Federal law requires small-group health insurance to be offered on a "guaranteed-issue" basis. That is, a small business cannot be denied coverage due to the health status or illness of its employees or their dependents, according to AHIP. Martin says his church struggled with its annual renewal because the insured staff in his conference filed many claims in the previous year. "Pastors lead relatively sedentary lives," he says. "We're not the healthiest group in the world."
Not surprisingly, smaller churches find the challenge of paying for health insurance premiums a serious burden. "Many of our congregations are so small (as few as 50 members), that it is difficult to pay the health insurance premium," Martin says. "Pastors are not highly paid, and the cost for the family premium in our conference—for two parents with children—is going to be $1,400 per month next year [in 2009]."
Small churches sometimes need to make very difficult decisions about even offering health insurance. When added to the expenses of paying the pastor a salary, operating the church facility, the cost of programs, ministries, and outreach—other things that a church should be doing—the health insurance premium "can be a huge obstacle," Martin says. "It isn't necessarily hard for the church where I'm the pastor, but for the smaller ones it can be a problem."