One of the challenges that small churches encounter in the program is the number of employees enrolled. "We are a small group, and pastors are notorious for making use of every benefit we have," Martin says. "We have an aging group and our demographics are not tipped toward young, healthy families. Consequently, I wish the law allowed all full-time pastors in Indiana or in a region to band together as one group. If we could all band together and be a group, then perhaps that would help drive prices down."
Good Health Pays
While buying in bulk doesn't guarantee lower rates, having a larger population base to survey may help by having more healthy people on the plan to balance out less healthy employees. Crandall says organizations that offer health insurance benefits cannot refuse to provide coverage to an individual, but they may choose to "rate it up." She says rates are driven by three things:
- The male/female content of the group (because males tend to visit the doctor's office less frequently);
- The ages of those to be insured (younger people will get a less expensive rate);
- The location. Rates tend to be less expensive in the South and go higher as you move north.
Health insurance for small groups is mostly regulated by state laws, according to information from AHIP. Roughly two-thirds of states have adopted premium-rating rules designed in the early 1990s by the National Association of Insurance Commissioners, which allow rates to be adjusted for the demographics of enrollees in a group, but place limits on the magnitude of adjustments for health status, industry, and other rating factors.