Insurance for the Arts Example:
Fractured Atlas
FRACTURED ATLAS, a national nonprofit arts service organization, provides information you
may need to help determine the most important types of insurance coverage for you and your
organization, including disaster insurance. There is a fee to join. support@fracturedatlas.org.
Twane L. Duckworth
Chief of the Risk Management Division
The City of Jacksonville
Insurance
for Artists
By Kenny
Rouh of
RouxArt, Inc.
ANEX, PERT)
(IAM, NOT,
Kate Garcia Rouh is my wife.
I retired from Corporate
America to transform her art
talent into an art business.
In mapping our Business
Plan,
a strategy for Insurance
coverage was also
needed.
Let’s talk about
Risk.
Daily Personal Risks:
 Getting
out of bed.
 Walking
in stocking feet on a carpeted
stairway.
 Pouring
 Driving
 Name
risk.
 You
hot water into the French press.
your automobile to work.
yours………YOU choose your level of
can choose to have some of your
Personal risks to be insured against a financial
impact.
Business Risks, as an employee of a major
company:
 Sales
Rep makes a new sale(or not).
 Customer
Service Rep makes customer angry.
 Finance
Mgr. buys a Futures contract to set low
fuel price for December.
 Fleet
Maintenance cares for company vehicles.
 Company
Driver delivers product to customer.
 Companies
choose to insure certain risks,
absorb some.
Insurance against
the financial consequences of
events that have Risk to your Art
business.
Risks of an Artist’s BUSINESS :
 Same
Personal Risks as most people.
 Declaring
yourself to be a businessadditional risk.
 Market
Risk – will your product sell ?
 Liability
risk - interacting with the public.
 Being
under-insured – risk to your
financial basis.
Declaring yourself to be a business:
 Business
use of home v. Homeowners insurance.
 Valuation of your works – Property insurance.
 Natural
 Rent
disaster or theft.
or own studio space – Property insurance.
 Limitations
of Renter’s Insurance; value of
materials inventory.
 Disaster
insurance – Loss of Income Insurance or
Flood Insurance.
 Transit insurance – works going to a show.
 Also:
materials moving or being stored at multiple
locations or a worksite.
Your Health insurance – ACA
 Automobile insurance to cover business activities

Interactions with your business.
 Public
interaction – General Liability
insurance.
At
festivals, even if sponsor has Liability
insurance. Will you work at the show?
Power tools?
Coverage of your work as a temporary
display.
 Your
employees – State and Federal
regulations.
Worker’s
compensation &/or Health
insurance.
 Volunteers
working for you – Liability
insurance and Waiver.
City of Jacksonville contracts
Indemnification – Hold harmless – Defend
 Insurance requirements as of April 2015
 Must procure before and maintain for the project
duration
 Must have certificate issued to COJ and
CCGJ
 Workmen’s Compensation and Employer’s
Liability
 For employees or uncovered contractors.
 Commercial General liability insurance
 Automobile liability
 Art Floater policy or Inland Marine insurance
 Covers art or materials that typically move
between locations, say, studio to job site or
studio to festival

City of Jacksonville contracts
(continued)
 Coverage
of Rental equipment.
 Waiver of Subrogation.
 IMPORTANT to review such a clause with your
Liability insurance carrier.
 All insurance must cover specific Named Insured
in a certificate.
 Insurance coverages must be primary in nature,
not from a pool of other insurances.
 If Artist is self-insured, City must agree to the
current deductibles.
 Insurance carriers must be upstanding and
approved as such by COJ.
 Other insurance requirements may be identified
by COJ and required of Artist, depending on the
scope of the project.
Advice:
 Get
to REALLY know a good,
personable Insurance agent.
 Let
THEM get to know YOU.
 Thoroughly
analyze (on paper) how
you conduct your business.
 Artist’s
thinking v Business thinking
 Identify
impact.
YOUR areas of risk for
 Analyze
act.
potential solutions and
Acknowledgements:
- The Business of Art: Business Insurance for
Individual Artists
Posted September 10, 2013 NYFA Current via
NYFA.org
Toccara A. Holmes Thomas is Program Associate,
NYFA Source
- Sculptor Magazine
June 2004
Article by Daniel Grant
http://www.sculpture.org/documents/scmag04/june
04/web%20specials/grant.shtml
Health Insurance 101 and
the Affordable Care Act
November 2015
About This Presentation
• Designed to provide an overview of health insurance and
the Affordable Care Act (ACA).
• Consists of two primary sections:
- What is Health Insurance?
- The Affordable Care Act
• Please feel free to ask questions as we go through the
presentation.
Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.
2
What is Health Insurance?
•
•
•
•
What is Health Insurance?
Why is Health Insurance Important?
How it Works
Selecting a Health Plan
What is Health Insurance?
• Health insurance is a contract between an individual and a health
insurance company.
• When you enroll in a health plan, the insurer agrees to pay part of
your medical costs for covered services.
• After you enroll, you pay a monthly bill – called a premium – to keep
your health plan.
• Health insurance covers two types of medical costs:
When You’re Sick
Keep You Healthy
•
•
•
•
Annual physical exams
Mammograms
Prescription drugs
Other preventive services
•
•
•
•
Ambulance transportation
Hospital facility fees
Surgery
Other types of treatment
Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.
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2
Why is Health Insurance Important?
• Everyone will need to use the health care system at some point –
whether for routine care, to treat an illness, or after an accident.
• Health insurance provides you with the ability to get medical care
when you need it and protects you from high treatment costs.
• Average treatment costs for common conditions include:
• Emergency room visit (Level 1) – $610
• Surgery to repair a broken leg – $9,623
• Prenatal care and childbirth (normal delivery) – $9,526
• Hip replacement – $21,472
Cost estimates from Healthcare Bluebook using ZIP code 32246
https://healthcarebluebook.com/page_ConsumerFront.aspx
Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.
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3
How it Works
Deductible
Copayment
and/or
Coinsurance
Out-ofPocket
Maximum
A health plan includes different types of member cost-sharing when you
get medical care:
• Deductible is the dollar amount that you must pay each year before
your insurance coverage begins to pay for covered benefits
• Copayment is a fixed dollar amount you pay for medical services
• Coinsurance is the part (or percentage) you pay for services after
you meet the plan’s deductible
• Out-of-Pocket Maximum is the most you will pay for covered health
care services during your plan’s coverage period
Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.
2
4
Example of Plan Benefits
Sample of how plan benefits are displayed on www.healthcare.gov:
Annual deductibles for
medical services and
prescription drugs
Annual out-of-pocket
maximums
Copayment and
coinsurance amounts
for covered medical
services and
prescription drugs
Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.
2
5
Selecting a Health Plan
You should consider key things when reviewing health plans and
compare them in order to determine the “total cost of ownership” and
choose the health plan that best fits your needs.
Premium: The monthly amount you pay for your health plan.
In general, plans with lower premiums have higher costsharing amounts (deductibles, copayments, and coinsurance).
Member Cost-Sharing:The out-of-pocket expenses you will
pay, such as the deductible, copayments, coinsurance, and
out-of-pocket maximum.Consider these costs for care you
currently receive (office visits, prescription drugs, etc.).
Provider Network:The group of doctors, hospitals,
pharmacies, and other health care providers that are
contracted to provide services for a health plan.Your out-ofpocket costs will be lower if you see an in network provider.
Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.
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6
The Affordable Care Act (ACA)
Key ACA Provisions:
•
•
•
•
Changes in Health Plans
Essential Health Benefits
Metal Level Benefit Plans
How Premiums are Calculated
Changes in Health Plans
Health Plan Characteristics:






No denials for pre-existing conditions
Everyone who applies for coverage
must be accepted
Coverage for Essential Health
Benefits with no lifetime maximums or
annual dollar limits
Choice of plans at different cost
sharing (“metal”) levels
Premiums based on age, location of
residence, smoking status
Financial assistance based on
household income
Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.
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Essential Health Benefits (EHB)
Plans must cover these benefits with no annual or lifetime dollar limits:
Graphic Source: AHIP
Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.
29
Metal Level Benefit Plans
Four Metal Level categories of health plans are available:
Platinum
Higher Premium
Gold
Silver
Bronze
Lower Premium
• Each metal plan covers the same set of Essential Health Benefits
• A plan’s Metal Level is based on what a plan will pay, on average, for
covered services and reflects differences in cost-sharing and out-ofpocket expenses for these services
• Plans at all metal levels are available in all 67 Florida counties
Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.
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How Premiums are Calculated
The cost of a health plan depends on:
Age
• Adult rates increase with age and cannot exceed a 3:1 ratio
• Children ages 0 – 20 will have the same rate
Location
• Premium will vary based on the county the applicant lives in
• Medical costs in area directly affect premium
Tobacco Usage
• Rates may be up to 50 percent higher for tobacco users
• Tax credits do not apply to tobacco surcharge
Premiums for families will be the sum of the rate for each person
to be covered, with a cap of 3 children ages 0 – 20.
Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.
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Health Insurance Marketplace
(Individuals)
•
•
•
•
•
•
•
Marketplace Overview
Types of Financial Assistance
Advance Premium Tax Credits
How the Premium Tax Credits Work
Cost Sharing Reductions
Individual Mandate and Penalties
2016 Open Enrollment Dates
Health Insurance Marketplace Overview
Allows consumers to determine eligibility for financial assistance and
access information to evaluate and enroll in health plans.
Consumer
completes
Marketplace
application
• Consumer
provides
demographic,
income, and
dependent
information
Marketplace
makes
eligibility
determination
Consumer
enrolls in
health plan
• Marketplace
provides eligibility
results and
amount of
premium tax credit
available
• Enrollment and
tax credit
information sent
to issuer of
selected plan
Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.
33
Types of Financial Assistance
This table outlines the Federal Poverty Level (FPL) income ranges that
will qualify for financial assistance for enrollment in 2016 coverage:
Household Size
100% FPL
250% FPL
400% FPL
1
$11,770
$29,425
$47,080
2
$15,930
$39,825
$63,720
3
$20,090
$50,225
$80,360
4
$24,250
$60,625
$97,000
Each add’l person
Add $4,160
Add $10,400
Add $16,640
• Household incomes below 100% FPL do not qualify for state or
federal financial assistance to obtain health insurance coverage
• Household incomes between 100 – 400% FPL qualify for Advance
Premium Tax Credits to offset premium costs
• Household incomes between 100 – 250% FPL also qualify for Silver
plans that have Cost Share Reductions (lower out-of-pocket costs)
Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.
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Financial Assistance – Advance Premium Tax Credits
Advance Premium Tax Credits (APTCs) – also known as “subsidies” –
are available to applicants based on a combination of:
Household
Income
Subsidy based on
second-lowest cost
Silver plan in county
Cost of
Silver
Plans
Each of Florida’s 67
counties has separate
rating factors
Available for incomes
between 100 – 400% of
the Federal Poverty
Level (FPL)
Family
Size
Based on the
number and ages of
people covered
County of
Residence
Tax credits must be used to purchase coverage through the Marketplace.
Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.
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How the Premium Tax Credits Work
• The tax credits are paid directly to the insurance company each month to
offset premium costs for the health plan an individual selects.
• The insurance company then sends a monthly bill to the individual for any
balance due.
• The individual pays the insurance company any balance due.
Monthly
Premium
$218
Tax Credit
Consumer
Owes
$74
$144
Example based on a 27-year old in Duval county with an annual income of
$25,000 (214% FPL) who purchases the second lowest cost 2016 Silver plan.
Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.
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Premium Tax Credits Calculation and Reconciliation
Apply and Enroll
• Advance payment amount calculated by the Marketplace
• Amount based on next year’s projected income, family size,
and cost of second lowest cost Silver plan in the county
During the Calendar Year
• Issuer reduces premium by premium tax credit amount
• Member notifies Marketplace of income, family size changes
When Preparing Tax Return
• Tax credits are reconciled with the advance payments
• Repay IRS if income was higher than projected
• Receive tax credits if income was lower than projected
Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.
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Financial Assistance – Cost Sharing Reductions
• Certain Marketplace plans include Cost Sharing Reductions (CSRs) that
reduce out-of-pocket expenses for covered health services.
• To be eligible for these CSR plans, an individual must:
• Have a household income between 100 – 250 percent FPL
• Receive the Advance Premium Tax Credit
• Enroll in a specific Silver plan through the Marketplace
2016 Plan
Income
Deductible
1410
Over 250% FPL
Over $29,425
$6,100
OOP Max
$6,850
Primary Care
Specialist
ER
Rx
1410A
1410B
1410C
200-250% FPL
150-200% FPL
100-150% FPL
$23,540 - $29,425 $17,655 - $23,540 $11,770 - $17,655
$4,300
$0
$0
$4,500
$2,250
$950
1 visit at $0, then 2 visits at $0, then 2 visits at $0, then 2 visits at $0, then
$65 Copay
$65 Copay
$2 Copay
$1 Copay
Ded then $90
Ded then $600
$85 Copay
$600 Copay
$25 Copay
$500 Copay
$10 Copay
$100 Copay
Ded then
$30/45/160/200
$20 Generic;
Ded then
$45/150/200
$16/45/80/200
$2/5/40/75
Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.
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Individual Mandate and Penalties (Fees)
• As of 2014, individuals
who do not have health
insurance must pay a
fee
• The amount will be the
greater of a flat fee or a
percentage of income
• The fee will be phased
in from 2014 to 2016
• Exemptions exist for
individuals who meet
financial hardship
criteria
Graphic Source: UnityPoint Health
Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.
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2016 Open Enrollment Dates
For coverage beginning January 1, 2016,
your open enrollment dates vary based on
the type of coverage you enroll in:
Type of Coverage
On the Marketplace
(may include financial assistance)
Off the Marketplace
(will not include financial assistance)
Medicare
Renewal of 2015 Coverage
(On or Off the Marketplace)
Open Enrollment Dates
November 1, 2015 to
January 31, 2016
October 1, 2015 to
January 31, 2016
October 15, 2015 to
December 7, 2015
Renew by December 15, 2015
to avoid a gap in coverage
Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.
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Questions?
Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.
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Future Workshops
o
o
o
o
Finance Matters: Taxes and Banking December 1, 2015 SIGN UP TONIGHT!
Going for the Gold: Grant Writing-February 2, 2016
Sell Yourself: Professional Branding – March 1, 2016
Show Your Work: Portfolio Development – April 5, 2016