Last Wednesday we held our first info session on Health Insurance Options for Artists & Small Groups, led primarily by our new insurance broker David Smith of USA Benefits Group.
Let me first say that David is an independent insurance broker. He is not on the payroll of any insurance company. He is a regular guy whose job is to know the current insurance industry inside and out so he can make the best recommendations to his clients for their particular lifestyle and needs.
When we poll the arts community here in Houston about what they want to know more about, one of the main topics that comes up is health insurance. With that in mind, what prompted us to host this info session at this particular time was because of what we experienced just recently here at Spacetaker in regards to our own health insurance.
When our annual insurance renewal came up at the beginning of April, we discovered that our insurance rates were going to go up by 46%. FORTY-SIX PERCENT, PEOPLE! Not only is that crazy, it was not going to be feasible for this office of two full-time staff during an economic recession.
We scrambled to find out what other options were out there and were referred to David Smith. We got him on the phone and within a short conversation learned that he could save us $2,500 per year per person by switching us from our small group health savings account policy to individual policies. AND, our insurance coverage is BETTER than it was before!
We were so pleased with our experience working with David that we wanted to share the wealth and make sure that the artists and non-profits we serve know what moves to make to get the best deal on their health insurance.
At the info session, David guided us through the questions one should ask when looking for health insurance. In addition, he covered the main changes in the current federal healthcare reform legislation and the timeline over which these changes are taking place.
A basic rundown of the main points you might want to know:
The new reform legislation was signed in March 2010.
The initial changes began to go into effect in September 2010 and therefore, once your plan is up for renewal, you may see (or may already have seen) a difference in the following:
- *Annual dollar-value limits on benefits are restricted. (translation: now there is no cap on how much an insurance company will cover; for example, insurance carrier X previously might have had a $2 Million cap on what they would pay for if you were undergoing major medical treatment. Now there is no cap – they must pay whatever it takes to get you well/healed.)
- *Insurers may not rescind (void) health insurance policies, except in cases of fraud or intentional misrepresentation.
- *Adult children who are currently on their parents’ policies and unable to get insurance through their jobs may stay on their parents’ policies until age 26, regardless of their marital status.
- *Plans may no longer impose pre-existing condition exclusions on children under 19. (Does not apply to “grandfathered” individual plans*)
- *New policies must cover the full cost of preventive care. (Does not apply to “grandfathered” individual plans.) (translation: Preventative care includes: office visits, lab, X-ray, child immunizations age 6-18, Pap smear, mammogram, prostate screening, and endoscopic services)
*“Grandfathered” plans include all plans purchased before March 2010. There are some rules surrounding what constitutes a “grandfathered” plan, see David's presentation included below.
These are the main changes that have taken place that are affecting current policies. While these changes are beneficial overall, we are already seeing a cost increase imposed on policy holders, and it seems like the brunt of the costs are being placed on small businesses.
By 2014, all insurance carriers must accept everyone whether they have preexisting health conditions or not.
Here are some questions that were answered during the session:
Q: If you are an employer or have a business, do I have to offer a group insurance policy?
A: NO. Businesses with less than 15 full-time employees can explore the option of paying for their employees’ individual policies (this is assuming that everyone in the company is relatively healthy and has not had trouble getting covered because of pre-existing conditions). Just like in our case here at Spacetaker, we went from a group policy to individual policies that are still paid for by the business (we are so lucky!) and it is saving the company thousands of dollars a year. This will only work for certain situations so please consult an insurance broker before you make any decision.
Q: Does it cost me anything to work with an insurance broker?
A: NO. Just like an apartment-finder, an independent insurance broker gets paid by the insurance company when a plan is purchased so there is no cost for the policy-seeker to consult a broker. An honest broker typically works with all major insurance carriers and has no allegiance to any one of them over the other. It behooves them to make sure you are happy with the plan that is right for you.
Q: If I’m paying a regular monthly insurance premium for major medical insurance and then get cancer or another illness, will my monthly premium go up when I renew my plan?
A: NO.Insurance companies cannot single out individuals and raise their rates due to changes in their health once they are already covered. The only time a person’s rate will go up is when that person’s particular pool (age range) goes up.
Fractured Atlas - As a partner in Fractured Atlas' Open Arts Network, we recommend Fractured Atlas to our Culture 365 members and others who are interested in affordable healthcare and liability options. If you are a Culture 365 member you are eligible to become an Associate Member of Fractured Atlas for free. Check out this amazing national arts services organization and all they have to offer.
Texas Health Insurance Pool – state-funded insurance for those who can not get insured through a major medical insurance carrier
Healthcare.gov – As of July 2010, the federal reform act mandated that the government must provide an Internet portal where individuals and businesses can go online to explore and compare insurance options.
The Artists Health Insurance Resource Center - AHIRC.org is an up-to-date, comprehensive and unbiased database of health care resources for artists, performers, freelancers and the self-employed.
Texas specific resources on the AHIRC website.
OTHER INTERESTING LOCAL HEALTHCARE RESOURCES:
Methodist Center for Performing Arts Medicine
The physicians and therapists of the Methodist Center for Performing Arts Medicine (CPAM) at The Methodist Hospital are here to help you by treating and/or preventing health problems associated with being a performing artist. CPAM's doctors have specialized knowledge and experience pertaining to the particular medical needs of performing artists, offering care through the only institutionally backed program of this kind in the country. Whether you are sick or injured, our specialists are committed to both helping you get back on stage quickly and supporting you through a long and healthy artistic career.
What Does CPAM Offer?
- The nation's most comprehensive group of medical professionals, based in the world-renowned Texas Medical Center and is teamed to provide preventive, diagnostic, specialty and emergency care to performing artists.
- Home to nationally recognized specialists in the fields of otolaryngology (ear, nose and throat), voice disorders, orthopedics, ophthalmology, kidney disease, neurology/neurosurgery, psychiatry and urology.
Personal Physician Group LLP
Personal Physician Group LLP(PPG) was founded in 1999 and offers a high level of patient-oriented medical care. PPG has a specific interest in Arts Medicine. Dr. Rebecca Clearman, Executive Director of Personal Physician Group LLP, has always had a special interest in performing artists, visual artists, writers and designers; she has been working in Arts Medicine since the 1980s.
Dr. Clearman and the Arts Medicine team are committed to the care of the Houston artistic community and are willing to give our services with full time performing and visual artists who would not otherwise be able to receive medical services.
Once a month, Personal Physician Group LLP sponsors a free Arts Medicine Clinic from 10 a.m. until 3 p.m.
If you are a professional artist or performer, lack of funds should not prevent you from getting help for your medical problem. If you are a dance, music, performance or visual arts student and require financial help for medical care, you may be eligible for this clinic.
To find out if the Arts Medicine Clinic is right for you, please visit http://ppghouston.com or call the office at 713-524-9800.
Harris County Hospital District “Gold Card”
Financial assistance for those who qualify, based on household income. To learn more and apply for the “Gold Card,” visit the HCHD website.
We plan to host an info session on healthcare at least twice a year and continually improve the quality and relevancy of information for artists and arts non-profit administrators. Next time we’ll tailor the session to pertain directly to self-employed artists.
In the meantime, if you have any questions that we can consider for the next session, please let us know by emailing us at info[at]spacetaker.org.
Thanks for reading!