This word, "accident"....

I must admit, this story (courtesy of FoIB Jeff M) surprised me:

"The family of the first known South Florida first responder to die from COVID-19 was crushed by his loss. Now, they feel like they’ve been dealt another blow, after the AIG insurance company twice denied their claim for an accidental death in the line of duty."

They were paid the face amount for his death, but for some reason think that dying of what is essentially the flu is the same as, say, getting shot or hit by a car.

Who thinks that?

Well, Deputy Shannon Bennett's brother does:

"He says the family was stunned that COVID-19 did not fall under the category of an injury or accident."

Why is this "stunning?" Would they have expected this if he'd had a heart attack or cancer?

And of course, this somehow makes AIG a villain:

"We want to make sure that any other agency that is partnering with AIG would potentially completely dismantle their relationship."

Dude, you're going to find that no carrier is going to classify such a death as "accidental."

Except, as Jeff M also notes, "How long before AIG caves to the mob?"

#CromulentPoint

Bad Boys, Bad Boys [Updated]

[Scroll down for update]

Brian Bartz, 38, of Rochester, NY, was arrested and charged by criminal complaint with wire fraud, attempted wire fraud, and aggravated identity theft. The charges carry a maximum penalty of 20 years in prison. Justice.gov

Comment: Charged but not (yet) convicted . . .

Still . . . 

over the past five years, the defendant has been employed as an insurance broker by several different life insurance companies including: the Benjamin Hollamby Agency, which sold life insurance policies on behalf of Nationwide Life Insurance Company; the Banker's Conseco Life Insurance Company; Mass Mutual Life Insurance Company; and the Lavoro Group via Mass Mutual, located in Rochester.

Five years and just now catching up with him.

Just what did this rascal allegedly do?

Bartz would submit false applications for life insurance policies to the insurance companies on behalf of individuals who were not aware of these applications. The applications included individuals' means of identification without their knowledge or consent. In order to avoid detection, the defendant used various victims' bank accounts to pay the premiums for the unauthorized policies. Between 2015 and 2020, Bartz defrauded or attempted to defraud a number of life insurance companies and dozens of investors out of more than $950,000.

Quite a busy guy.

Stay tuned for more.

UPDATE [From HGS]: The scope of this fraud is simply astounding and, as was pointed out in the comments, it's unclear how the perp agent actually profited from it. I think I might have at least a partial answer:

Depending on his level of production with the carriers, he may have been eligible for significant commission "overrides" (kind of like production bonuses). Many years ago, a friend of mine told me about a scheme that he had learned about where the agent's compensation for a case was 125% (and please forgive me if I'm fuzzy on the details, this was a long time ago). The deal was that he'd go to his clients and say "here, buy this policy an I'll give you back the entire premium, and you'll have a year's free insurance." Yes, this was illegal, unethical, immoral and likely fattening, but at least his clients knew about it.

The article also notes that at least a few of his victims made "premium payments to him directly instead of to the life insurance company with which they had or believed they had a policy."

We've seen how well that works out.

The Latest Case for Health Care Transparency

Well, health care cost transparency, anyway.

We've long been advocates of this concept; all the way back in '05, we had an exclusive interview with one of its earliest architects:

"Recently, I had the opportunity to interview Dr Dexter Campinha-Bacote, Aetna Medical Director ... this is a great example of consumer driven health care (CDHC) ... These employers asked Aetna to develop tools that their employees could use to make “better informed decisions.” One of these tools is the pilot transparency program."

Over time, I became enamored of what I named "The McDonald's Model," which was eventually manifested most explicitly by a clinic in Southern California. Again, the emphasis was on providers giving consumers the price of their services up front, just as Ronald McDonald or Burger King tell us how much that burger and fries is going to cost.

Now, FoIB Steve Downey alerts us to the latest development:

"Trump White House wins court ruling upholding plan to require insurers and hospitals to disclose prices"

Well first, good on them - it's been a slog.

Second, it will ... interesting ... to see how (if?) this is actually implemented. As it is, the ruling seems to apply only to "the actual prices for common tests and procedures," the idea being that this will encourage competition and thus lower costs. Obviously, we're all for that latter, but I remain skeptical that this will actually be the end result.

For once, I hope to be proven wrong.

[Hat Tip: FoIB Shari G]

Up, up and away (Finally!) [UPDATED]

[Scroll to bottom for update]

Our friends at Global Underwriters have some hopeful news about short-term travel trends:

1. Airlines are enacting policies to make travelers feel safe again, as well as outline security measures (I.E. testing or certification to board flights) that are being taken, in order to allow passengers back on planes.

2. There are still hundreds of thousands U.S. Citizens and Foreign Nationals stranded outside their home country.

3. Some Domestic meetings that were postponed might be moved to the fall, hopefully creating a strong fourth quarter for hotels and restaurants that were able to reopen.

4. International Travel will resume at a moderate pace depending on the country, but it will probably take 3-6 months minimum before things start to look normal again.

So it looks like, although few folks are currently traveling, that may soon change as the country continues to "open up." And it's not just the obvious things, like camping or vacations, but other, less-obvious situations:

"[V]olunteers, part-time staff and participants working at food banks, shelters, or on natural disaster response teams, etc. that are rarely covered by workers compensation policies."

These folks (or rather, their employers/sponsors) can obtain coverage via "domestic Special Risk Accident coverage to help fill in the gaps and mitigate financial exposure for the organization that they work for."

Nice!

UPDATE: Click here for even more helpful info, including Business Travel and International Travel insurance trends.

*Another* oustanding customer service experience

Here's a tip: if you're going to use your cell phone to time the burgers on your grill, best practices dictate that you remember to bring it back into the house with you when they're done.

Especially if there's rain in the forecast.

So I awoke Monday morning, bright eyed and bushy tailed, and reached for my cell phone.

Which was not where it was supposed to be.

I eventually found it next to (you guessed it) the still-open grill. Hit it with the compressed air and threw it in rice, and hoped for the best. Twenty-four hours later it turned on, and I could access notes, calendar and contacts, but couldn't charge (and thus couldn't back up) [ed: and please don't get me started on The Cloud]. My better half suggested that I call the folks at Batteries+ (which also does some cell phone repair work). After asking me some questions, they referred me to Gem City Digital (a few miles up the road). I called Gem City, described the issues, and they said "bring it on in, we have a $30 service where we take it apart, dry it out, repair any water damage and try to fix the problem. And if we can't, well, it's only $30 [which is a fair cop], And no, you don't need an appointment."

Nice!

So I headed on over, they took the phone to their workshop, and a few minutes later told me that they couldn't find any water or water damage. but that the charging port seemed to be the culprit. They hooked up a new one to check that theory, and a short time later reported that the phone was indeed charging. I asked about the cost and they said $45, which seemed more than reasonable to me.

So, a few minutes later they were ringing me up, and said the charge was $48.

Wait, what? Shouldn't that be $78 ($30 service charge plus $45 for the new charging port and tax)? "Nope, $48 is what we think is fair."

And they didn't even have a tip jar!

Highly recommended.

An interesting conundrum

Offered without comment:

What does it say about a president who improves health insurance markets when there is no political goodwill to be gained on either side? It's unprecedented. If you're in the media, it is worthy of exploration. https://t.co/VAYMMr8SyY pic.twitter.com/5CfvEF2bGW

— Greg Fann (@greg_fann) June 22, 2020

Well?

Fees, fees and more more fees....

Our friends at FlexBank remind us that the "requirement to file and pay the annual PCORI fee is just around the corner."

And just what is this PCORI fee, you wonder?

Well, it's an acronym for the Patient-Centered Outcomes Research Institute, which "funds studies that can help patients and those who care for them make better-informed healthcare choices."

Oh goody.

Anyway, the ACA requires health plans, including employers with Health Reimbursement Arrangements (HRAs) to pony up these fees each year. And they can add up, too; as FlexBank notes:

"The IRS has announced the applicable PCORI fee is $2.54 for HRA plan years ending on or after October 1, 2019 and before October 1, 2020."

While that may not seem like a lot, it adds up: the Feds estimate that upwards of 11 million folks are covered by these plans, so we're really talking about almost $28 million.

Not too shabby.

Anyway, the fee is due no later than July 31 of the calendar year immediately following the last day of your HRA plan year.

And now you know.

Queen City Trifecta

Our friends at Cincinnati Insurance also have a blog, and there are currently several noteworthy posts that  may be helpful to our readers:

■ First up, something that a lot of folks don't seem to understand about their home and the insurance thereon: the market value is not (necessarily, or even generally) the same as the replacement cost. That is, the home's value in the eyes of the realtor is going to be very different that what an insurance underwriter sees:

"Market value is the selling price on the open market — how much someone will pay for the property ... Replacement cost is the price to rebuild the house in the event of a total loss."

A distinction lost on more than a few, sometimes to their detriment come claim time.

■ Second, Spring and Summer tend to bring big-time storms, often accompanied by copious amounts of lightning. Matt Hunter brings us the latest preparation (and prevention) tips from the Insurance Information Institute.

For example:

"Before the storm:• Plan ahead when going outside, so you can get to a safe place quickly if thunderstorms develop• Know the weather patterns in your area and listen to the weather forecast for any outdoor area you plan to visit."

And lots more.

■ Finally, if you're a business owner (or key employee), there are insurance-related steps you can take to mitigate some of the risks associated with severe weather in the age of COVID:

"[P]lanning for natural disasters is an inevitable and necessary part of every disaster preparation or business continuity plan. But how effective will these plans be in the midst of the current COVID-19 pandemic?"

There's no doubt that these uncertain (but not unprecedented) times offer some unique challenges, and this post from a pair of loss control specialists has some very helpful suggestions, and some areas of concern that folks may not have considered:

"Shelters – Shelters may need to be reconfigured to accommodate social distance guidelines. Decreased occupancy rates at hotels may present a viable shelter option to maintain social distancing."

More at the link.

And speaking of Long Term Care

Yesterday we discussed the value of information gathering and the Long Term Care insurance buying process:

"While I certainly encourage my clients to be informed consumers, there's a point where that becomes "information overload," and one simply shuts down, unable to make an actual decision."

That was really about product design (and budget, of course) before actually needing care.

But a key piece that did not, in fact come up, is the cost of the care itself. And of course, that information would be quite helpful in evaluating insurance solutions, no?

Well, our friends at Mutual of Omaha have updated their Cost of Care Calculator, and are once again making it available to the general public. With it, one can search for long-term care costs by state, and even see what those costs might look like five, ten, up to twenty years in the future. Wouldn't that be nice to know?

The calculator is *here - I really encourage you to take it for a spin.

Analysis Paralysis*

Back in April, an agency client (we'll call him Mark) inquired about Long Term Care insurance (LTCi). As usual, I forwarded the link to FoIB Herman Bruns' evergreen primer on purchasing this valuable coverage.

Yesterday, I received this in email:

"Hi,

Just wanted you to know I am still here, just sidetracked with other responsibilities.

I am back to reading about LTC. 

Also I am curious about the combination policies that link together LTC and universal life [ie hybrid plans]; not sure I understand the death benefit. If I don't use the LTCi funds my heirs would receive a death benefit i.e. life insurance?  But you put a lot of money in upfront? Not sure how that compares with annual premiums.

Lots of questions. and apparently one can decide on certain components of traditional LTC.

I am almost at the time where we need to talk."

So, rather than try to answer all that via email, I called him.

The conversation ran for almost an hour, but I took away a few key points that I thought would be helpful to our readers.

First, I told Mark that, while I certainly encourage my clients to be informed consumers, there's a point where that becomes "information overload," and one simply shuts down, unable to make an actual decision.

And that would be bad.

Why?

Well, to paraphrase a dear friend:

The best LTCi plan is the one that is in force on the day you enter the nursing home.

The worst plan is the one that you never bought, and so wasn't in force when you needed it.

So ultimately, it doesn't really matter which plan you buy, as long as you make the conscious decision to either pull the trigger or self-insure.

Now, one may quibble as to which plan design represents the "best bang for the buck," and I'm happy to have that convo, as well. But the bottom lime is that a well-designed plan, that fits one's budget (both current and projected) is the goal.

It really is that simple.

(* Thanks, Jeff M!)

OffBeat BluesNews

■ First up, this item from our friends at GeoBlue (one of our travel medical plan vendors):

"The last thing you want is for one of your clients to be surprised by their coverage, or lack thereof, while living abroad ... it is important to understand options available and how pre-existing coverage may vary between competitors. Preexisting conditions may be covered from day one, pending proof of credible coverage."

This is indeed a critical point, and one that may get short shrift, especially when dealing with folks not just on a cruise or vacation, but especially those who have decided to move to a different country. Regular readers may recall the strange case of Courtney Wilson, for example.

The GeoBlue folks explain that their ex-pat plans "strive to cover as many pre-existing conditions as possible" (at a price, of course).

So, something to consider when contemplating that move abroad.

■ "Hey Alexa, what does 'co-insurance' mean?"

Yup, the hi-tech folks at Anthem are now offering a direct line from your Alexa device to a number of online services, including:

• Access to their health savings account (HSA) or health reimbursement account (HRA) balance

• Ability to check how close they are to their health plan’s deductible or out-of-pocket amounts

• Help finding definitions for more than 200 insurance terms

And more.

This can even include access to dental plan info (where applicable).

Caveat: Might want to avoid calling out "Hey Alexa, it hurts when I do this."

Just sayin'.

Clickbait Uber Alles

I am often amused by the lengths to which clickbait sites will go to generate traffic. Recently, FoIB Holly R tagged me in a Facebook post with the scary tite:

"Coronavirus survival comes with a $1.1 million, 181-page price tag"

Oh noes!

Of course, the article itself eventually belies the headline (we'll circle back to that).

Regular readers may recall the 2018 story of the "the young lad, attending a wedding reception replete with expensive (and apparently fragile) art work, who (apparently accidentally) knocked over a priceless glass statue,"and whose parents were ostensibly sued for $132,000.Of course, that tuned out to be clickbait, too:

"All the city did was file an insurance claim," Overland Park communications manager Sean Reilly told CNET ... We are NOT seeking payment from the family"

And so it is with the Coronavirus patent mentioned aboive:

"The bill is technically an explanation of charges, and because Flor has insurance including Medicare, he won’t have to pay the vast majority of it."

Oh. So not a bill.

The reason I am so amused by these is the credulity demonstrated by my fellow citizens who immediately condemn these episodes as some sort of indictment of the American health care system (which, to be sure, is far from perfect). This is because we're reluctant to have the real discussion: how much should this treatment cost? And who decides whether that patient is actually worth it?

And, of course, the post generated the usual "oh, you poor Americans, the Canadian government-run model is so much better and more efficient."

The cognitive dissonance is truly a sight to behold:

The article explicitly (if belatedly) explains that this actually ocuured under a government-run system, and one which certain policitcos have expressly advocated that we should apply to every American: Medicare.

Sheesh.

Alphabet Soup & CV-19: The Latest

From our friends at FlexBank:

"The COVID-19 relief measures and benefit plan compliance changes keep coming at a rapid pace. Recently, the IRS issued additional notices (beyond the provisions of the CARES Act and the DOL guidance released on April 29th) that further relax rules related to group health coverage and Section 125/FSA benefits."

Specifically, this news applies to an employer's POP (Premium Only Plan), also frequently (and not quite accurately) called a Section 125 Pan.

Briefly, a POP plan is what enables an employer to deduct the employees' portion of the group health insurance premium pre-tax, which generally result in decent savings for both the employer and the emnployee. The plan document is the magic wand that allows this to be considered legit by the IRS.

Oh, and what are those changes?

For example:

"Employees may make a new election to enroll in employer-sponsored health coverage on a prospective basis if the employee initially declined to elect employer-sponsored health coverage."

And there's more - click here for the whole picture.

Outstanding Vendor Service

My better half has a rather long commute to and from work, most of which is highway miles. As one might imagine, this has resulted in quite a few little chips and dings on her car's hood; last year some gravel really did quite the number on it, and we finally got around this year to having that fixed.

(We went the self-pay route on this, since it was fairly minor and it didn't seem prudent to file an insurance claim)

After getting a couple estimates from local body shops, we selected the Collision Center of Dayton.

Why them?

Well, primarily because Marty (the manager, who also did the estimate) just struck me as a genuinely honest and helpful person. He stressed how important it was that the newly-painted hood match up with the fenders (which were *not* being re-painted), and he spoke about how his "paint guy" was one of the best in the business at this sort of thing.

It also didn't hurt that his estimate was about 20% lower than the other fellows (for the same exact job).

And I also liked that he made a point at the initial appointment that, no matter who did the work, we should follow up in a month or so with a plastic shield (from another vendor altogether) to prevent this sort of thing from happening again.

We dropped her car off on Tuesday morning, assuming it'd be available for pickup this afternoon. But they actually called yesterday about noon to let me know that the car was done. Wow!

So we drove over, and the car looked beautiful, there was literally no indication that it had ever been damaged. Which was what we were promised, and they delivered. But what really stood out was something very small, but tells you everything you need to know about the pride they take in making their customers feel special: they had also cleaned the inside of her car.

We would never have expected that, and it just underscores the value they place in providing excellent customer service.

Recommended!

Can I Have Medicare Advantage AND a Medicare Supplement?

Yes, but why would you want both?

If you have an MA plan and apply for a Medigap, one of the caveats on the app states "You don't need both an MA and Medigap plan".

Of course no one ever reads those things.

That includes some agents . . .

If you have an MA plan and enroll in a PDP (Prescription Drug Plan), you are automatically disenrolled from your MA plan. But if you only buy the Medigap and forgo the drug plan, your MA plan will continue without missing a beat until YOU cancel the plan.

If you keep the MA plan your Medigap carrier will never see or pay a claim.

Essentially you are paying for worthless coverage.

Riddle Me This: A Health Insurance Premium Update

So, a few weeks ago, we noted this challenge:

"I’ve gotten $100 back from my auto insurance company because of the decrease in traffic. With health care utilization down as much as 70%, where’s my check from my health insurance company?"

At the time, we posited a few answers, and were even provided a credible rebuttal:

"Only 3% of our April claims were COVID related. And no guarantee the avoided elective procedures won’t skyrocket now. Not the same thing."

But that was then, and this is now.

A small group client just received this from Anthem:

"We continue to look for ways to provide support and financial relief to you and your employees during the COVID-19 emergency.

Shelter-in-place orders across the country have caused significant disruptions to traditional patterns of care. As a response to these challenges, we are supporting our customers by issuing you a premium credit based on your April 2020 invoice."

That is, a credit on their August premium representing 10% of what they paid in April. Is this too little too late, or simply a nice gesture acknowledging the pain we've all been experiencing? I'm in the "don't look gift horses in the mouth camp," and grateful.

#YouMakeTheCall

Clickbait or Fact: Riots and Your Health (and maybe life)

So here's a pretty relevant question:

Does your health insurance cover your expenses if you're injured in a riot?

And what, precisely, does "in" mean here?

As we learned from last week's post on homeowner's insurance, the definition of a word is often (usually? always?) relevant when we're speaking of what's covered and what's not.

Okay Henry, what's your point?

Well, FoIB Bill M sent along a link to this little item:

"One might assume that if an individual who has health insurance is injured at one of these protests, their health insurance will cover their medical expenses. But the reality is not quite as cut and dry."

And indeed, this appears to be very much the case.

In researching this post, I learned a few things, myself:

First, as usual, consulting the exclusions of a policy is generally pretty helpful in determining whether or not you have a valid claim (we'll circle back to this).

Second,the type of plan you have matters: individual versus group plans, even from the same company, may treat the issue differently (and indeed, one such carrier's individual plan has no exclusion for riot-related claims, while their group plans do).

Third, and I think this may the be the most important distinction of all: among those plans which exclude riots (and/or civil unrest), some exclude only those injuries resulting while an active participant, while others just exclude any and all riot-related expenses. This is important, as we've seen innocent folks pulled from their cars and others hit in the head by bricks thrown at them from yards away.

Oh, and what about other kinds of insurance? Well, turns out that, in general:

·         Life insurance (no longer) has no such exclusion, but Accidental Death riders may

·         Some individual disability plans do exclude riots/civil unrest, and some don't

·         Group plans seem to ...

And what about the Big Daddy, Medicare? Well, that also kinda depends. According to Kaiser Health News, "Medicare, the insurance program for people age 65 and older and people with disabilities, doesn’t have these exclusions."

BUT: Medigap policies (Supplements) typically follow Medicare's lead on what's covered or not, but that doesn't seem to be universal. For example, Viva Medicare Select Plus says:

"... the following items and services are not covered by ViVa Medicare Plus Select:47. Services required as a result of participation in a riot"

Hunh.

As usual, check with your own agent or carrier (or simply look up the exclusions in your policy itself). In this case, it really does pay to be informed.

[Special IB thanks to Brian D, Tana H, Beth D, Fred W, Michael B, Roger D, and co-blogger Bob V]

Homeowner's Heads' Up

Many of us have relatives who've been moved, for whatever length of time, into a nursing home.

Or, for estate planning purposes, put our home in a trust.

Or taken a new job in a new city three states away.

Yes, Henry, this happens all the time. What's your point?

Well:

"A couple in Georgia bought a “fixer upper” home that was being renovated by their contractor son before their occupancy began. During this three to four month period, they stayed in an apartment. Near the end of the renovation, the house suffered a $186,000 fire loss. The insurance company denied the claim under the homeowners policy."

All of these examples, both hypothetical and real-life, involve a little-known, and even lesser understood, insurance policy phrase "residence premises." And just what is "resident premises?" Well, it's typically defined as "the dwelling “where ‘you’ reside.” Okay, that seems straightforward enough, as long as we all agree on what "reside" means.

Hunh?

Well, when I leave for work in the morning on my long, arduous 6 minute commute, I may not be present in the house for the next few hours, but I still reside there. Likewise, when we take a week-long family road trip, we still technically reside there. It becomes a little fuzzier for snowbirds, but this is common enough that it's not really an issue.

As FoIB (and P&C Guru) Bill M advises, we begin to run into problems when we look at the terms terms 'occupancy' and 'ownership:'

When we assign ownership of our home to the Smith Family Trust, even though we still live (reside) there, we need to notify our insurance company, because the ownership has changed (although I would note that the risk has not, but then, one should never conflate 'common sense' with 'insurance'). When we maintain ownership, but actually move out and far away, this changes the nature of the risk, and we need to - you guessed it - notify our insurance carrier, or at least have a genuine heart-to-heart with our agent about what they advise.

What one should not do is simply pretend there's no issue or potential problem, because it's a lot easier (and cheaper) to address it before a claim and potential lawsuit.

#WordToTheWise

Sigh: Another Riot-related P&C Post

So we know that our homeowner's and business insurance policies likely cover damage from the on-going riots, but what about all those cars we've seen being bashed and burned?

Well, we reached out to FoIB (and P&C Guru) Bill M for the skinny on that:

First, this is a covered claim, assuming that you have comprehensive coverage (comp, as opposed to collision or liability), and of course subject to the deductible.

And I found this interesting: if you have rental reimbursement coverage on the vehicle, that comes into play, as well, so that you're not even further inconvenienced.

Bill also confirmed that a business auto policy would also cover this, as long as one had the aforementioned comp coverage.

If the damage appears to be minor, it may make sense to get an estimate before turning in a claim, especially oif it's under (or just over) your deductible.

Thanks, Bill!

Life insurance matters

Our friends at the Cincinnati Insurance blog have a helpful new post up answering some common questions about life insurance.

For example:

"How much do I need? What does life insurance do? How much will it cost? Where do I begin?"

As the author notes,while these are important questions, they're not particularly difficult ones, they just require a little planning and honest soul (and checkbook) searching.

Good stuff!

Our Friend and Erie Insurance doing good

We've posted before about how carriers are giving back to their clients:

"In general, insurers that represent four out of five auto insurance policies sold in the United States have offered to refund some portion of driver premiums."

But Erie's taken it up a notch, by partnering with local agents to support communities. In this case, FoIB (and resident P&C Guru) Bill M has chosen KIND (Kinds in New Directions) as his worthy cause:

"KIND is a free, inner-city, after-school and summer learning program."

As Bill explains, KIND provides young people with help and guidance with academic classes and life-skills (such as sewing and nutrition). Kudos!

If you'd like to help, just click here.