Earlier this year, I wrote about how the Treasury Department/IRS had taken a keen interest in stop-loss insurance as evidenced by a request for comment notice regarding PPACA code section 162 m. At issue is how stop-loss insurance figures into new tax rules mandated by the health care reform law restricting the tax deduction health insurance companies can take for compensation paid to certain employees.
More precisely, Treasury/IRS is suspicious that self-insured health plans with low attachment point stop-loss policies are really fully-insured plans in disguise. This was made clear in a meeting this week with senior Treasury Department and IRS officials when Treasury’s point person on the issue commented that “obviously products that look, smell and breathe like health insurance have our attention.”
While the audience was new the line of interrogation was not.
In meetings with HHS and DOL officials late last year in connection with the preparation of PPACA-mandated reports on self-insured group health plans, pointed questions were raised about “sham self-insurance,” which has become a popular catch phrase among the regulator class.
Of course, this suspicion did not materialize immaculately. The HHS/DOL team volunteered that they had been lead to believe that sham self-insurance is commonplace. While they did not disclose their sources, it is reasonable to believe that our friends from AHIP were among those whispering in their ears.
Getting back to the meeting this week, Treasury/IRS picked up where HHS and DOL left off although without any obvious bias. Stop-loss was clearly a new animal to them and my sense was that they were truly interested to understand it better.
Joining me was the “Seal Team Six” of stop-loss insurance experts who deftly responded to questions about low attachment point stop-loss polices by pointing out that this does fit the business model of carriers which control the vast majority of the marketplace.
As part of this discussion it was pointed out that contrary to the hype that small employers are moving to self-insurance in big numbers (and buying low attachment point policies) to avoid PPACA regulatory requirements, the facts don’t bear this out. In fact, the carrier representatives noted that that the lack of claims data is a major hurdle for companies with fewer than 100 employees for making the switch to self-insurance. They reported that the real growth in the stop-loss marketplace is actually coming from larger employers who may have not utilized stop-loss insurance in the past but are buying it now in response to unlimited lifetime limits.
Oh and by the way, the contention that there is a motivation among smaller employers to self-insure to avoid new regulatory requirements is specious because for non-grandfathered self-insured plans there really are no significant regulatory advantages.
We also highlighted the fact that states regulate stop-loss insurance separately than health insurance, PPACA regulatory guidance has acknowledged the difference, and legal precedent supports this position. All in all we made a pretty compelling case why stop-loss insurance should not be construed as health insurance.
While a contrary interpretation would create tax complications for stop-loss carriers, the broader concern is that if the IRS comes out with a new definition of stop-loss insurance this could completely disrupt the current regulatory environment.
Our audience maintained poker faces throughout the meeting (which I suppose is typical of tax people) so it was tough to get a read on how they were digesting our input. We’ll know for sure when the proposed rule comes out, but that won’t like be published for a while because the new compensation rules are not scheduled to take effect until 2013.
In the meantime, it should be instructive to those in the self-insurance industry that federal regulators are watching what is going in the marketplace. For companies pushing the envelope with “innovative” stop-loss products beware that you may be inviting negative attention.
Thursday, May 26, 2011
My Tree, Their Vehicle... Whose Insurance (Repost from 10/23/09)
About a year ago I received a call from my neighbor. He sounded as if something was wrong; “Where are you” he asked? I informed him that I was away from home at the moment but was there something I could help him with. “Yeah, you can come get your huge tree limb off my SUV!” I immediately turned around and headed home. Once I got there I saw what is pictured here in this blog post. Because of heavy winds my huge front yard tree had dropped a limb and totally smashed the top of my neighbor’s vehicle. He and I spent the whole next day cutting away at the tree limb so that we could eventually tow his car to a body shop.Now my neighbor lives next door to an insurance man so he was already well versed in whose insurance takes care of the damages to his SUV but for those of you that are not as privileged to live next to an insurance man I thought I would explain. Even though it was my tree that caused the damage my homeowner policy would not be involved in paying for the damages. In order for me to be responsible I would have to be negligent in some way but since it was an “act of God” (wind) negligence could not be pointed at me. Therefore, the coverage for the damage to his vehicle would fall under his personal auto policy. More specifically it would be his comprehensive or “other than collision” coverage. Since this coverage usually has a deductible (the amount the policy holder has to pay out of pocket before the insurance company takes care of the rest) I offered to help pay the amount he would have to pay out of pocket. I was not required to do this but since I like my neighbor and it was my tree, I felt it was the right thing to do.
There is, however, one situation that could have made the tree limb fall my fault. If for some reason my neighbor felt that my tree was unhealthy and dangerous he could compose a letter and “send receipt” a letter to me (meaning upon delivery I would have to sign a document stating I had received the letter). In the letter he would have to state that he felt my tree was in danger of falling and causing damage to his property. If that had been the case and my neighbor had sent me the letter he could have had grounds that I was negligent. This in turn would cause my homeowner policy to pay out for his damages and not his personal auto policy.
By the way, my tree is very healthy so there is no need for my neighbor to write a letter.
Saturday, May 14, 2011
Your Facebook Password
Infoworld reports potential issues with Facebook users' personal information and recommend changing your password...
"Symantec Tuesday warned that advertisers, analytic platforms, and other third parties may be able to access Facebook users' personal information using inadvertently leaked application tokens. The security company advised Facebook users to change their passwords on the social networking site in order protect their accounts from being mined.
Facebook said it has fixed a year-old flaw, reported by Symantec, that caused iframe applications to inadvertently leak access tokens. Those tokens can be used maliciously to get at users' profiles, photographs, and chats, as well as for posting messages -- which could include links to malware sites -- to their Facebook pages.
Facebook's fix, however, has only stopped the leak; the aforementioned tokens still reside in log files of third-party servers or are still being actively used by advertisers. Symantec estimated that as of April of this year, close to 100,000 applications were enabling the leakage: "We estimate that over the years, hundreds of thousands of applications may have inadvertently leaked millions of access tokens to third parties.
"Concerned Facebook users can change their Facebook passwords to invalidate leaked access tokens. Changing the password invalidates these tokens and is equivalent to 'changing the lock' on your Facebook profile," according to Symantec.
Details of how the leak works is viewable in Symantec's blog."
Thursday, May 5, 2011
Water In Your Basement?
This rain has caused one common phone call for our agency this spring, “I have water in the basement”. Whether it is a home, business or rental property, water has been finding its way into places it should not be; so what better topic to blog about today than water in your basement. The first question we are asked is whether or not it is covered. This depends on a few factors. The two main factors are the source of where the water is coming from and the type of insurance policy you have. If water is coming into your basement through window wells or other opening in your basement (excluding drains), then that would be considered a flood loss which often is not covered by your normal insurance policy. In fact, even if you had a flood policy it normally doesn’t cover contents located in parts of a building that are underground, i.e. a basement. If the water is gathering in your basement because of a sump pump failure or a backed up drain or sewer than there could be coverage, as long as you meet the second factor which is having the type of policy that covers those things. Rental property policies have the most limiting coverage for water in the basement. The main coverage you need is called “Water Back up of Sewers and Drains” and many insurance companies don’t offer that on rental properties. Commercial building insurance policies have the “Water Back up of Sewers and Drains” endorsement as an optional coverage so it just depends if you purchased that option or not if you would have coverage. Homeowners polices more often than not have the “Water Back up of Sewers and Drains” included in their basic policy but if someone tried to skimp on the premium they may have taken that coverage out.
There are a few tips that we would like to let you know about as far as dealing with such a rainy spring. First, if you don’t go to your basement very often make sure that during this time of year you do take more frequent trips for inspection purposes. If you have a sump pump, check it regularly to make sure it is functioning properly. Also, make sure that drains are clear of anything that might cause blockage.
If you do have the bad luck of finding standing water in your basement make sure to give your insurance person a call. Whether it is covered or not they would have advice as to who to call for clean up. It is a good idea to try and clean the water up as soon as you can since mold can settle in after a few days. Also, if the basement is in a commercial building that stores chemicals of any kind it might be best to stay clear from the water. The water may have caused leaked chemicals to mix and could be harmful.
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