Category Archives: Employee Benefits

How Does Risk Management Create Value?

Risk management isn’t just a defensive tactic designed merely to keep something bad from happening. Effective risk management can also be constructive and encourage the creation of something positive. This positivity is a culture of value and self-awareness.

How to create value with risk management

Risk management doesn’t have to be a secondary addition to your business strategy, it can be incorporated into your overall business plan to give you direction and help you make the best decisions.

Balancing risk avoidance activities and responsibilities throughout the company makes it so that everyone is aware of what the risks are and how they are to approach them. Rather than a strategy dictated from up above, risk management becomes more of an open discussion that includes input from multiple areas. Not only is a fully comprehensive view of risk management at work in a company, it’s all-inclusive for management and employees alike.

Risk management allows for risks to become opportunities

Executives and board members are likely to have a much longer list of worries than their average employee would. Especially in the digital information age and with the popularity of social media for example, reputational risk is of real concern to many companies

Managing these types of risks, risks that have many variables, as part of your business strategy allows for large scale projects such as social media monitoring to be broken down into smaller manageable tasks and spread throughout the company. Employees can become more involved in the company’s risk management. It also potentially makes for more effective risk management if employees are encouraged to make suggestions for improvement or development.

Risk management best practice

To best understand how your risk management can bring value to your business, you need to understand how these risks can affect you. Generally they fall into four areas – strategic, operational, financial and compliance. How would your business plan get thrown off? What would loosing the use of a key piece of machinery mean to business? Often times the answers will come from those who would be directly affected by these risks, frontline staff.

Proactively managing these risks not only gives management, but all members of staff piece of mind that risks have been comprehensively assessed.

The value risk management creates can be viewed in many ways. It’s including employees of every level in the protection and management of the company. It’s tying business strategy with risks avoidance and management for efficient planning and strategizing. It’s creating opportunities for everyone to get involved and strengthening the company’s defenses against risk.

If you have risk management questions, click here to ask an expert

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Risk Assess Your Employee Benefits

When it comes to signing up for your Employee Benefits you will want to perform some level of risk assessment. Employee Benefits packages are carefully constructed by your employer and provider and are legally obliged to conform to statutory regulations so it’s unlikely they will contain a large risk. But it’s always advised that you take the time to look at your options and become acquainted with and possible long term risks and be in the position have your questions answered.

Cost of Options

Some employers offer a number of packages available at varying prices. This could include added benefits, variation in cover types or increased coverage. The affordability of the health cover your employer offers is only measured on the lowest available option, additional extras are not subject to the affordability regulations.

For this reason, you might want to take extra time to assess the cost of the your options and look at the affordability on your own terms. You may find you don’t want anything above the lowest cost option or an alternative package may be better value for your situation.

Family coverage

Some companies offer the option of family insurance coverage, but at a cost. Affordability penalties do not apply to the coverage offered to employee families, so there is no guarantee the cost of family coverage will be in line with the affordability of your self-only policy.

Compare the cost of family insurance with an outside provider against the cost of the premium through your employer. Family insurance can be very expensive; including this in your employee benefits may come at a very high price in the long term.


Employee Benefits packages differ from business to business and even within business, with different packages on offer to employees. Many packages include retirement benefits, including pensions and extended health care – but there is no standard requirement. If you have any existing plans for your retirement, look to see how your employee benefits package fits this plan or what changes might take place.

If you haven’t put any plans in place, look to see if the options available appeal to you as an outcome. If your retirement benefits don’t meet your expectations, talk to your employer about your plans or look into alternative options such as outside providers or investments for an option that suits.

Risk assessing your Employee Benefits package has a lot to do with assessing the possible long term affects on your situation. By taking the time to look at these points in the beginning, you are in a good position to bring any queries to your employer and fully understand your options.

If you have questions about Employee Benefits, ask an expert here.

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Healthcare Reform and COBRA FAQ

In 2010, health care reform became a reality with the passage of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010. The U.S. Department of Labor has issued Frequently Asked Questions on how the health care reform law affects COBRA and the COBRA premium subsidy.

Did the health care reform legislation extend the COBRA premium reduction (subsidy)? No. The new health care reform legislation, The Patient Protection and Affordable Care Act (PPACA) as amended by the Health Care and Education Reconciliation Act, did not extend the eligibility time period for the COBRA premium reduction. Eligibility for the subsidy ended May 31, 2010; however, those individuals who become eligible on or before May 31, 2010 can still receive the full 15 months as long as they remain otherwise eligible.

Certain qualifying events, or a second qualifying event during the initial period of coverage, may permit a beneficiary to receive a maximum of 36 months of coverage.

Individuals who become disabled can extend the 18 month period of continuation coverage for a qualifying event that is a termination of employment or reduction of hours. To qualify for additional months of COBRA continuation coverage, the qualified beneficiary must:

  • Have a ruling from the Social Security Administration that he or she became disabled within the first 60 days of COBRA continuation coverage (or before); and
  • Send the plan a copy of the Social Security ruling letter within 60 days of receipt, but prior to expiration of the 18-month period of coverage. If these requirements are met, the entire family qualifies for an additional 11 months of COBRA continuation coverage.

Did the health care reform legislation eliminate COBRA?
No. The new health care reform legislation, The Patient Protection and Affordable Care Act (PPACA) as amended by the Health Care and Education Reconciliation Act, did not eliminate COBRA or change the COBRA rules. See An Employee’s Guide to Health Benefits Under COBRA-The Consolidated Omnibus Budget Reconciliation Act for more information about COBRA.

How does the new health care reform legislation affect my coverage under my group health plan?
The new health care reform legislation, The Patient Protection and Affordable Care Act (PPACA) as amended by the Health Care and Education Reconciliation Act, makes many changes to employee health benefit plans. Some of the changes go into effect for the first plan year that begins on or after six months after enactment (September 23, 2010), so for calendar year plans, January 1, 2011. However, many changes do not go into effect until the first plan year beginning on or after January 1, 2014.

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Will Healthcare Reform Affect P&C Insurance Rates?

Many of the Affordable Care Act’s (ACA) major provisions take effect Jan. 1, 2014, and business owners across the country are curious about the effects that the health care changes will have on the Property & Casualty (P&C) market. Industry experts speculate that the ACA will have the greatest direct impact on medical malpractice liability insurance and workers’ compensation coverages—but whether the changes will result in higher or lower rates is still an ongoing debate.

In theory, as more people gain access to health care, the number of medical malpractice liability lawsuits could decrease because patients will be able to receive earlier treatment for medical problems, leading to better health outcomes. Similarly, as more workers have access to health care, workers’ compensation (WC) rates may also decrease.

Alternatively, some analysts express concerns that the influx of newly covered patients could exacerbate existing staffing shortages and stretch doctors and nurses too thin. This could result in a higher frequency of medical errors and potentially increase the amount of time workers must wait to receive treatment—ultimately leading to higher rates.

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Should I Buy Coverage for HIPAA?

The final rule has been issued on the Health Insurance Portability and Accountability Act. This federal law broadly covers the privacy and security of personally identifiable health information as well as the government’s ability to enforce these rules and request reports on information breaches. The final rule is intended to enhance these privacy protections and provide them with new rights to their health information.

Personal Information

The final rule in HIPAA goes a long way in protecting individuals’ right to access their personal health information and have it protected. Under the Final Rule, individuals’ rights to receive electronic copies of their health information are expanded. The final rule also goes against a 2009 proposal and prohibits most health plans from using or disclosing genetic information for underwriting purposes. Individuals are also reassured by the fact the fact that the government’s abilities to enforce these laws are enhanced in this modification of the law.

There are also changes to authorization requirements that may be needed to gather information on cases such as child immunization proof for schools and enabling access to decedent information by family members or others.

Covered Entities

The final rule in HIPAA has modified the applications of the act to make business associates of covered entities directly liable for compliance with certain Privacy and Security requirements. As well as this it requires modification and redistribution of a covered entity’s notice of privacy practices. There are also limitations imposed on the use and disclosure of protected health information for marketing purposes and prohibits the sale of this information without individual authorization.

Do I Need to Buy Liability Protection for HIPAA Claims?

From a liability perspective, it’s going to depend on the policy itself and the allegations that are made. Some directors & officers, employment practices, and fiduciary liability policies may provide coverage for certain violations of HIPAA. Some may have exclusions specifically related to HIPAA violations. Bottom line, coverage for HIPAA violations may be available, but the key lies in what allegations are made in a claim.

This final rule has done a lot to ensure the security of protected health information while also enhancing the access for the individuals involved. Covered entities are also pushed to be more responsible and hold more accountability for the delicate information in their possession. The HIPAA Final Rule heralds many changes for both the insured individual and their provider.

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Steaming Toward the ObamaCare “Train Wreck”

By Karl Rove

The Wall Street Journal
April 18, 2013

The implementation of this unpopular law is a story of missed deadlines and general bungling.

In congressional testimony last week, Health and Human Services Secretary Kathleen Sebelius blamed Republican governors for her department’s failure to create a “model exchange” where consumers could shop for health-insurance coverage in states that don’t set up their own exchange.

Nice try, but GOP governors aren’t the problem. Team Obama’s tendency to blame someone else for its shortcomings is tiresome. The Affordable Care Act requires HHS to operate exchanges in states that won’t operate their own. Since the act became law in March 2010, it has been abundantly clear that the agency would have to deploy a model exchange. It is Ms. Sebelius’s fault there isn’t one.

There is more to this failure. Even exchanges organized by Democratic and Republican governors may not be functioning by the health-law’s Oct. 1 deadline, because HHS has been slow with guidance and approvals.

Last month Gary Cohen, an official with the Centers for Medicare and Medicaid Services who oversees technology for the exchanges, told members of America’s Health Insurance Plans (a trade association) that he was “pretty nervous” about implementation. He hoped enrollment is “not a third world experience.”

Part of this problem stems from the way the law is crafted. For example, a subsidy to help small businesses provide insurance coverage while ObamaCare ramped up was so complicated and difficult to use that only 1% of its $40 billion budget was spent.

Other provisions have been poorly executed or needlessly delayed. Ms. Sebelius’s HHS has missed dozens of deadlines for major rule-making or program start dates required by the law.
For example, ObamaCare created the Small Business Health Options Programs, where small businesses could select insurance plans beginning in October with coverage starting in January. The program has been set up, but employees are offered only one plan, not a choice among many. HHS announced a full range of plans would be delayed until 2015.

Then there is President Obama’s promise that no American would be denied coverage because of a pre-existing condition. The Affordable Care Act set aside $5 billion to subsidize, through 2014, coverage for an estimated 270,000 to 350,000 people with pre-existing conditions and no insurance. So far 135,000 have been covered but the $5 billion is nearly exhausted. HHS stopped signing up people in February.

A long-term care entitlement, the so-called Class Act, turned out to be so fiscally untenable that Democratic support evaporated before its 2012 start date. The entitlement program was repealed in the December fiscal cliff deal.

Then there is the Independent Payment Advisory Board, the 15-person committee charged with reducing Medicare spending to a “target level” by 2015. Its recommendations take effect automatically unless overruled by a congressional supermajority.

By law, the board cannot “raise revenues or Medicare beneficiary premiums . . . deductibles, coinsurance, and copayments, or otherwise restrict benefits or modify eligibility criteria.” This means that the board would likely have to cut reimbursements to health providers who already receive roughly 80% of what private insurers pay for the same procedures for non-Medicare patients. This will discourage doctors from taking on Medicare patients.

The IPAB’s first recommendations are due Jan. 1, 2014 and are supposed to take effect a year after that. The president hasn’t appointed anyone to the board, and it’s unlikely he can come up with 15 nominees, get them confirmed, and have them in place to deliver recommendations in time. Maybe he plans to leave the recommendations up to the secretary of HHS, which is allowed under the health law, but that ought to concern anyone who’s seen Ms. Sebelius in action.

Or maybe the president will just let the deadline for IPAB recommendations slide. An ugly battle in 2014 over Medicare cuts proposed by a committee he appointed might rile up seniors in the midterm elections, leading to the defeat of House and Senate Democrats who voted for the law.

Still, the administration is eager to get one health-care program under way. ObamaCare provides $54 million to hire individuals and groups to facilitate enrollment when the exchanges begin this October.
There are rumblings in Washington that HHS believes more money is needed for these “navigators” or “helpers.” The House Energy and Commerce Committee wrote Ms. Sebelius this week asking what kind of groups are eligible, how they’ll be selected, what standards must they meet, how they will be trained and supervised, and what the success measures will be. This program could turn into patronage for Mr. Obama’s liberal allies such as unions and community activists.

The Affordable Care Act may be unworkable in the aggregate, but it is also dogged by incompetent implementation. Even Democrats are increasingly concerned. At a hearing on Wednesday, Sen. Max Baucus expressed his frustration about a variety of problems, including whether the health-insurance exchanges will be established on time. “I just see a huge train wreck coming down,” he told Ms. Sebelius.

A version of this article appeared April 18, 2013, on page A13 in the U.S. edition of The Wall Street Journal, with the headline: Steaming Toward the ObamaCare ‘Train Wreck’ and online at

Privacy Policy Copyright © 2013 Karl Rove & Co.
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HHS Proposes Delay to Key Aspect of SHOP Exchanges

Beginning in 2014, individuals and small employers will be able to purchase health insurance through online competitive marketplaces, or Exchanges. The Affordable Care Act (ACA) directs each state that chooses to operate an Exchange to also establish a Small Business Health Options Program (SHOP). According to the Department of Health and Human Services (HHS), the SHOP will assist eligible small employers in providing health insurance for their employees.

In addition, ACA directs HHS to establish and operate the federally-facilitated Exchange (FFE) in each state that does not establish its own Exchange. The FFE will include both individual market and SHOP components.

Small employers with up to 100 employees will be eligible to participate in the Exchanges. However, until 2016, states may limit employers’ participation in the Exchanges to businesses with up to 50 employees. Beginning in 2017, states may allow businesses with more than 100 employees to participate in the Exchanges.

On March 11, 2013, HHS issued a proposed rule that would amend some of the standards for SHOP Exchanges. Most notably, the proposed rule would create a transition policy regarding an employee’s choice of qualified health plans (QHPs) in the SHOP. The transition policy would delay implementation of the employee choice model as a requirement for all SHOPs until 2015 plan years.

At this point, the transition policy has not been finalized. However, it is a good indicator of the approach HHS intends to take with respect to implementing the SHOPs.

Functions of Shop

On March 27, 2012, HHS issued a final rule on establishment of the Exchanges. This final rule describes the minimum functions of a SHOP. The final rule provides that a SHOP must allow employers the option to offer employees all QHPs at a level of coverage chosen by the employer—bronze, silver, gold or platinum. In addition, the final rule permits SHOPs to allow a qualified employer to choose one QHP for its employees.

In a separate final rule issued in March 2013, HHS provided that the federally-facilitated SHOP (FF-SHOP) would give employers the choice of offering only a single QHP, as employers customarily do today, in addition to the choice of offering all QHPs at a single level of coverage.

Transition Policy 

In the proposed rule, HHS provides a transition policy for 2014 plan years that is intended to provide all SHOPs (both state SHOPs and the FF-SHOP) with additional time to prepare for the employee choice model.

Under the proposed transition policy, for plan years beginning on or after Jan. 1, 2014, and before Jan. 1, 2015, a state SHOP would not be required to permit qualified employers to offer their employees a choice of QHPs at a single level of coverage. However, a SHOP may decide to provide this option to employers for 2014 plan years.

In addition, for plan years beginning on or after Jan. 1, 2014, and before Jan. 1, 2015, FF-SHOPs would not allow qualified employers to offer their employees a choice of QHPs at a single level of coverage. For 2014 plan years, the FF-SHOP would assist employers in choosing a single QHP to offer their qualified employees.

According to HHS, the transition policy would increase the stability of the small group market while providing small groups with the benefits of SHOP in 2014 (for example, choice among competing QHPs and access for qualifying small employers to the small business health insurance tax credit).

The 2012 final rule also included a premium aggregation function for the SHOP that was designed to assist employers whose employees were enrolled in multiple QHPs. Because this function will not be necessary in 2014 for SHOPs that delay implementation of the employee choice model, the proposed rule would make the premium aggregation function optional for plan years beginning before Jan. 1, 2015.

Texas Associates Insurors will continue to monitor health care reform developments and will provide updated information as it becomes available.

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5 Questions Businesses Should Be Asking About Employer Shared Responsibility

Under the Affordable Care Act, employers have new responsibilities towards their employees to provide them with affordable health coverage. These Employer Shared Responsibilities have very specific guidelines – so here are 5 questions you should be asking.

How do I know if this applies to my company?

These regulations concern companies that are deemed to be large employers. This means companies employing 50 full-time employees or the equivalent in a combination of full and part-time employees are liable for Employer Shared Responsibilities and must offer affordable healthcare. If you employ fewer than 50 full-time, or equivalent, employees or already offer affordable health care, this does not apply to you.

How do I calculate whether I meet the employee threshold?

Full-time employees are considered as working a minimum 30 hours a week. Part-time employees are assumed to work half that, 15. If your employees, be it all full-time or a combination, work the equivalent hours of 50 full-time employee then you meet the threshold.

How is an employer to know that the coverage is affordable?

Affordable coverage is defined as being no more than 9.5% of an employee’s annual household income. If the employer does not know the annual household income, it must not be more than 9.5% of the annual wages paid to the employee.

What about companies close to the 50-employee threshold?

Employers can calculate their average number of employees over a six-consecutive-month period in the year and use this to determine whether or not they need to offer a health care plan. There is Transitional Relief available from an Employer Shared Responsibility payment in this case.

When is an employer liable for an Employer Shared Responsibility payment?

If an employer is found to be in breach of the Employer Shared Responsibility provisions set out by the Affordable Care Act, they are liable to make a payment. They are considered liable if they do not offer health care to their full-time employees, or the coverage offered is found to be unaffordable or not providing minimum value. If an employer is offering health care to most of their employees but one or more of their full-time employees receives a premium tax credit for enrolling in a government program, the employer is liable for a payment.

If you have more insurance questions, click here to contact an expert

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Filing Whistleblower Complaints Under the Affordable Care Act

Some very interesting information provided in a recent legislative brief from Texas Associates Insurors…

The Affordable Care Act (ACA) includes whistleblower protections for employees. Employees are protected from retaliation for reporting alleged violations of Title I of the ACA. Employees are also protected from retaliation for receiving a federal health insurance income tax credit or a cost-sharing reduction when enrolling in a qualified health plan.

The U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) published an interim final rule in the Federal Register that governs whistleblower complaints filed under Section 1558 of the ACA. The rule was effective on Feb. 27, 2013. Comments may be submitted until April 29, 2013.


The ACA contains various provisions to make health insurance more affordable and accountable to consumers. To further these goals, the ACA’s section 1558 provides protection to employees against retaliation by an employer for reporting alleged violations of Title I of the Act or for receiving a health insurance tax credit or cost-sharing reductions as a result of participating in a Health Insurance Exchange or Marketplace.

Title I includes a range of insurance company accountability requirements, such as the prohibition of lifetime limits on coverage or exclusions due to pre-existing conditions. Title I also includes requirements for certain employers. Many of the provisions in Title I are not effective until 2014.


The definitions “employer” and “employee” under this whistleblower provision are found in the Fair Labor Standards Act. Therefore, this provision prohibits retaliation by private and public sector employers.


An employer may not discharge or in any manner retaliate against an employee because he or she:

  • Provided information relating to any violation of Title I of the ACA, or any act that he or she reasonably believed to be a violation of Title I of the ACA to the employer, the federal government or a state’s attorney general;
  • Testified, assisted or participated in a proceeding concerning a violation of Title I of the ACA, (or is about to do so); or
  • Objected to, or refused to participate in, any activity that he or she reasonably believed to be in violation of Title I of the ACA.

In addition, an employer may not discharge or in any manner retaliate against an employee because he or she received a credit under section 36B of the Internal Revenue Code of 1986 or a cost-sharing reduction under section 1402 of the ACA for health coverage purchased through an Affordable Health Insurance Exchange (also known as a Health Insurance Marketplace).

If an employer takes retaliatory action against an employee because he or she engaged in any of these protected activities, the employee can file a complaint with OSHA.


An employer may not take unfavorable employment action against an employee based on the employee’s protected activity. Specifically, an employer may be found to have violated the ACA if the employee’s protected activity was a contributing factor in the employer’s decision to take unfavorable employment action against the employee.

Unfavorable employment actions may include:

  • Firing or laying off;
  • Blacklisting;
  • Demoting;
  • Denying overtime or promotion;
  • Disciplining;
  • Denying benefits;
  • Failure to hire or rehire;
  • Intimidation;
  • Making threats;
  • Reassignment affecting prospects for promotion; and
  • Reducing pay or hours of work.


Retaliation complaints must be filed within 180 days after an alleged violation of the ACA occurs. An employee who believes that he or she has been retaliated against in violation of the ACA may file a complaint with OSHA. An employee’s representative may also file a complaint on the employee’s behalf.


An employee can file an ACA complaint with OSHA by visiting or calling the local OSHA office or sending a written complaint to the closest OSHA regional or area office. Written complaints may be filed by facsimile, electronic communication, hand delivery during business hours, U.S. mail (confirmation services recommended) or other third-party commercial carrier.

The date of the postmark, facsimile, electronic communication, telephone call, hand delivery, delivery to a third-party commercial carrier or in-person filing at an OSHA office is considered the date filed. No particular form is required and complaints may be submitted in any language.

For OSHA area office contact information, please visit or call 1-800-321-OSHA (6742).

Upon receipt of a complaint, OSHA will first review it to determine whether there is a valid complaint allegation (for example, timeliness or coverage). Complaints are then investigated in accord with the statutory requirements.


If the evidence supports an employee’s claim of retaliation and a settlement cannot be reached, OSHA will issue an order requiring the employer to, as appropriate, reinstate the employee, pay back wages, restore benefits and provide other possible relief to make the employee whole.

OSHA’s findings and order become final within 30 days, unless they are appealed within that time period. After OSHA issues its findings and order, either party may request a full hearing before an administrative law judge of the Department of Labor. The administrative law judge’s decision and order may be appealed to the Department’s Administrative Review Board.

If a final agency order is not issued within 210 days from the date the employee’s complaint is filed or within 90 days after the employee receives OSHA findings, then the employee may file a complaint in the appropriate U. S. district court, with a copy provided to OSHA.


For a copy of the Affordable Care Act, the regulations (29 CFR 1984) and other information go to

For information on the Office of Administrative Law Judges procedures and case law research materials, go to and click on the link for “Whistleblower.” For information on the Affordable Care Act, go to

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Final Rule Issued on HIPAA Privacy and Security Protections

On Jan. 17, the Department of Health and Human Services (HHS) issued a final rule modifying the HIPAA Privacy, Security, Enforcement and Breach Notification Rules. The final rule is intended to enhance a patient’s privacy protections, provide individuals new rights to their health information and strengthen the government’s ability to enforce the law.

The final rule implements a number of changes to the HIPAA Rules and is made up of the following:

  • Final modifications to the HIPAA Privacy, Security and Enforcement Rules mandated by the HITECH Act, and certain other modifications to improve the Rules, which were issued as a proposed rule on July 14, 2010.
  • Final rule adopting changes to the HIPAA Enforcement Rule to incorporate the increased and tiered civil money penalty structure provided by the HITECH Act, originally published as an interim final rule on Oct. 30, 2009.
  • Final rule on Breach Notification for Unsecured Protected Health Information under the HITECH Act, which replaces the breach notification rule’s “harm” threshold with a more objective standard and supplants an interim final rule published on Aug. 24, 2009.
  • Final rule modifying the HIPAA Privacy Rule as required by the Genetic Information Nondiscrimination Act to prohibit most health plans from using or disclosing genetic information for underwriting purposes, which was published as a proposed rule on Oct. 7, 2009.
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