There are no state or federal laws that require employers to offer health insurance benefits to any employees at all, says Robert Zirkelbach, director of strategic communications for America's Health Insurance Plans (ahip.org). While churches aren't obligated to provide health insurance for their staffs, most want to provide those benefits for their pastors and full-time employees. Yet many pastors today need to look elsewhere for health insurance—perhaps through an employed spouse—or simply risk living without it. Why?

"From my standpoint, finding coverage for a small church is not a problem," says Shirley Crandall, president of Crandall & Associates, Inc., a full-service insurance agency in San Antonio, Texas. "Any of the companies I work with will write a policy for a church with a minimum of two employees."

Big Business Benefits

So the challenge for smaller churches isn't getting health insurance but finding affordable plans—affordable to both the church and the pastor. According to figures from the 2008 Employer Health Benefits Survey prepared by the Kaiser Family Foundation and the Health Research & Educational Trust (hret.org), the average family's out-of-pocket expense for health insurance premiums more than doubled in less than 10 years, even though more people enrolled in high-deductible plans.

The Kaiser survey found that workers in small businesses (firms of three to 199 workers) that offer health benefits pay, on average, $4,101 annually for family health insurance coverage, while workers at larger firms pay just $2,982 annually. Why the large difference?