Zion HealthShare, Inc. v. Office of the Insurance Commissioner

FILED

FEBRUARY 5, 2026

In the Office of the Clerk of Court

WA State Court of Appeals, Division III

IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON

DIVISION THREE

ZION HEALTHSHARE, INC., ) No. 40454-4-III

)

Appellant, )

)

v. ) PUBLISHED OPINION

)

WASHINGTON STATE; THE )

WASHINGTON STATE OFFICE OF )

THE INSURANCE COMMISSIONER, )

MIKE CREIDLER, COMMISSIONER, )

)

Respondents. )

LAWRENCE-BERREY, C.J. — Zion HealthShare, Inc. (Zion) appeals a final

administrative order upholding a cease and desist order issued by this state’s Office of the

Insurance Commissioner (OIC). OIC’s order concluded that Zion was acting as an

insurer, ordered Zion to cease its insurance business until it registered as an insurer, and

imposed a fine, a two percent premium tax, and penalties and interest on that tax.

Zion argues it is not an insurer. It alternatively argues that the seasoning

component in RCW 48.43.009—the component preventing it from being exempt from

registration—is unconstitutional. In affirming, we conclude that Zion is an insurer and

reject its constitutional challenges.

No. 40454-4-III

Zion HealthShare, Inc. v. Office of Ins. Comm’r

FACTS

Background

Zion HealthShare, Inc. is a nonprofit corporation based in Utah whose purpose “is

to offer and administer a voluntary and benevolent healthcare cost sharing corporation.”

Administrative Record (AR) at 260. Zion was formed on November 7, 2018, has

26 U.S.C. § 501(c)(3) tax-exempt status, and does not hold a certificate of authority to

transact insurance in Washington. In its articles of incorporation, Zion states its general

purpose is “[a]dministering a voluntary community benevolence program designed to

assist in the sharing of legitimate medical expenses by and for the exclusive benefit of

program members.” AR at 260. Zion has about 48,000 members throughout the United

States.

Zion’s Membership Guidelines

Zion’s members sign up for membership through Zion’s website. Zion’s

membership guidelines, a 41-page document, is published on its website for prospective

members to review. In its guidelines, Zion describes its business model and how it

differs from traditional insurance:

A HealthShare is a non-profit membership program that allows members to

share in medical expenses. Zion HealthShare is not an insurance program,

but members share major medical costs with one another as a community.

AR at 388.

2

No. 40454-4-III

Zion HealthShare, Inc. v. Office of Ins. Comm’r

To earn and maintain membership with Zion, individuals must adhere to Zion’s

principles of membership and submit monthly contributions. These principles include:

• I believe that a community of ethical, health-conscious people can

most effectively care for one another by directly sharing the costs

associated with each other’s healthcare needs. . . .

• I understand that Zion HealthShare is a benevolent organization,

not an insurance entity, and that Zion HealthShare cannot guarantee

payment of medical expenses.

....

• I agree to submit to mediation followed by subsequent binding

arbitration, if needed, for any instance of a dispute with Zion HealthShare

or its affiliates.

AR at 353.

In addition to abiding by these principles, individuals must make the monthly

contributions associated with their membership tier to gain and maintain eligibility to

share costs with other members. Zion retains a percentage of monthly member

contributions to cover its administrative costs. Zion allocates the remaining contributions

toward a fund, which it holds and administers, to pay member-submitted medical

expenses that qualify for sharing under its member guidelines.

When enrolling with Zion, members choose an “Initial Unshareable Amount”

(IUA) of $1,000, $2,500, or $5,000. AR at 360. The lower a member’s chosen IUA, the

higher the member’s monthly contribution. The member is responsible for paying their

chosen IUA before medical expenses are eligible for sharing with other Zion members.

3

No. 40454-4-III

Zion HealthShare, Inc. v. Office of Ins. Comm’r

Members need not pay the IUA again for that medical need until they are symptom free

for 12 months. Additionally, once a member pays three IUAs in a 12-month period, any

shareable expense over $500 is paid by the fund.

Premembership medical conditions are not eligible for sharing during the first year

of payment and are thereafter limited through the first four years. Subject to the

foregoing, there are 40 types of medical conditions or services that are eligible for

sharing, subject to various restrictions. There are 16 types of medical conditions or

services that are not eligible for sharing, including abortion.

Zion has a procedure for resolving disputes if a member disagrees with its

determination that an expense is not shareable:

If a member believes that a limitation was incorrectly placed on member

sharing, an appeal may be submitted. Members may submit an appeal and

provide supporting medical evidence to have the membership limitation

removed. All appeals are reviewed by a committee that includes at least

one Zion HealthShare board member, as well as trained medical

professionals.

AR at 359. Appeal requests must be submitted within 30 days of Zion denying the need

request.

Zion repeatedly asserts in its guidelines that it is not an insurance company. Zion

includes a lengthy two-paragraph disclaimer on the last page of its membership

guidelines. The portion of the disclaimers relevant to this appeal state:

4

No. 40454-4-III

Zion HealthShare, Inc. v. Office of Ins. Comm’r

While Zion HealthShare has shared all eligible expenses of its members to

date, membership does not guarantee or promise that your eligible need

requests will be shared. . . . The financial assistance members receive will

come from other members’ monthly contributions and not from Zion

HealthShare.

. . . These guidelines do not create a legally enforceable contract between

Zion HealthShare and any of its members. . . .

AR at 391.

Procedural History

Zion enrolled 1,694 Washington residents into its cost-sharing program between

2019 and 2021. OIC learned of Zion’s operation through a consumer’s inquiry. OIC

investigated Zion and concluded it was acting as an unauthorized insurer in Washington.

OIC issued an order requiring Zion to cease and desist conducting business in

Washington as an insurer until it registered with the insurance commissioner and ordered

Zion to pay a $50,000 fine, a two percent premium tax on contributions Zion had

collected from its members in Washington, and penalties and interest on that tax.

Zion requested an administrative hearing to contest OIC’s order. The parties filed

cross motions for summary judgment. The initial order granted OIC’s motion and denied

Zion’s motion. Zion appealed administratively. The reviewing officer issued a final

order affirming the initial order. Zion appealed the final order to Thurston County

5

No. 40454-4-III

Zion HealthShare, Inc. v. Office of Ins. Comm’r

Superior Court. By stipulated motion, that court certified review to this court in

accordance with RCW 34.05.518.

ANALYSIS

STANDARD OF REVIEW

“[W]here the original administrative decision was on summary judgment, the

reviewing court must overlay the [Administrative Procedure Act, chapter 34.05 RCW]

standard of review with the summary judgment standard.” Verizon Nw., Inc. v. Emp. Sec.

Dep’t, 164 Wn.2d 909, 916, 194 P.3d 255 (2008). This court views all facts in the light

most favorable to the nonmoving party. Ehrhart v. King County, 195 Wn.2d 388, 409,

460 P.3d 612 (2020). Summary judgment is appropriate only when there is no genuine

issue as to any material fact and the moving party is entitled to judgment as a matter of

law. CR 56(c). “We review questions of law and an agency’s application of the law to

the facts de novo, but we give the agency’s interpretation of the law great weight where

the statute is within the agency’s special expertise.” Cornelius v. Dep’t of Ecology, 182

Wn.2d 574, 585, 344 P.3d 199 (2015).

A. WHETHER ZION IS AN INSURER

Subject to exceptions, an “insurer” is “every person engaged in the business of

making contracts of insurance.” RCW 48.01.050. Zion does not claim that it comes

within any exception. Instead, it argues that it does not make contracts with its members.

6

No. 40454-4-III

Zion HealthShare, Inc. v. Office of Ins. Comm’r

A “contract” is a “promise or set of promises for the breach of which the law

provides a remedy.” 25 DAVID K. DEWOLF, KELLER W. ALLEN & DARLENE BARRIER

CARUSO, WASHINGTON PRACTICE: CONTRACT LAW AND PRACTICE, § 1:1, at 2 (3d ed.

2014). Zion argues there is no legally enforceable promise between itself and its

members. In support of its argument, it references its own disclaimer: “These guidelines

do not create a legally enforceable contract between [Zion] and any of its members.”

AR at 391.

A party opposing summary judgment “must set forth specific facts showing that

there is a genuine issue for trial.” CR 56(e). A “fact” is “‘an event, an occurrence, or

something that exists in reality.’” Michak v. Transnation Title Ins. Co., 148 Wn.2d 788,

795, 64 P.3d 22 (2003) (quoting Grimwood v. Univ. of Puget Sound, Inc., 110 Wn.2d

355, 359, 753 P.2d 517 (1988)). The disclaimer phrase—“these guidelines do not create

a legally enforceable contract”—is not a fact. The disclaimer phrase is a legal conclusion

and like other legal conclusions, we give it no deference. Cf. McCarty v. King County

Med. Serv. Corp., 26 Wn.2d 660, 684, 175 P.2d 653 (1946) (“‘No one can change the

nature of insurance business by declaring in the contract that it is not insurance.’”

(quoting Allin v. Motorists’ Alliance, 234 Ky. 714, 29 S.W.2d 19, 23 (1930))).

When construing a writing, we apply the objective manifestation theory and

consider what a reasonable person would understand the writing to mean. Plumbing

7

No. 40454-4-III

Zion HealthShare, Inc. v. Office of Ins. Comm’r

Shop, Inc. v. Pitts, 67 Wn.2d 514, 517, 408 P.2d 383 (1965). Here, there are two

provisions in the membership guidelines that are particularly important in our analysis of

whether Zion objectively manifests a promise to pay its members’ eligible medical

expenses.

First, the guidelines contain a dispute resolution process so that members can

challenge whether Zion wrongly denied payment of an eligible medical expense. This

process implies a commitment by Zion to pay in accordance with its guidelines. Second,

in its disclaimer, Zion assures prospective members that it “has shared all eligible

medical expenses of its members to date,” and explains that payment comes from other

members’ monthly contributions, not from Zion itself. AR at 391. A reasonable person

would understand that payment of an eligible medical expense is contingent on the

sufficiency of the members’ pooled funds. We conclude that Zion made a legally

enforceable promise to pay its members’ eligible medical expenses, even though its

promise is subject to the sufficiency of its members’ pooled funds.

Zion asks this court to construe its membership guidelines in a manner that would

render its payment of eligible medical expenses entirely discretionary. OIC responds that

courts eschew a construction that would render “promises” illusory. We agree with OIC.

“If a party retains ‘an absolute right not to perform at all, there is an absence of

consideration.’” Armed Citizens’ Legal Def. Network v. Office of Ins. Comm’r,

8

No. 40454-4-III

Zion HealthShare, Inc. v. Office of Ins. Comm’r

28 Wn. App. 2d 64, 75, 534 P.3d 439 (2023) (quoting Felice v. Clausen, 22 Wn. App.

608, 611, 590 P.2d 1283 (1979)). “Where ‘the provisions of an agreement leave the

promisor’s performance entirely within [their] discretion and control, the “promise” is

illusory.’” Id. (quoting Felice, 22 Wn. App. at 611). Courts seek to avoid an

interpretation that would render a “promise” illusory. Taylor v. Shigaki, 84 Wn. App.

723, 730, 930 P.2d 340 (1997).

We conclude that Zion promises its members it will pay their eligible medical

expenses from the fund it holds and administers. We reject Zion’s argument that it does

not make contracts with its members.

B. WHETHER THE SEASONING COMPONENT IN RCW 48.43.009 IS

UNCONSTITUTIONAL

A health care sharing ministry is not an insurer. RCW 48.43.009. Zion seeks

to come within the definition of a “health care sharing ministry.” RCW 48.43.009;

26 U.S.C. § 5000A(d)(2)(B)(ii). To do so, it argues that the one definitional component it

cannot satisfy is unconstitutional. This component requires the ministry

to have “been in existence at all times since December 31, 1999.” 26 U.S.C.

§ 5000A(d)(2)(B)(ii)(IV). We refer to this component as “the seasoning component.”

Zion argues that the seasoning component violates (1) the privileges and

immunities clause of the Washington State Constitution, (2) the First Amendment’s

9

No. 40454-4-III

Zion HealthShare, Inc. v. Office of Ins. Comm’r

establishment clause in the United States Constitution, and (3) the free exercise clause of

the Washington State Constitution.

We presume that statutes are constitutional. Wash. Educ. Ass’n v. Dep’t of

Retirement Sys., 181 Wn.2d 233, 241, 332 P.3d 439 (2014). A party challenging a

statute’s constitutionality must establish there is no reasonable doubt that it violates the

Washington Constitution. Id. We next address Zion’s constitutional challenges.

1. Privileges and immunities clause of the Washington State

Constitution

Our state’s privileges and immunities clause provides:

No law shall be passed granting to any citizen, class of citizens, or

corporation other than municipal, privileges or immunities which upon the

same terms shall not equally belong to all citizens, or corporations.

WASH. CONST. art. I, § 12. This clause was enacted to “‘prevent people from seeking

certain privileges or benefits to the disadvantage of others.’” Grant County Fire Prot.

Dist. No. 5 v. City of Moses Lake, 150 Wn.2d 791, 809, 83 P.3d 419 (2004) (quoting

State v. Smith, 117 Wn.2d 263, 283, 814 P.2d 652 (1991) (Utter, J., concurring)).

An alleged violation of the privileges and immunities clause calls for a two-part

test. Bennett v. United States, 2 Wn.3d 430, 443, 539 P.3d 361 (2023). First, we must

determine whether the law grants what the state constitution considers a privilege or

immunity. Id. Generally, these only include fundamental rights of state citizenship and

10

No. 40454-4-III

Zion HealthShare, Inc. v. Office of Ins. Comm’r

not those left to the discretion of the legislature. Martinez-Cuevas v. DeRuyter Bros.

Dairy, 196 Wn.2d 506, 519, 475 P.3d 164 (2020). If the answer is yes, we then

determine whether reasonable grounds exist for the law. Bennett, 2 Wn.3d at 443.

Washington courts recognize the right to carry on business as fundamental, but

this right is implicated only in very narrow circumstances. Wash. Food Indus. Ass’n v.

City of Seattle, 1 Wn.3d 1, 28, 524 P.3d 181 (2023). Zion asserts the right to carry on

business as a health care sharing ministry. The seasoning component does not deny Zion

the right to carry on business as a health care sharing ministry, it only requires Zion to

comply with generally applicable insurance laws. There is no fundamental right for a

business to be exempt from generally applicable laws.

2. Establishment clause of the United States Constitution

The establishment clause of the United States Constitution states, “Congress shall

make no law respecting an establishment of religion.” U.S. CONST. amend. I. The clause

prohibits the federal government or any state from passing a law that aids one or all

religions or prefers one religion over another. Everson v. Bd. of Educ. of Ewing Twp.,

330 U.S. 1, 15, 67 S. Ct. 504, 91 L. Ed. 711 (1947).

The Supreme Court requires courts to interpret the establishment clause by

“‘reference to historical practices and understandings.’” Kennedy v. Bremerton Sch.

Dist., 597 U.S. 507, 535, 142 S. Ct. 2407, 213 L. Ed. 2d 755 (2022) (quoting Town of

11

No. 40454-4-III

Zion HealthShare, Inc. v. Office of Ins. Comm’r

Greece v. Galloway, 572 U.S. 565, 576, 134 S. Ct. 1811, 188 L. Ed. 2d 835 (2014)). The

line between permissible and impermissible must “‘accor[d] with history and faithfully

reflec[t] the understanding of the Founding Fathers.’” Kennedy, 597 U.S. at 536

(internal quotation marks omitted) (quoting Town of Greece, 572 U.S. at 577). If we

cannot identify an identical practice or understanding at the time of the founding, we look

to available historical analogues for guidance. Hunter v. U.S. Dep’t of Educ., 115 F.4th

955, 965 (9th Cir. 2024).

Prior to Kennedy, courts applied a multi-pronged approach established in Lemon v.

Kurtzman, 403 U.S. 602, 91 S. Ct. 2105, 29 L. Ed. 2d 745 (1971). See Kennedy, 597

U.S. at 507. Following the formal abandonment of the Lemon test and adoption of the

historical standard in Kennedy, the Supreme Court has continued to examine whether a

statute makes denominational preferences in deciding whether to apply strict scrutiny.

See Catholic Charities Bureau, Inc. v. Wisconsin Lab. & Indus. Review Comm’n, 605

U.S. 238, 248-52, 145 S. Ct. 1583, 221 L. Ed. 2d 881 (2025).

“[W]hen we are presented with a state law granting a denominational preference,

our precedents demand that we treat the law as suspect and that we apply strict scrutiny in

adjudging its constitutionality.” Larson v. Valente, 456 U.S. 228, 246, 102 S. Ct. 1673,

72 L. Ed. 2d 33 (1982). In Larson, the court considered an amendment to Minnesota law.

Prior to the amendment, all religious organizations were exempt from the registration and

12

No. 40454-4-III

Zion HealthShare, Inc. v. Office of Ins. Comm’r

disclosure requirements for solicited contributions. Id. at 231. In 1978, Minnesota

amended the law to include a “50 per cent rule.” Id. The 50 per cent rule narrowed the

exemption to “‘[a] religious society or organization which receive[s] more than half of

[its] contributions . . . from . . . members . . . or . . . from a parent organization or

affiliated organization.’” Id. at 231-32 n.3 (emphasis added). Shortly after its

enactment, Minnesota authorities notified the Unification Church that it was no longer

exempt from the general registration and disclosure requirements for solicitation of funds.

Id. at 232. The Unification Church brought an action in federal court to have the

amendment declared unconstitutional. Id. In support of its summary judgment request, a

Unitarian Church member submitted a declaration stating, “[A]mong the activities

emphasized by the Church were ‘door-to-door public-place proselytizing and solicitation

of funds to support the Church’ . . . and that the application of the . . . fifty percent rule

would deny its members their ‘religious freedom.’” Id. at 234. The court then discussed

Murdock v. Pennsylvania, 319 U.S. 105, 63 S. Ct. 870, 87 L. Ed. 1292 (1943), which

concerned Jehovah’s Witnesses, a religious organization that similarly solicited

contributions from the public. The Larson court concluded that the Minnesota

amendment made “explicit and deliberate distinctions between different religious

organizations.” Id. at 246 n.23. The court further concluded that these distinctions

13

No. 40454-4-III

Zion HealthShare, Inc. v. Office of Ins. Comm’r

granted denominational preferences and invalidation was required unless it satisfied the

strict scrutiny test. Id. at 246.

Relying on Larson, Zion argues that the seasoning component makes explicit and

deliberate distinctions between health care sharing ministries based solely on when they

were founded. Pet’r’s Reply Br. at 24. We disagree with Zion’s argument. Zion

conflates “distinctions between different religious organizations” (that require strict

scrutiny) and “distinctions between health care sharing ministries” (that do not).

Any religious denomination can qualify as a health care sharing ministry. The

seasoning component applies with equal force to all denominations. That is, all

denominational health care sharing ministries formed after December 31, 1999, must

register as an insurer under Washington law. Because the seasoning component does not

discriminate between religious denominations, we reject Zion’s argument that strict

scrutiny applies. Zion does not challenge the seasoning component under any other

standard than strict scrutiny. We conclude that Zion fails to satisfy its heavy burden of

proving that the seasoning component violates the establishment clause.1

1

In its statement of facts, Zion admits it does not know why the United States

Congress added the seasoning component. Pet’r’s Opening Br. at 12. It then drops a

footnote citing a 2019 law review article. In its briefing, Zion does not raise a disparate

impact argument. Zion’s footnote citation, without argument, is insufficient to raise

disparate impact. But cf., King County Pub. Hosp. Dist. No. 2 v. Dep’t of Health, 178

Wn.2d 363, 379, 309 P.3d 416 (2013) (A thorough argument in a two-page footnote is

14

No. 40454-4-III

Zion HealthShare, Inc. v. Office of Ins. Comm’r

3. Free exercise clause of the Washington Constitution

Article I, section 11 of the Washington Constitution provides:

Absolute freedom of conscience in all matters of religious sentiment, belief

and worship, shall be guaranteed to every individual, and no one shall be

molested or disturbed in person or property on account of religion; but the

liberty of conscience hereby secured shall not be so construed as to excuse

acts of licentiousness or justify practices inconsistent with the peace and

safety of the state.

The free exercise of religion is a fundamental right. First United Methodist

Church v. Hearing Exam’r, 129 Wn.2d 238, 246, 916 P.2d 374 (1996).

OIC argues that the seasoning component does not violate Zion’s free exercise of

religion because the definition of a “health care sharing ministry” is neutral and generally

applicable. However, this is the standard applied to alleged violations of the free exercise

clause of the First Amendment to the United States Constitution. See Dep’t of Human

Res. v. Smith, 494 U.S. 872, 110 S. Ct. 1595, 108 L. Ed. 2d 876 (1990). Article I, section

11 of the Washington Constitution provides broader protection than its federal

counterpart. City of Woodinville v. Northshore United Church of Christ, 166 Wn.2d 633,

642, 211 P.3d 406 (2009).

A party challenging the government action first must prove “that their religious

convictions are sincere and central to their beliefs.” Munns v. Martin, 131 Wn.2d 192,

sufficient to warrant review.).

15

No. 40454-4-III

Zion HealthShare, Inc. v. Office of Ins. Comm’r

199, 930 P.2d 318 (1997) (quoting Backlund v. Bd. of Comm’rs, 106 Wn.2d 632, 639,

724 P.2d 981 (1986)). The challenger next must show that the law or government action

burdens its free exercise of religion. Munns, 131 Wn.2d at 200; see also State v. Arlene’s

Flowers, Inc., 193 Wn.2d 469, 527, 441 P.3d 1203 (2019).

A burden exists when the law or action has a coercive effect on the practice of

religion. First United Methodist Church, 129 Wn.2d at 246. “‘A facially neutral, even-

handedly enforced statute that does not directly burden free exercise may, nonetheless,

violate article 1, section 11, if it indirectly burdens the exercise of religion.’” Open Door

Baptist Church v. Clark County, 140 Wn.2d 143, 153, 995 P.2d 33 (2000) (quoting

Munns, 131 Wn.2d at 200).

If the challenger meets these requirements, “the burden of proof shifts to the

government to show the restrictions serve a compelling state interest and are the least

restrictive means for achieving the government objective.” First United Methodist

Church, 129 Wn.2d at 246. A compelling interest calls for a “‘clear justification . . . in

the necessities of national or community life.’” State ex rel. Bolling v. Superior Ct.,

16 Wn.2d 373, 385, 133 P.2d 803 (1943) (quoting Barnette v. W. Virginia State Bd. of

Educ., 47 F. Supp. 251, 254 (S.D. W. Va. 1942)).

Citing to the declaration of its chief executive officer and president, Nathan Udy,

Zion states that its reason for existence is to encourage its members to share their burdens

16

No. 40454-4-III

Zion HealthShare, Inc. v. Office of Ins. Comm’r

with one another—a tenet espoused by Paul the Apostle to the churches in Galatia.2

Pet’r’s Opening Br. at 55. Zion satisfied the first step of the two-part inquiry.

With respect to the second step, Zion argues:

The [seasoning component] would not only interfere with, but

positively preclude Zion from acting pursuant to, its religious beliefs. The

[seasoning component], if applied, would preclude Zion from assisting and

facilitating Washington members’ sharing of medical expenses with each

other.

Pet’r’s Opening Br. at 55. But for a footnote dropped by Zion, we would be left to guess

how it contends the seasoning component burdens its exercise of religion. In the

footnote, Zion adds:

Even if Zion were to comply with the requirement that it register as an

insurer, doing so would make it subject to state law mandates—such as the

tax on “premiums,” and the mandate to facilitate payments for abortion

services. See RCW 48.43.073 (Requiring all health insurance policies

issued in Washington State to provide coverage for abortion related

services). Zion could not conscientiously agree to facilitate payment for

abortion services because doing so would be inconsistent with its sincerely

held religious beliefs. AR 403 (Udy Dec., ¶ 6).

Pet’r’s Opening Br. at 55 n.16.

We disagree that requiring Zion to be a licensed insurance company in

Washington would have a coercive effect on Zion encouraging its members to share their

2

Galatians 6:2.

17

No. 40454-4-III

Zion HealthShare, Inc. v. Office of Ins. Comm’r

burdens with one another. First, the two percent premium tax levied on member

contributions is negligible, not coercive, and can be passed on to members.

Second, being subject to Washington State insurance law would encourage greater

sharing of medical burdens with one another. Under Washington law, Zion would be

required to cover preexisting medical conditions and a wider array of medical services

and procedures with less restrictions. Although this will require higher monthly

contributions from members, encouraging increased sharing of burdens is consistent with

Zion’s reason for existence.

Third, being subject to Washington State insurance law would require Zion

to pay for abortions only if it retains coverage for maternity care or services.

RCW 48.43.073(1)(a) provides in relevant part: “[I]f a health plan . . . provides coverage

for maternity care or services, the health plan must also provide a covered person with

substantially equivalent coverage to permit the abortion of a pregnancy.” Zion does not

argue that excluding maternity care from its covered services would have a coercive

effect on its religious beliefs. We conclude that Zion fails to satisfy its heavy burden to

show that the seasoning component violates our state’s free exercise clause.

18

No. 40454-4-III

Zion HealthShare, Inc. v. Office of Ins. Comm’r

We affirm the agency’s final order.

________________________________

Lawrence-Berrey, C.J.

WE CONCUR:

_____________________________________

Staab, J.

Birk, J.3

3

The Honorable Ian S. Birk is a Court of Appeals, Division One, judge sitting in

Division Three pursuant to CAR 21(a).

19