Self-employed and working three jobs, Tim Ray expects his health insurance to protect him all day long – not just on nights and weekends.
So he was surprised to learn that Group Health, his longtime insurance carrier and one of Washington’s largest, decided this year to stop covering workplace-caused illness and injury in its individual and small-group plans.
With only days to go before the March 31 deadline to purchase 2014 health insurance, Ray switched from Group Health to an individual policy from Premera Blue Cross. Premera, Ray said, told him it will cover workplace health issues.
Now, Ray will have to find a new doctor, one on Premera’s list. But at $421 a month his new, more comprehensive Premera policy will cost him $8 less than Group Health would have charged for a policy that excludes workplace issues, he said.
“If we’re going to have health care at all we need to have health care all hours of the day and not be excluding the time when I’m working on the job,” he said.
Ray, 59, has a complex workday: He teaches cross-country skiing, owns rental houses and programs computer-controlled industrial cutting machines. After hours he enjoys woodworking and tinkering with cars. The possible injuries from his hobbies are no different from the injuries he could experience while he’s at work, he said.
Group Health’s decision is one more reminder, he said, that people shopping for health insurance coverage ought to consult an insurance broker and study the fine print before they buy.
On that point, the insurance industry and the government officials who regulate it are in agreement.
Unfortunately for self-employed consumers like Ray, coverage of workplace injury and illness rarely comes up in the continuing national uproar over health care reform.
For most Americans, health coverage comes from a large-group plan, offered by their employers. Coverage of workplace injury or illness is handled separately, by workers’ compensation policies that large employers generally are required to provide.
For the self-employed, however, a workers’ compensation plan is optional under Washington state law.
Group Health dropped this coverage from its individual plans because the costs from workplace injuries and rehabilitation have been so high. Rick Henshaw, Group Health’s director of individual and family sales, said Group Health was losing money on that aspect of its benefit package.
Requirements of the Affordable Care Act made health coverage more expensive to provide, he said, so to keep its rates competitive Group Health had to drop the benefit. There are rumors in the industry, Henshaw added, that other carriers might be preparing to do the same.
Ray said it wasn’t clear to him what the distinction is, between the medical issues Group Health would cover during his long workdays and the issues it wouldn’t.
Henshaw explained it this way: “If you were doing something for the benefit of your employer or client and you were injured or became ill as a result, then your injury or illness is work related.” As an example, he cited a construction worker who removes asbestos from buildings and contracts a chronic lung disease from inhaling the asbestos fibers.
Workers’ compensation coverage, Henshaw pointed out, is available for self-employed people to buy from the Washington state Department of Labor and Industries.
Ray said he knows about workers’ compensation coverage, from years ago when he managed a hardware store; it’s costly, he said, and what he wants now is basic health coverage.
But workers’ compensation covers a great deal more than medical bills, said Rena Shawver, a spokeswoman for the department. It also pays wages lost while an ill or injured worker is off the job, pays for rehabilitation and pays for vocational counseling if the worker becomes disabled and has to choose another career.
The cost of workers’ compensation varies, because it’s based on the risks involved in each worker’s trade. According to the state’s 2014 rates, an underground miner would pay $4 per hour worked; a florist, 71 cents; a janitor, $1.29. For Ray’s three careers, Shawver said, the rates might be: $2.05 for skiing guide, $1.12 for property management and 12 cents for software design.
Applicants for workers’ insurance coverage need to consult with a state account manager to figure out their rate, Shawver said.
Stephanie Marquis, a spokeswoman for the state insurance commissioner’s office, said it’s no surprise and within the rights of an insurance carrier to drop coverage of workplace issues as Group Health has decided to do. Coverage of work-caused maladies is becoming less common among individual health policies, she said, and apparently is being left to the state’s workers’ compensation system.
Ray said he finds the situation to be evidence that U.S. health care reform didn’t go far enough. It’s a problem, he said, “when you allow (insurance companies) to cherry pick what they’re going to cover.”
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