter Day Saints, and the United Pentecostal Church International, etc.
3. The statement affirms an orthodox view of Jesus Christ as fully God and fully man,
in broad agreement with the Council of Chalcedon (451 A.D.). It also affirms the
virgin birth, Christ’s sinless life, His literal death to atone for sins, His bodily
resurrection, and His ascension to heaven to rejoin God the Father.
4. The statement also affirms people can only be saved from eternal death “by grace
alone, through faith alone, trusting only in Christ’s atoning death and resurrection
to save us from our sins and give us eternal life.” This is an explicitly Protestant
interpretation of the doctrine of salvation, as evidenced by the terminology “grace
alone, through faith alone, trusting only in Christ’s atoning death …” 20 For
example, these statements are at odds with the Roman Catholic Church’s doctrine
of salvation, both in its formal catechism and in the canons and decrees of the
Council of Trent.
5. The statement explains Trinity believes in the literal, bodily resurrection “of all who
have put their faith in Jesus Christ.”
Trinity not only put forth an explicitly Christian statement of faith, but an explicitly
Protestant expression of the Christian faith and message. This ethos seems to be
contradicted by the broader, generic faith statements it obligates its members to agree to.
Moreover, Trinity’s bylaws state membership is limited to those who prescribe to the
statement of faith in its own bylaws (see bylaws, Art. III.1; in Exhibit 8e, pg. 12), not the

20. Emphasis mine. For further information on the “alone” and “only” statement bolded above, and the
distinction between the historic Protestant and Roman Catholic understandings of salvation, see any
public source discussion of the context of the “five solas” of the Protestant Reformation – even
Wikipedia.
OIC Case # 1589861

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 more generic faith statements that Aliera markets to consumers (Exhibit 8e, pg. 10).
Trinity’s claim that, in essence, it merely requires members to “believe in God” is incorrect.
iii. Website:
Trinity’s website, as it appeared on 01/24/19, emphasized the affordability of its plans for
consumers (Exhibit 8f). It promotes “an alternative solution to the rising costs of health
insurance without sacrificing on great healthcare.” The site explains, “Trinity HealthShare
is a unique healthcare sharing ministry (HCSM) because it offers membership to persons
of all faiths and provides superior healthcare at a competitive price.”
Below is a comparison between Trinity’s webpage, and the more explicitly religious
motivation of another HCSM: 21

21. The image from Samaritan Ministries was captured from https://samaritanministries.org/.
OIC Case # 1589861

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 Trinity’s “Healthcare Cost Sharing Explained” page compares components of traditional
health insurance and HCSMs. It explains, “Trinity Healthshare's medical cost sharing
plans provide affordable and effective alternatives for those who believe in individual
responsibility, healthy living, and caring for one another,” (Exhibit 8g). It goes on, “Trinity
HealthShare is a health care sharing ministry and bases its principles of health care upon
sharing one another's burdens. With most medical cost sharing plans, individuals come
together around a common religious or ethical belief, or both. Members must sign a
statement of beliefs in order to join a health care sharing ministry.”
On 09/14/18, the ministry’s “FAQ” page explained, “becoming a member is simple;
complete the membership application process online,” (Exhibit 8h, pg. 3). It also related,
“Trinity HealthShare welcomes members of all faiths who can honor the Statement of
Beliefs, by which the Trinity HealthShare program operates,” (Exhibit 8h, pg. 6).
c. ANABAPTIST HEALTHSHARE AND UNITY HEALTHSHARE:
i. Background on Unity:

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 During previous investigations, RIU learned Aliera formerly contracted with another
HCSM, Unity Healthshare (“Unity”). RIU determined Unity was domiciled in Virginia, and
obtained publically available documents from the Virginia Secretary of State regarding
the entity (Exhibits 9b – 9e). Unity registered as a domestic Virginia corporation on
11/10/16 (Exhibit 9b, pgs. 2-3), and noted its records would be kept at an address identical
to Aliera’s, in Georgia (Exhibit 9b, pg. 4). RIU cannot find any record that Unity registered
as a foreign corporation in the State of Georgia.
On 12/05/17, approximately three weeks after Unity was created, a press release
appeared promoting touting Unity and explained the HCSM had the same operating
relationship with Aliera that Trinity currently has (Exhibit 9e):

In August 2018, Unity filed both a change of address and registered agent, and changed
its

name

(Exhibits

9b

–

9d).

As

of

January

2019,

Unity’s

website

(www.unityhealthshare.com) automatically redirects to Trinity’s website. Aliera explained
that Unity’s board terminated its agreement with Aliera (Exhibit 5a, pg. 5), which likely
prompted Unity’s address, resident agent and name changes.
From the documents RIU obtained during its four various investigations concerning Aliera
while it was Unity’s marketer, this investigation determined Unity had precisely the same
generic “faith statements” as Trinity (Exhibits 9j – 9m). The following graphics
demonstrate this (Exhibit 9j [pg. 2] from Unity, and Exhibit 5c [pg. 19] from Trinity,
respectively):

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 Given that Trinity replaced Unity as Aliera’s HCSM partner, their identical “faith
statements” raises reasonable questions about whether Trinity was formed with the
express purpose of entering into a marketing agreement with Aliera, and about the
veracity of the nature (not the content) of its religious ethos.
ii. Background on Anabaptist
RIU queried the Virginia Secretary of State, which provided all documents it possessed
regarding Anabaptist Healthshare (“Anabaptist”). The entity was incorporated as a

OIC Case # 1589861

Page 28 of 35

 domestic Virginia corporation on 5/25/15 (Exhibit 9f, pg. 4). The same individual, Tyler
Hochstetler, acted as the registered agent for both Anabaptist and Unity. 22
In its 2018 annual report, Unity listed two Aliera executives as directors (Exhibit 9g). In
May 2018, Chase Moses, Aliera’s Executive Vice President, submitted Unity’s Form 990
for calendar year 2016 (Exhibit 9h). The form explained Anabaptist’s purpose was “to
provide health care sharing support for the missionaries, volunteers, and employees of
conservative Anabaptist ministries and businesses,” (Exhibit 9h, pg. 2).
iii. Agreement with Aliera
Aliera provided RIU with a copy of its agreement with Unity (Exhibit 9i), which was signed
on 02/01/17, approximately two months after Unity incorporated (Exhibit 9i, pg. 9). The
agreement is similar to Trinity’s, in that Unity gave Aliera exclusive license to sell and
distribute Unity products (Exhibit 9i, pg. 4).
The agreement suggests Unity was formed as an HCSM for the express purpose of
entering into this agreement with Aliera. It states that, “to facilitate the intent and purpose
of this agreement,” Anabaptist “has formed a subsidiary named Unity Healthshare, LLC,”
(Exhibit 9i, pg. 7). Aliera even agreed to reimburse Anabaptist up to $1,000 “for costs
directly associated with the creation and filing of a new Section 501(3)(C) [sic] ‘health
share charitable organization’ to be known as Unity Healthshare, LLC,” (Exhibit 9i, pg. 7).
5. REVIEW OF EVIDENCE OBTAINED
a. DOES TRINITY MEET THE DEFINITION OF A HCSM?
The evidence indicates Trinity does not meet the definition of a HCSM because (1) its
representations about its religious convictions are contradictory, (2) it has not been
operating as a 501(c)(3) legal entity and sharing member medical needs continuously

22. Compare Exhibit 9f, pg. 7 and Exhibit 9a, pg. 4.
OIC Case # 1589861

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 since December 31, 1999, and (3) evidence indicates Trinity was formed in 2018 for the
express purpose of entering into a marketing agreement with Aliera.
i. Religious convictions
OIC’s interest is not in the content of Trinity’s religious ethic; its interest is in the veracity
of the nature of Trinity’s representations about this religious motivation. If Trinity and its
members do not share a religious or ethical motivation, then it cannot be an HCSM.
Trinity’s contradictory representations about the nature of its religious ethic to State and
Federal government agencies and to consumers indicates it either does not understand
its religious motivation, or fails to communicate a consistent message about its religious
ethic to State and Federal regulators and its own members.
In representations to HHS, the State of Delaware and the OIC, Trinity states it holds to
an explicitly conservative, Protestant expression of the Christian faith. Moreover, its
bylaws obligate its members to affirm this specific Statement of Faith. However, the faith
statements in its marketing materials and solicitations are very different. Indeed, one
Aliera-linked trainer explained to prospective agents who will sell the HCSM product, “[i]t
basically is saying that you believe in a higher power. It doesn't necessarily have to be a
Christian God, or a Buddhist God, or a Jewish God. It doesn't … it doesn't matter as long
as we all believe that there is a higher power …”
Trinity incorrectly asserted the Statement of Faith in its bylaws, in essence, simply
requires members to “believe in God.” This is incorrect; the Statement of Faith requires
members to believe in a very particular expression of the Christian faith and message.
Indeed, they require members to believe in a very particular Trinitarian conception of God.
ii. Legal status since December 31, 1999
Trinity was incorporated in 2018, and the Federal statute says a HCSM must have been
in continuous existence sharing member health needs continuously since 12/31/1999.
Trinity suggests OIC is incorrect to interpret the 1999 date as binding. It acknowledges
OIC Case # 1589861

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 its very recent formation date, but states its religious ethos reflects the Baptist tradition of
sharing health needs, which dates to at least the 16th century.
However, evidence suggests Trinity was formed for the express purpose of entering into
a marketing agreement with Aliera, which was precisely what happened with Aliera’s
previous HCSM partner, Unity. Trinity incorporated, signed an agreement with Aliera, and
brought no HCSM consumers to the agreement. Moreover, it retains virtually no funds
from sales, delegates all operations to Aliera, and even yields maintenance, ownership
and access to the membership list to Aliera. Unity and Trinity even obligate its HCSM
consumers to agree to the exact same generic faith statements.
iii. Summary
Because (1) it was formed as a legal entity after 12/31/1999 and evidence suggests Trinity
was formed for the express purpose of entering into a marketing agreement with Aliera,
and (2) Aliera made (and continues to make) numerous contradictory representations
about the nature of its religious ethic to consumers, State and Federal regulators, (3)
Trinity does not meet the definition of an HCSM, according to RCW 48.43.009. Therefore,
Trinity is not exempt from insurance regulation and is acting as an unauthorized insurer
(as defined by RCW 48.01.050) which offers a variety of unauthorized disability insurance
plans (as defined by RCW 48.11.030), because it undertakes to indemnify a consumer or
pay a specified amount upon a determinable contingency of bodily injury, sickness or
other health-related matters (see RCW 48.01.040).
Aliera declined to provide detailed information to RIU about the number of Trinity’s HCSM
products it has sold and the total amount of funds collected (Exhibit 5h). RIU did not elect
to then seek the information via a subpoena.
b. ARE ALIERA’S ADVERTISEMENTS ABOUT THE TRINITY HCSM
OPTIONS FALSE OR MISLEADING?
The evidence indicates this allegation is substantiated.
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 i. Legal basis for the determination
Because the evidence indicates Trinity is not a HCSM, as defined by RCW and Federal
statute, the laws concerning advertising for disability insurance likely apply to Trinity’s
HCSM products. Regardless of this finding, because these HCSM products mirror
disability policies in their function (not the legal structure of the entity offering them), it is
prudent to use disability advertising statutes to determine whether Trinity and Aliera are
providing misleading or deceptive advertisements regarding HCSM products.
To that end, RCW 48.30.040 explains Trinity and Aliera cannot “knowingly make, publish,
or disseminate any false, deceptive or misleading representation or advertising in the
conduct of the business of insurance.” According to WAC 284-50-050(1), the “format and
content” of these disability insurance advertisements “shall be sufficiently complete and
clear to avoid deception or the capacity or tendency to mislead or deceive.” The statute
explains that such advertisements “shall be truthful and not misleading in fact or in
implication. Words or phrases, the meaning of which is clear only by implication or by
familiarity with insurance terminology, shall not be used,” (WAC 284-50-050[2]).
Likewise, WAC 284-50-060(1) relates that “[n]o advertisement shall omit information or
use words, phrases, statements, references, or illustrations if the omission of such
information or use of such … has the capacity, tendency, or effect of misleading or
deceiving purchasers or prospective purchasers as to the nature or extent of any policy
benefit payable, loss covered, or premium payable.” The fact that the consumer later
receives plan documents to review “does not remedy misleading statements.”
The OIC “shall” determine whether a particular disability advertisement “has a capacity or
tendency to mislead or deceive” based on “the overall impression that the advertisement
may be reasonably expected to create upon a person of average education or
intelligence, within the segment of the public to which it is directed,” (WAC 284-50-050[1]).
ii. Advertisements are deceptive and misleading
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 Evidence indicates Aliera’s advertisements for Trinity’s HCSM products are deceptive and
misleading for both the selling agents and the consumers. The overall impression an
average agent or consumer would likely receive from these advertisements and training
tools is that the HCSM products are insurance:
-

The agent training videos and assessment do not instruct prospective agents to
convey the religious/ethical ethos which the RCW and Federal statute envision
potential consumers will have. In fact, these tools use statutory and colloquial
insurance terminology when describing the HCSM products to new agents who will
sell them. This evidence therefore suggests the faith statements and disclaimer at
the end of the agent assessment are pro forma.

-

An Aliera consumer advertisement video promises that Aliera is “redefining the
healthcare experience” by putting the “power of choice” in the consumer’s hands
(Exhibits 4x and 4y). An Aliera’s executive explained on television that Aliera has
created new “healthcare choices” through innovation (Exhibits 4z and 4aa, 1:05 –
1:20). The television host explained the Aliera executive was there to discuss
“healthcare in America” (Exhibits 4z and 4aa, 0:00 – 0:50), and the executive
described the HCSM plans for a national television audience without ever
mentioning a religious/ethical motivation or caveat. This evidence suggests
Aliera’s HCSM disclaimers to consumers in its literature are pro forma.

In mid-2018, when Unity was Aliera’s marketer, RIU received complaints from four
consumers who stated the Aliera-contracted agent misrepresented the HCSM product as
an insurance plan. 23 Since Trinity became Aliera’s HCSM partner, RIU has received a
similar complaint against Aliera in which the consumer alleged misrepresentation and
explained he was solicited Trinity HCSM products along with actual insurance plans. 24

23. See RIU cases 1560917, 1549758, 1539832 and 1546395. RIU opened each investigation to determine
whether Aliera was selling insurance products without a license. Once it became apparent these
complaints involved HCSM products, RIU closed each complaint as unsubstantiated. RIU did not make
determinations about misrepresentation, because it determined it lacked jurisdiction over HCSM
organizations.
24. See RIU case 1598492. The complaint did not cooperate with RIU or respond to requests for further
information, and RIU did not open an investigation.
OIC Case # 1589861

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 Another consumer related an agent claimed her physician and dentist were “in network,”
but later discovered this was incorrect. 25
The evidence indicates Aliera (1) failed to represent Trinity’s actual Statement of Faith,
as defined by Trinity’s bylaws, (2) provided misleading training to prospective agents
about the nature of the HCSM products, and (3) provided misleading advertisements to
the general public and potential consumers that have the capacity or tendency to mislead
or deceive consumers, based on the overall impression that these advertisements may
be reasonably expected to create upon a person of average education.
Conclusions
1. The allegation that Trinity does not meet the statutory definition of a HCSM
under RCW and Federal statute is substantiated. Trinity is therefore acting
as an unauthorized insurer, in violation of RCW 48.05.030.
The allegation is substantiated because (1) Trinity’s representations about its religious
convictions are contradictory, (2) it has not been operating as a 501(c)(3) legal entity and
sharing member medical needs continuously since December 31, 1999, and (3) evidence
indicates Trinity was formed in 2018 for the express purpose of entering into a marketing
agreement with Aliera.
2. The allegation that Aliera’s various advertisements on behalf of Trinity are
deceptive and have the capacity and tendency to mislead or deceive
consumers to believe they are purchasing insurance rather than a HCSM
membership, in violation of RCW 48.30.040, WAC 284-50-050 and 284-50-060,
is substantiated.
The evidence indicates Aliera (1) failed to represent Trinity’s actual Statement of Faith,
as defined by Trinity’s bylaws, (2) provided misleading training to prospective agents
25. See RIU case 1595064. RIU directed the consumer to work with Aliera’s customer service to resolve
the issue, and to contact OIC’s Consumer Protection division for advocacy assistance, if necessary.
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 about the nature of the HCSM products, and (3) provided misleading advertisements to
the general public and potential consumers that have the capacity or tendency to mislead
or deceive consumers, based on the overall impression that these advertisements may
be reasonably expected to create upon a person of average education.

____________________________
Tyler Robbins
Investigations Manager

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 State of Washington
Office of Insurance Commissioner
Legal Affairs Division
Regulatory Investigations Unit

Final Investigative Report
Exhibits List
Exhibit 1 (09.11.2018) Initial Complaint
Exhibit 2 (12.10.2018) NAIC license details
Exhibit 3a (10.01.2018) NoI to Aliera and Trinity
Exhibit 3b (11.08.2018) NoI to Trinity
Exhibit 3c (02.26.2019) Follow-up Request for Info to Trinity
Exhibit 3d (01.30.2019) Follow-up request to Aliera
Exhibit 4a (12.18.2015) Aliera's Home Registration with Delaware Secretary of State
Exhibit 4b (01.10.2019) Aliera #1 Documents from Delaware
Exhibit 4c (04.28.2016) Aliera's Registration with Georgia Secretary of State
Exhibit 4d (03.20.2017) Aliera Healthcare 2017 Georgia Registration
Exhibit 4e (01.10.2018) Aliera Healthcare 2018 Georgia Registration
Exhibit 4f (03.13.2017) Aliera Healthcare of Georgia Formation
Exhibit 4g (03.14.2018) Aliera of Georgia 2018 Registration
Exhibit 4h (07.05.2017) HealthPass USA Merger with Aliera
Exhibit 4i (09.14.2018) Aliera Brochure for Brokers
Exhibit 4j (11.05.2018) Aliera training portal homepage
Exhibit 4k (09.28.2018) Training Modules Aliera (video)
Exhibit 4l (09.28.2018) Training Modules Aliera (audio)
Exhibit 4m (2016) Aliera Healthcare - Your ACA Solution (from Aliera's broker training site)
Exhibit 4n (2016) Aliera Healthcare - Your ACA Solution (video)
Exhibit 4o (2016) How to Use Your HealthPass Membership (video)
Exhibit 4p (2016) Aliera Healthcare - How to Use Your Membership (from Aliera's broker
training site)
Exhibit 4q (2016) How to Activate Membership
Exhibit 4r (2016) How to Activate Your HealthPass Membership (video)

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 Exhibit 4s (11.05.2018) Aliera Agent Assessment
Exhibit 4t (10.29.2018) Aliera Healthcare Product Overview (video)
Exhibit 4u (10.29.2018) Aliera Healthcare Product Overview
Exhibit 4v (11.01.2018) Aliera Healthcare Enrollment Process (video)
Exhibit 4w (11.01.2018) Aliera Healthcare Enrollment Process
Exhibit 4x (09.19.2018) Aliera Healthcare - A New Era in Healthcare Choices (video)
Exhibit 4y (09.19.2018) Alliera Healthcare A New Era in Healthcare Choices
Exhibit 4z (10.01.2018) Aliera Healthcare featured on The Balancing Act, Lifetime TV
(video)
Exhibit 4aa (10.01.2018) Aliera Healthcare featured on The Balancing Act, Lifetime TV
(mp3)
Exhibit 4ab (2018) Aliera Comprehensive Care Brochure
Exhibit 4ac (2018) Aliera CarePlus Advantage Brochure
Exhibit 4ad (2018) Aliera Short-term Care Brochure
Exhibit 4ae (2018) Trinity Dental and Vision Plan
Exhibit 5a (10.22.2018) Aliera's First Response to OIC
Exhibit 5b (10.01.2018) Trinity's 501(c)3 Certificate
Exhibit 5c (2018) AlieraCare BSG Member Guide
Exhibit 5d (2018) AlieraCare VPP Member Guide
Exhibit 5e (2018) CarePlus Member Guide
Exhibit 5f (2018) InterimCare Member Guide
Exhibit 5g (11.16.2018) Aliera's Agreement with Trinity
Exhibit 5h (02.19.2019) Aliera's Second Response to OIC
Exhibit 6a (06.17.2015) HealthPass USA Articles and Certificate of Organization in
Georgia
Exhibit 6b (2016) HealthPass USA 2016 Annual Registrations in Georgia
Exhibit 6c (03.30.2017) HealthPass USA 2017 Annual Registration
Exhibit 7a (11.05.2018) Request to Delaware for Aliera (5045109)
Exhibit 7b (01.10.2019) Aliera #2 Documents from Delaware
Exhibit 7c (09.29.2011) Aliera's (#2) Home Registration with Delaware Secretary of State

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 Exhibit 8a (06.27.2018) Trinity HCSMs Home Registration with Delaware Secretary of
State
Exhibit 8b (11.01.2018) Trinity's Registration in Georgia
Exhibit 8c (11.29.2018) Undeliverable Letter to Trinity
Exhibit 8d (12.07.2018) First Response from Trinity
Exhibit 8e (03.11.2019) Second Response from Trinity
Exhibit 8f (01.24.2019) Trinity's Website Home Page
Exhibit 8g (2018) Trinity Health Care Sharing explained
Exhibit 8h (2018) Trinity Healthshare FAQs
Exhibit 9a (11.15.2018) Unity's Incorporation in Virginia
Exhibit 9b (08.08.2018) Unity's Registered Agent Address Change
Exhibit 9c (08.14.2018) Unity's Principal Address Change
Exhibit 9d (08.22.2018) Unity's Principal Address Change
Exhibit 9e (12.05.2017) Press Release for Unity's New Website Launch
Exhibit 9f (11.16.2018) Request to and Response from Virginia About Anabaptist
HealthShare Docs
Exhibit 9g (08.08.2018) Anabaptist Healthshare 2018 Annual Report
Exhibit 9h (05.18.2018) Anabaptist HealthShare's Form 990 for 2016
Exhibit 9i (11.16.2018) Aliera's Agreement with Unity
Exhibit 9j (05.25.2018) 1539832 acknowledgment
Exhibit 9k (06.05.2018) 1546395 acknowledgment
Exhibit 9l (06.05.2018) 1549758 acknowledgment
Exhibit 9m (06.05.2018) 1560917 acknowledgment

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