L&H: Employers Entertain Paying Individual Premiums 

Misty Baker, Life & Health Insurance Information

Employer groups are asking agents why they can’t pay for their employees’ individual premiums either on or off the exchange. Agents can easily find answers to protect their clients from making this costly mistake in several recent IRS publications.

Under IRS notice 2013-54 an employer that reimburses employees for their individual health insurance, inside or outside the Marketplace, has created an employer payment plan. An employer payment plan, according to this notice is considered to be a group health plan subject to market reforms, including the prohibition on annual limits for essential health benefits and the requirement to provide certain preventive care without cost sharing.

On May 13, 2014, the IRS issued FAQs addressing the consequences for employers that do not establish a health insurance plan for their own employees, but instead reimburse those employees for premiums they pay for health insurance. Because these employer payment plans do not comply with the ACA’s market reforms, the IRS indicated in the FAQs that these arrangements may be subject to an excise tax of $100 per day for each applicable employee ($36,500 per year, per employee) under Code section 4980D.

The notice does not reference an arrangement under which an employee may have an after-tax amount applied toward health coverage or take that amount in cash compensation. The IRS implies that the arrangement could still be subject to the $100 per day per employee excise tax penalty.

For more information on employee benefits, contact Misty Baker.

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Agencies Release Exchange-Related COBRA Guidance

Agencies Release Exchange-Related COBRA Guidance

by Christine Roberts


Recent weeks have seen the publication of several pieces of agency guidance that reflect the increasing prominence of individual coverage on the health exchanges as an alternative to continuation of group coverage under COBRA. The new guidance consists of:

  • updated model COBRA notices from the Department of Labor that describe exchange coverage as a COBRA alternative;
  • DOL proposed regulations that streamline issuance of future model COBRA notices;
  • an announcement of, and links to, the new model COBRA notices and proposed regulations, in Affordable Care Act FAQ XIX, together with guidance on other ACA issues; and
  • announcement, in a Department of Health and Human Services bulletin, of a limited special enrollment period permitting those who elected COBRA coverage under outdated election forms to drop it, between now and July 1, 2014, and enroll in coverage on a federally facilitated exchange (FFE); and
  • an FAQ published by the Centers for Medicare and Medicaid Services (CMS) Centers clarifying the circumstances under which COBRA qualified beneficiaries may switch to exchange coverage.

Each development is discussed in turn, below.

Updated COBRA Notices

On May 2, 2014, the Department of Labor, the agency responsible for COBRA notice and disclosure duties, published online updated versions of both the “general” notice (given upon initial plan eligibility), and the “election” notice (triggered by a qualifying event). The notices now expressly identify the availability of exchange coverage, including access to premium tax credits for those eligible, as an alternative to COBRA coverage. The model notices currently are posted online at the DOL website in English, and Spanish language versions will soon follow.

Proposed DOL Regulations re: COBRA Notices 

Also on May 2, 2014, the Department of Labor issued an advance copy of proposed regulations (technically, a “Notice of Proposed Rulemaking”) pursuant to which future model COBRA notices may appear in written agency guidance, including through online posting, rather than as “appendices” to proposed and final regulations published in the Federal Register. One of the stated reasons for this approach is to “eliminate confusion that may result from multiple versions of the model notices being available at different locations.” And in fact, if view the online version of DOL Technical Release 2013-02, which in May of last year announced earlier exchange-related revisions to the model COBRA election notice, the link to the model notice link now clicks through to the most recent update posted last week, rather than to the version that originally was issued with the Technical Release.

 Summary of COBRA Developments in ACA FAQ Part XIX

May 2, 2014 also saw publication online of Affordable Care Act FAQs Part XIX, of which Q&A 1 summarizes the above developments and directs readers to the new model COBRA notices and the proposed regulation.

FAQ Part XIX contains additional guidance on a number of ACA issues including cost-sharing limitations, coverage of preventive services, and Summaries of Benefits and Coverage. I will cover this new guidance soon in a separate post.

Special Enrollment Period to Transfer from COBRA to FFE Coverage

Generally, an individual may enroll him or herself in exchange coverage upon first becoming eligible for COBRA, during an exchange open enrollment period, or upon exhausting COBRA coverage. However, persons currently enrolled in COBRA may have elected to do on the basis of COBRA notices that did not identify exchange coverage as a COBRA alternative in these situations. Accordingly, on May 2, 2014 the Department of Health and Human Services issued a bulletin announcing a limited special enrollment period, lasting until July 1, 2014, during which COBRA qualified beneficiaries in states that use the Federally Facilitated Exchange or Marketplace may drop COBRA coverage and enroll on the FFE. The guidance does not mandate that state-run exchanges extend the same special enrollment period.

CMS FAQ re: Transition from COBRA to Exchange Coverage

Lastly, on April 21, 2014 the Centers for Medicare and Medicaid Services (CMS) posted an online FAQ https://www.regtap.info/faq_printe.php?id=1496 asking whether someone who voluntarily drops COBRA coverage during an exchange open enrollment period may enroll in the exchange (and, if eligible, qualify for premium tax credits). CMS made clear that this transition is possible even for someone whose COBRA has not expired, and that enrollment on the exchange is permitted any time during the year for someone whose COBRA coverage has expired. The FAQ made it clear that a qualified beneficiary whose COBRA coverage had not yet expired could not enroll in exchange coverage outside the annual exchange open enrollment period. (The next exchange open enrollment period is from November 14, 2014 to February 15, 2015.)

 Speculation as to COBRA’s Future

Against that background, some speculation as to COBRA’s future is warranted. COBRA continuation coverage, enacted in 1985, was in essence a legislative response to pricing and underwriting barriers to individual coverage that the Affordable Care Act has either eliminated (for instance, by banning pre-existing condition exclusions) or made less burdensome (for instance, through access to premium tax credits and cost sharing on the exchanges).   Without question, the health exchanges are a “disruptive technology” to the COBRA model, but COBRA continuation coverage likely will remain in some demand until such time as individual exchange coverage is comparable, in terms of provider networks and in other respects, to current group coverage.  That tipping point may not occur for some years, or even at all.      What is likely in the short term is that COBRA’s already steep adverse selection rate will continue to climb, as continuation of group coverage becomes more and more about retaining access to a broad network of healthcare providers.

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The Biggest Reason People Didn’t Sign Up For Obamacare

The top reason uninsured people didn’t enroll in coverage under Obamacare this year is they still don’t feel like they can afford health insurance, according to a new survey.

The findings in a report published by the Henry J. Kaiser Family Foundation Tuesday highlight the affordability gap facing some U.S. households, especially those with incomes near or above the income cutoff for tax credits that reduce premiums, or those who simply don’t believe health insurance is a good value.

Thirty-six percent of people without health coverage reported they looked for health insurance during the enrollment period that nominally ended March 31, but found the available plans too expensive, according to the Kaiser Family Foundation survey. Just 7 percent said they preferred to pay a tax penalty under the law’s individual mandate, rather than purchase an insurance policy. Others said they believed the mandate doesn’t apply to them, didn’t know about the mandate, or tried and failed to enroll.

obamacare affordable

Health insurance remains a costly product and the Affordable Care Act targets its financial assistance to low-income families. Tax credits to defray the cost of coveragearen’t available to households that earn more than 400 percent of the federal poverty level, which is $45,960 for a single person. The law also provides subsidies to reduce out-of-pocket costs for those who earn up to 250 percent of poverty, or $28,725 for an individual.

The tax credits provided under the Affordable Care Act are pegged to the price of the second-cheapest “silver” level plan in a person’s geographical area, and to household income. The subsidy gets smaller as income increases, so people who earn near 400 percent of poverty receive relatively little help paying for their coverage, and those who make just a little more pay full price.

The average national price for one of these benchmark silver plans is $808 a month for a household of two 40-year-olds with two minor children that earns over 400 percent of poverty, which is $94,200 for a family of four, according to a calculator on the Kaiser Family Foundation website. The same family making exactly 400 percent of poverty would be eligible for a tax credit worth $63 a month.

The vast majority of those enrolling in private insurance under Obamacare are getting help paying for their coverage. As of March 1, 83 percent of enrollees received tax credits for premiums, according to the Department of Health and Human Services.

The Kaiser Family Foundation report includes quotations from some of those surveyed that illustrate the point of view that health insurance is too costly. “What’s out there now is just unaffordable,” one respondent said. “Because I think food on the table is more important,” wrote another. Coloring those views may be a general lack of awareness about the availability of the tax credits, previous surveys have shown.

Although not addressed in the Kaiser Family Foundation poll, the largest affordability gap in health coverage is found in 24 states that didn’t adopt the Affordable Care Act’s expansion of Medicaid to more poor people after the Supreme Court made it optional for states. Those earning up to 133 percent of poverty, or $15,282 for a single person, were supposed to have access to Medicaid, while tax credits are reserved for those who earn at least poverty wages, which amounts to $11,490 for an individual. That meansthe poorest residents of those 24 states aren’t eligible for any help, so millions are expected to remain uninsured.

The Kaiser Foundation Family poll also shows a majority of Americans continue to disapprove of the Affordable Care Act, with 46 percent having an unfavorable view, compared with 38 percent holding a favorable opinion. These attitudes are closely tied to partisan affiliation, with Republicans being much more likely to disapprove and Democrats more likely to approve. A majority, however, wants Congress to improve the law, compared with more than one-third who would prefer it to be repealed and replaced with an alternative.

obamacare affordable

Despite President Barack Obama trumpeting the news this month that private insurance enrollments via the Obamacare exchanges have exceeded 8 million — or 1 million more than the highest projection from the Congressional Budget Office — the public doesn’t see it that way. Even though more than 40 percent were aware that signups had topped 8 million, nearly six out of 10 said enrollment came in below the federal government’s expectation.

obamacare affordable

Story by Jeffrey Young  at Huffington Post

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HSA Limits Will Increase for 2015

HSA Limits Will Increase for 2015


On April 23, 2014, the Internal Revenue Service (IRS) issued Revenue Procedure 2014-30, which increases limits for health savings accounts (HSAs) effective for calendar year 2015. The following HSA limits will increase for 2015:

  • Annual contribution limits for single and family coverage;
  • Maximum out-of-pocket expense limits for coverage under a high deductible health plan (HDHP); and
  • Minimum annual deductibles for coverage under an HDHP.

hsA contribution limits

For 2015, the annual HSA contribution limit for an individual with self-only coverage under an HDHP is $3,350 (up from $3,300 for 2014).

For 2015, the annual HSA contribution limit for an individual with family coverage under an HDHP is $6,650 (up from $6,550 for 2014).

hdhp Out-of-pocket expense limits

The maximum out-of-pocket expense (deductibles, copayments and other amounts, but not premiums) limit for self-only HDHP coverage for 2015 is $6,450, which is up from $6,350 for 2014.

For family HDHP coverage, the maximum out-of-pocket expense limit for 2015 is $12,900, which is up from $12,700 for 2014.

hdhp MINIMUM deductibles

For 2015, the deductibles under an HDHP must be at least $1,300 for self-only coverage (up from $1,250 for 2014) and $2,600 for family coverage (up from $2,500 for 2014).

effective date

These new limits are effective for calendar year 2015.

more information

For a copy of IRS Revenue Procedure 2014-30, see www.irs.gov/pub/irs-drop/rp-14-30.pdf.

How to Effectively Manage Enterprise Risk

According to a recent survey for the Risk & Insurance Management Society, more than half of risk professionals are using enterprise risk management (ERM) programs in their companies. Of nearly 1,100 risk managers, insurance buyers and other risk professionals that featured on the survey, 63% of respondents stated they have ‘fully or partially integrated’ ERM strategies into their risk management programs. Of course, the bigger the business, the bigger the number of risks. However, enterprise risk management is becoming increasingly popular among businesses of all shapes and sizes as it effectively ensures that risks are evaluated and avoided while any credible opportunities to achieve the company’s objectives are seized. But it’s not always easy finding the right ERM strategy for your business. By following these simple steps however, ERM can be made easy.risk reduction strategy

Determining your Objectives & Risk Appetite

Before you can go about identifying potential risks that could threaten your organization, you must address your risk appetite and outline a clear set of objectives. Determining the objectives of your ERM strategy will help you develop a philosophy towards risk management. What determines these objectives will be your organization’s risk appetite. Implementing an effective Enterprise risk management strategy is a process. You won’t be able to make changes over night. Defining your risk appetite and philosophy towards risk management should top your ERM agenda so that you can set about outlining objectives and subsequently identifying what risks you need to be wary ofs.

Identifying risks

In many ways, the identification of risks is exactly what your Risk Management Strategy is designed to do. Risk events that could negatively impact on the company and it’s objectives are the biggest consideration of the enterprise risk management process. These risks, internal and external, must be identified and assessed so that you can prepare for and protect against them. By considering factors such as likelihood and potential impact is surest way of assessing how they should be managed.

Responding to potential risk events

Once you have a clear indication of what risks may negatively impact on your business, you can go about setting out a preventative strategy, aimed at mitigating the possibility of a risk event occurring. The enterprise risk management process should not only be used as a preventative measure however, it should also give businesses the technical know-how of responding to these potential events. Some responsive measures include avoiding, accepting, sharing and reducing risks. Whichever step the company chooses to take depends entirely on the outlined objectives and risk appetite of the company.


All of the above steps would be rendered completely useless if the company’s enterprise risk management strategy was not applied at every level of the organization, on a consistent basis. Employees at every level must be trained in on the risk management plan. By applying policies and procedures that allow risk response to be effectively carried out, you can brief your entire staff on company policy with regards ERM. In order to ensure every inch of the operation is under the one roof, a strong communication strategy must exist across a company, at every level.

Once an effective enterprise risk management strategy has been established, changes will occasionally need to be made to keep the plan up to date with the constant changes within the company. Other factors such as emerging risks and reputational risk management may also impact on the ERM strategy so it is important to remain flexible and open to policy changes. First and foremost though, it is important to set out your strategy as outlined above. In doing so, you can easily ensure the protection of your Business and the safety of the brand.

Risk Management can be challenging for businesses, particularly with continuously emerging risks. By getting yourself a free risk assessment, you can protect your business against the challenges that lay ahead.


Coy Sunderman is a risk advisor specializing in risk solutions for construction businesses, oil & gas operations, manufacturers and distributors/wholesales. Coy is a Certified Work Comp Advisory and holds his CIC (Certified Insurance Counselor) designation.

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Now is a GREAT Time to Offer Identity Theft Insurance to Your Employees

identity-theft3According to the Federal Trade Commission, as many as 9 million Americans become victims of identity theft each year. Identity theft occurs when someone obtains personally identifying information, such as your name, credit card number, birth date, Social Security number, home address and bank account numbers, and then illegitimately uses this information. This unauthorized use of your personal information can result in great financial loss as the thief amasses credit card debt and tarnishes your credit rating.

Repairing the damage from identity theft can be a daunting—and financially taxing—task. After losing money to identity theft, you don’t want to spend more on the various fees and charges that accompany re-establishing your name and credit. Some employers offer identity theft insurance as a voluntary benefit that can help protect you in case you become a victim of identity theft.

What Is Identity Theft Insurance?

Identity theft insurance is designed to relieve you of the financial burden of repairing damages after your identity has been stolen. This type of insurance does not reimburse loss from theft such as stolen credit card numbers or forged bank checks, but rather prevents further loss once you have already become a victim of identity theft. Also, aside from some plans which may provide free credit monitoring, identity theft insurance does not work to prevent identity theft. Instead, identity theft coverage helps with expenses as you navigate the identity recovery process, which is useful whether or not you actually lost money to an identity thief.

What Does Identity Theft Insurance Cover?

Identity theft insurance assists you with the potentially costly and complicated process of recovering from identity theft, and most plans will cover basic expenses incurred during your identity recovery. Eligible expenses may include the following:

  • Postage and certified mailing costs
  • Phone bills
  • Photocopying charges
  • Notary and filing fees
  • Legal fees and attorney fees
  • Fees for reapplying for loans, grants or other credit lines that were denied due to identity theft
  • Lost wages due to time away from work to meet with police, confer with attorneys or engage in other recovery-related activities
  • Cost of obtaining credit bureau reports

In addition, the insurance may cover fees for a fraud specialist who can support and guide you through the recovery process, and some plans may provide their own experts to assist you.

How Does Identity Theft Insurance Work?

As a voluntary benefit offered to your employees,  premiums for identity theft insurance will likely be paid through a payroll deferral. Because the insurance is offered through you the employer, employees are likely getting a group discount on the premium.

After making a claim, the insurance company will reimburse the insured for expenses that are specified in the plan. For some plans, there may be a deductible, which is the amount you would have to pay before the insurance would start paying anything.

In addition, the coverage amount is usually limited between $10,000 and $1 million. Your insurance may have a limit for each occurrence, a limit per policy period, or both.

Having identity theft insurance can contribute to your peace of mind and give you necessary assistance should you ever become a victim of identity theft.

Dana Rostro is the Director of Employee Benefits Sales and Operations at Texas Associates Insurors. Dana is ACA certified and has helped clients develop the best strategies for their operations within the new healthcare legislation.

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Small Business Health Care Tax Credit Applications Due by 12/23/13

On Nov. 27, 2013, HHS delayed online enrollment for FF-SHOPs until November 2014.  This means that small employers can enroll directly in SHOP coverage through agents, brokers or insurers. If you plan to claim the Small Business Health Care Tax Credit, you’ll need to get an official eligibility determination from the SHOP Marketplace, which means submitting a SHOP application.  If you’re eligible, you’ll claim the tax credit when you submit your federal income tax returns for 2014. For SHOP coverage to begin on Jan. 1, 2014, HHS intends to extend the enrollment deadline to Dec. 23, 2013.

Here’s how to figure out if the company will qualify for a small business health care tax credit:


To get started, you’ll need to complete a small business SHOP application and read the Frequently Asked Questions about SHOP.

To be eligible, you must:

•  Cover at least 50 percent of the cost of single (not family) health care coverage for each of your employees.

•  You must also have fewer than 25 full-time equivalent employees (FTEs). You are probably wondering: what IS an FTE. Basically, two half-time workers (less than 30 hr/ wk) count as one FTE. That means 20 half-time employees are equivalent to 10 FTEs, which makes the number of FTEs 10, not 20.

•  Those employees must have average wages of less than $50,000 (as adjusted for inflation beginning in 2014) per year.

**Remember, you will have to purchase insurance through the SHOP Marketplace to be eligible for the credit for tax years 2014 and beyond.

How do you claim the credit?

You must use Form 8941, Credit for Small Employer Health Insurance Premiums, to calculate the credit. For detailed information on filling out this form, see the Instructions for Form 8941.

Your tax adviser / Certified Public Accountant (CPA) should be able to assist you with the preparation when the company is submitting the federal tax returns.

If you are a small business, include the amount as part of the general business credit on your income tax return.

 Also, the amount of the credit you receive works on a sliding scale. The smaller the business or charity, the bigger the credit. So if you have more than 10 FTEs or if the average wage is more than $25,000 (as adjusted for inflation beginning in 2014), the amount of the credit you receive will be less.

You will need an agent or broker to help you with your application to the SHOP. Please let us know how we can assist you.

Dana Rostro is the Director of Employee Benefits Sales and Operations at Texas Associates Insurors. Dana is ACA certified and has helped clients develop the best strategies for their operations within the new healthcare legislation.

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Planning a Foreign Trip This Holiday? Look into K&R Insurance

Kidnapping is defined as the unlawful act of stealing, carrying off or abducting someone by force or fraud, especially for use as a hostage to extract a ransom payment. What were once canstock13916519crimes perpetrated exclusively against the affluent and influential, kidnappings, abductions, unlawful detainments, illegal arrests and ransoms are happening more and more to people from all socioeconomic levels and walks of life.

Kidnapping statistics are alarming. In the U.S., for instance, there has been a significant rise in child abductions due to parental custody disputes. Internationally, surges in human trafficking and tourist hijackings have also been reported – especially in remote and unsafe parts of the world. In 2012, the following top 10 global kidnapping hot spots were identified, prompting state and federal agencies to issue travel warnings and alerts in these zones:

  • Afghanistan
  • Somalia
  • Iraq
  • Nigeria
  • Pakistan
  • Yemen
  • Venezuela
  • Mexico
  • Haiti
  • Colombia

The problems are not just isolated to the above-mentioned Nations, but are quickly spreading to more locations worldwide. Kidnapping today is big business: Extortion and ransom payments total in the multi-millions of dollars each year.

What Is Kidnap And Ransom Insurance?

Kidnap and ransom insurance provides comprehensive coverage and protection for those traveling in high-risk parts of the world. It’s designed to minimize the financial impact of these incidents on both individuals and multinational corporations.

Who’s At Risk?

Traditionally, high-profile families (famous celebrities and powerful company executives), non-government organizations and employees of corporations operating abroad are the most vulnerable, however, potentially anyone can fall victim to such crimes.

What Does Kidnap And Ransom Insurance Cover?

Kidnap and ransom insurance policies typically cover losses from monies paid for ransom, as well as reimburse the insured for other expenses related to kidnapping or extortion, such as:

  • Transit and delivery costs
  • Investigation, negotiation and recovery services
  • Accidental death or injury
  • Legal fees
  • Medical care
  • Lost wages
  • Crisis management consulting

What You Can Do To Minimize The Danger

Kidnappings, hijackings, abductions, detainments and unlawful imprisonment can happen when you least expect it. The following are some things that you can do to help lower your chances of becoming a target:

  • Avoid traveling in dangerous regions and countries
  • Be hyper-vigilant of your surroundings, both at night and during daylight hours
  • If you are living or working in hazardous areas, participate in kidnapping prevention and preparedness training.

Peace Of Mind When Traveling

Many insurance companies offer coverage to traveling employees and their families, as well as to individuals as part of a personal insurance travel package. As mentioned earlier, anyone can be vulnerable to a kidnap, ransom or extortion crime while visiting a foreign land, so it’s prudent and recommended that one be adequately protected. Discuss your particular situation with an agent or broker experienced in the kidnap and ransom insurance area so you’ll be able to enjoy peace of mind knowing you and your family are safer and more secure when far away from home.

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What Types of Insurance Do Small Businesses NEED?

????????????????????????????????????????Every year in the United States, 600,000 new businesses are started. There are many reasons people start their own small business, from a desire to be in control of their own destiny, to the passion to pursue a lifelong dream. Regardless of your reasons for starting a small business, protecting that business investment with insurance is an important part of business ownership. The right insurance will minimize the risks you face due to unexpected events, liabilities, and losses.

Types of Small Business Insurance

Liability Insurance 

The most basic type of insurance that any small business requires is liability insurance. The basic idea behind liability insurance is to protect the policy holder against lawsuits or other legal exigencies. Small-business liability insurance covers things like bodily damage or third-party property damage vis-a-vis your staff, products and services. Liability insurance is the bedrock of small business insurance because it protects your most valued assets.

Workers’ Compensation

Workers’ compensation is perhaps the second most important form of insurance to protect you and your small business. This type of insurance focuses on wage replacement and employee medical benefits in the unfortunate circumstance that a small-business employee is injured while on the job.

The important thing to bear in mind is that small-business employees, by signing up for workers’ compensation, waive the right to sue the employer for negligence vis-a-vis an injury sustained on the job. Workers’ compensation effectively indemnifies small business owners against huge payouts and/or protracted court appearances. Most states require workers’ compensation for small businesses hiring W2 workers.

Professional Liability Insurance 

Professional liability insurance, also known as errors and omissions coverage, protects small business owners against charges relating to advice given or services rendered by employees. Professional liability insurance can help lower the cost of defending the business against negligence claims in court and/or reduce the monetary damages granted in a civil lawsuit.

Small business owners in the fields of real estate, law, accounting, consulting or myriad other advice-giving professions that hire less than 500 employees should consider professional liability insurance to weather possible negligence claims. This type of insurance coverage goes beyond regular liability insurance.

Business Owner’s Policy 

This brand of small business insurance is a commercial insurance package specifically designed for small to medium-sized businesses. Business owner’s policies couple general liability insurance and property insurance into one bundled insurance coverage package. Small business owners can expect a reduced premium when purchasing business owner’s policy insurance coverage.

That said, although business owner’s policy coverage can be economical for your small business, business owner’s policies often have stringent eligibility conditions. The property insurance portion of a business owner’s policy covers things like fires, explosions and vandalism whereas the general liability side covers third-party injury or dismemberment.

Commercial Auto Insurance 

Commercial auto insurance helps protect all vehicles owned and/or used by a small business. This kind of insurance is especially handy for small businesses that use staff to transmit goods and services. Work cars, trucks and delivery vans are all indemnified against damage and collision under commercial auto insurance policies.

If your small business employees are driving their own vehicles for professional reasons, you may also want to consider non-owned auto liability to insure the company vis-a-vis an uninsured or underinsured employee.

In some instances, non-owned auto liability can be bundled with a business owner’s policy to reduce the overall cost of coverage for cash-strapped small business owners.

Beyond Basic Coverage

Some small business owners may want to consider disability, life and health insurance. While not directly related to small business operations, purchasing one or all three kinds of external coverage could prove prudent in the long run.

Randy Reynolds is the Managing Partner for Texas Associates Insurors. His knowledge and experience extends to the manufacturing and construction industries, as well as to financial services, hospitality and not-for-profit organizations.

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Higher Health Care Costs for Metabolic Syndrome Risk

metabolic syndromeMetabolic syndrome is not one specific syndrome, but a group of related syndromes which can have a negative effect on your overall health.  Generally, the phrase “metabolic syndrome” includes the conditions:

  • High blood pressure
  • High blood sugar levels
  • Bad cholesterol
  • Excess body fat around the waist (a waist circumference greater than 35” for women and 40” for men)
  • High levels of triglycerides

The presence of one or several of these conditions can greatly increase your risk for diabetes, heart disease, and stroke.

Higher Healthcare Cost

A person with metabolic syndrome will in most cases need to see the doctor more frequently and will likely need more prescriptions and medical assistance than those without the syndrome, costing insurance companies more. Because of the risks associated with metabolic syndrome, people that display some of these symptoms often pay more for insurance in anticipation of them needing more medical care than a healthy person.

The Actual Cost

Studies have shown that people suffering from only one condition of metabolic syndrome pay almost twice as much as those not dealing with this condition. Even suffering from just one facet of metabolic syndrome (such as high blood pressure) renders a person five times more likely to develop diabetes. These increased risks and costs make health care even more difficult – and expensive – to maintain for those that may need it most.

How to Afford it if you Can’t Afford it?

The best way for people with metabolic syndrome to lower the cost of health care is to attack the root of the problem and focus on changing their habits and lifestyle. Most, if not all, of the conditions associated with metabolic syndrome can be made more manageable with increased physical activity and diet change. Some specific lifestyle changes that can decrease your risk for high healthcare costs (and further health problems) include losing weight, exercising, quitting smoking, and increasing fiber intake.

Reducing Employer Healthcare Costs

Employers interested in lowering the cost of their corporate health insurance program can be proactive in creating employee wellness programs geared towards helping employees lose weight and quit smoking. Such programs have a number of benefits:

  • Losing as little as five to ten percent of your body weight can greatly decrease your risk of diabetes, heart disease and stroke. Excess fat can also cause high blood pressure because the heart must work harder and under more pressure to transfer blood to the whole body. This pressure can ultimately prove fatal.
  • Weight loss can be achieved by simply lowering calorie-intake and exercising more. Doctors recommend getting your heart rate above-average for at least 30 minutes a day to stay healthy. Whether it’s a bike ride, aerobic activity, swimming, or just a quick walk; any increase in activity will strengthen your heart and reduce fat over time.
  • In addition to all of the other side-effects of smoking, using tobacco products has been proven to raise blood pressure and increase the risk of heart disease (more so in women than men). Quitting smoking is therefore a crucial step in combating metabolic syndrome risks and inherently combating higher healthcare costs.

A good corporate wellness program will give employees the tools they need to address the underlying lifestyle issues that contribute to poor health and, in many cases, metabolic syndrome. When employees make healthy lifestyle choices, not only does the cost of providing them with healthcare decrease, their productivity also increases, making employee wellness an investment with strong ROI.

Dana Rostro is the Director of Employee Benefits Sales and Operations at Texas Associates Insurors. Dana is ACA certified and has helped clients develop the best strategies for their operations within the new healthcare legislation.

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