More from P&C World: CV-19 update

While we've been focused primarily on the health insurance aspect of the pandemic, we've also blogged petty extensively about Business Interruption coverage in commercial lines packages, and even noted how the P&C side of the biz is likely sheltered from catastrophic losses.

But something I hadn't seen addressed, at least until now, is the Worker's Comp issue:

Michel Leonard of @iiiorg says highest impact will be on Work Comp with exposure highest for carriers covering medical, first responders, transportation and retail. Need for greater education around policies and coverages regarding #COVID19

— National Association of Insurance Commissioners (@naic) March 20, 2020

That is, as more workers succumb to the Chinese Coronavirus while on the job. I can see this; for example:

Had to meet a relative at the ER yesterday, and while she was squadded in, I had to walk to the ER from the parking lot. I was immediately stopped by a very polite yong nurse tech(?) who took and reported my temp and asked a few health questions. Her PPE consisted of a blanket (it was a bit chilly, and the door was propped open) and a pair of latex gloves. And yet, here I waltz in, breathing (and maybe coughing?) and I'm thinking that that blanket and those gloves are no match for CV-19.

#Food4Thought

Good news, bad news: CV-19 style

The good news is that, through government action and insurance company efforts, (initial) CV-19 testing is "free" (scare quotes because, well, we all know why).

The bad news, as FoIB Sheron Sidbury notes, is less obvious:

I wonder how many people think their health insurance will pay for Corvid19 treatments. Waving a copay for the test is not the same as waving a fee for your "treatment". HDHP folks you are still on the hook. They ar only waving copays for the test.https://t.co/XHs7skx0F2

— Sheron E Sidbury (@SheronESidbury) March 19, 2020

And it gets worse: pretty much all individual plans, and not a few group ones, are built on an HMO-chassis, which means that if the only (or closest) treatment facility is out-of-network, you're outta luck.

Ouch.

Disability Insurance and CV-19

As we continue to monitor carriers' response to the pandemic, here's some helpful info from our friends at Companion Life (full discourage: CompLife is our go-to carrier for ancillary non-medical group coverage, including short- and long-term disability plans):

"If you have, or have been exposed to, COVID-19 and have been diagnosed by a certified medical professional, you can file a short-term disability claim."

Subject to waiting periods and the like.

Now, we've also been following the Business Interruption coverage issue:

"In the event of my absence, if anyone for commercial lines calls and asks if there is any business income coverage due to their business shutting down during the Coronavirus outbreak, the answer is "No"."

Okay, but what about disability coverage?

Well:

"We understand that some of our groups maybe faced with temporarily closing their doors dure to COVID-19. As an employer, if you choose to deem your employees still "actively employed" and "benefits-eligible" during that temporary closure, Companion Life will recognize those statuses."

This is similar to the Medical Mutual of Ohio stance on group plans.

It's important to note, of course,  that as with the BI issue, absent an actual "physical loss" these folks aren't 'disabled,' so aren't eligible for benefits.

On the other hand, and in keeping with current sentiments currently coming out of DC, the company is "extending the grace period for remitting premium payments."

Kudos.

Speaking of #SurpriseBilling

Out-of-network balance billing has long been a bugaboo of ours; it's part of the whole "transparency in health care" issue we've long since supported. Here, for example:

"Briefly, the issue is that there is essentially a class of providers who, although they may ply their trade inside a network-approved facility, are nonetheless not contracted with a given (or any) network."

This has became a burgeoning problem, especially since so many ObamaPlans are now on an HMO chassis (that is, very skinny networks coupled with virtually no out-of-network coverage).

But there may be a light at the end of the tunnel. Our friend tsrblke has been pushing this for at least the past year, and graciously sent us this link: :

"MemorialCare instituted a policy for physicians’ groups that provide doctors to treat patients in its hospitals: make sure those doctors are in the same insurance networks as the hospitals."

#GreatStart

[Hat Tip: FoIB tsrblke]

Anthem & CV-19

As noted yesterday, Medical Mutual of Oho seems to be the first (and thus far only) carrier to address the question of group plans and continued eligibility:

"If one person remains employed by the company and covered by the plan, e.g. the owner or a management employee, the company can continue to cover laid-off employees as long as premium is paid."

We did receive an email from UHC announcing a conference cll on the current situation, but thus far have received no written guidelines.

And Anthem just sent this:

"As our communities work through these challenging and uncertain times, our commitment to our customers and the health and safety of our communities remains our focus."

They went on to identify all the processes they've put in place regarding social distancing and the like, but nary a word on what employees (and employees) mare supposed to be doing if their company is (temporarily) shuttered.

It seems to me that these carriers have had sufficient time to craft and disseminate a policy on this, and I'm keenly disappointed that only one has seen fit to do so.

Again, we'll keep updating as appropriate.

Skype calls vs Housecalls

As more folks (and providers) turn to telemedicine as an alternative health care delivery option, especially now due to CV-19, the issue of patient privacy comes up:

"HHS ... will exercise enforcement discretion and waive penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communications technologies, such as FaceTime or Skype, during the COVID-19 emergency." https://t.co/ODkfMA9Smk

— AssocAmerPhys&Surg (@AAPSonline) March 17, 2020

I reached out to co-blogger Kelley for conformation and she responded:

"The tweet is correct, here is the information."

She also graciously attached an email from the Medical Group Management Association (MGMA), which says (in part):

"Today, the Centers for Medicare & Medicaid Services (CMS) issued guidance on Secretary Azar’s waiver authority that broadens access to Medicare telehealth services ... CMS will:

• Waive geographic restrictions, meaning patients can receive telehealth services in non-rural areas;

• Waive originating site restrictions, meaning patients can receive telehealth services in their home;

• Allow use of telephones that have audio and video capabilities"

And more. Click here for the full report.

And wash your hands:

Now what? CV-19 vs Group Health Insurance

Co-blogger Patrick has, perhaps, the quintessential COVID-19 tweet, at least as it applies to group health insurance:

A bigger fear than paying for COVID-19 testing and treatment is how do small businesses & people being laid off pay premiums for health insurance? @insureblog @MikeBertaut

— Patrick Paule (@patpaule) March 17, 2020

That is, if companies are (temporarily?) shuttered, what happens to their group plans?

And, of course, there's the question of folks with individual policies, as well, but that's a bigger can of worms.

As it is, there are a number of issues here, and answers will also depend on whether a given plan is fully or self-insured.

One of my small groups provides vending and games machines to bars, so our Governor's order closing all of those has left his company shuttered. He called to ask if he laid off all his employees (including himself), could he keep the group plan in place, and even pay the premiums for his employees?

For now, the only carrier that has given me specific, actionable guidance has been Medical Mutual of Ohio, but I'm certain that other carriers will offer the same options. For example:

"Q. My plan is fully insured. If I have to lay off my entire workforce in response to the COVID-19 crisis, can the company continue to cover those employees?

A. If one person remains employed by the company and covered by the plan, e.g. the owner or a management employee, the company can continue to cover laid-off employees as long as premium is paid. Please note that you must offer this coverage on a uniform, non-discriminatory basis. In other words, you may not choose only certain people for whom you continue to pay premium."

Typically, carriers require a minimum group size (usually at least one or two, sometimes three, employees); this seems to indicate that this requirement may be waived for the nonce. That would certainly make sense.

He also asked me what his options were if he just canceled the group for now, and we discussed some of those (generally about Short Term Medical plans, for now).

I'm going to update this post as more carriers weigh in.

[Special Thanks to FoIB Beth D]

Safety Uber Alles

Depending on the carrier, one's age and the face amount at (potential) risk, many life insurance applicants must undergo a paramedical exam (or more). This usually entails a service obtaining blood and urine specimens, taking a blood pressure reading, and the like. Given the current CV-19 situation, I wasn't surprised to receive this notice form our primary carrier:

"With the coronavirus, ExamOne has been taking precautions when performing exams for your clients.  Below is a link to their site for updates on how they are responding and implementing safeguards.  Due to the declared state of emergency requiring all non-essential businesses to close, examiners are no longer performing exams in Pennsylvania (entire state) and the San Francisco Bay area (San Francisco, San Jose, Oakland, and the surrounding counties). This is effective immediately."

And of course, that moratorium may soon extend to other states, as well.

This means that at least a few folks will gave to wait on their new policies to be underwritten.

Now, there's an interesting twist here: when one initially makes application, if one also includes a check for the first premium with that app, one is issued a "conditional binding receipt." This obligates the company during the underwriting phase, but only so far: "It provides that the applicant is covered immediately from the date of application as long as he or she passes the insurer's underwriting requirements." [emphasis in original]

One can imagine the role this little tidbit may end up playing here...

[Hat Tip: FoIB Major B]

Hunh: CV-19 testing - Covered?

So-called "excepted benefit" plans, which include Short Term and Travel Medical policies, have gotten short-shrift in the CV-19 discussion, but that may be changing (for the good). These policies, which are not ACA-compliant (NTTAWWT), may also include Coronavirus testing.

Here's why:

These plans, while exempt from federal oversight, are still generally subject to rules and reg's put forth by the individual states in which they're sold:

"In Washington state, for example, Mike Kreidler, the insurance commissioner, is requiring all health insurers in the state to cover testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes Covid-19 pneumonia, without imposing preauthorization requirements, co-payment requirements or deductibles, at least until May ."

In other words: "free."

GeoBlue, for instance, which offers ravel medical plans, "has announced that it will cover medically necessary, prescribed SARS-CoV-2 diagnostic testing at no cost to  the enrollee."

As has National General on their Short Term Medical plans.

And other carriers are also stepping up.

Kudos!

Now we just have to wait for the tests to be (more?) widely available.

Also: Wash your hands!

From the P&C Files: CV-19 Exclusions

The other day, we learned that Business Interruption coverage is unlikely to extend to business that (temporarily) close their doors while the pandemic plays out. Turns out, there's likely a few more lines of coverage that will likely exclude CV-1-related claims.

Our good friend (and P&C guru) Bill M tips us to this item:

"U.S. P&C insurers face 'limited exposures' from coronavirus"

"While the virus will undoubtedly impact the health and life insurance markets, the U.S. property & casualty (P&C) sector may emerge relatively unscathed once the pandemic subsides."

Okay, I'll bite: why is that?

Well, it comes back to something we've seen before:

"Bill taught me a new phrase, and suggested I use it whenever I'm looking at these kinds of (potential) claims: "cause of loss." That is, which circumstances are specifically covered, and which are specifically excluded."

And here's where that phrase comes into play, CV-19-wise:

"However, if a factory closes because of fears that an infected worker contaminated equipment, BI coverage could be triggered. “But even in this case,” Fitch says, “claim exposures would likely be limited by policy sub-limits.”

This is different from the situation we discussed this past Friday: in this case, there seems to be an actual physical cause; but again, even that claim will probably be limited in scope.

This would also apply, for example, to supply chain disruptions and even travel interruption plans.

We  discussed this a couple of weeks ago:

"Plans where the Cancel for Any Reason upgrade has been purchased allows travelers to decide for themselves whether to travel or cancel their trip according to the terms of the plan."

One can imagine there's been a substantial uptick in interest in those kinds of plans, but as the article notes, "the adverse impact insurers will likely face will be from a decrease in demand" as folks decide to maybe trade in a staycation for that cruise (at least for the nonce). And it doesn't have to be international travel, either:

A colleague told me the other day about a friend of his who had tickets for the A-10 (?) basketball tourney in New York. He cabbed from the airport to his hotel, checked in, and learned that the event ha been canceled. Okay, disappointing, but we'll just take in a show, right?

Ummm:

"Broadway Shuts Down: Performances Canceled Through April 12 Due to COVID-19 Pandemic"

/sigh

Now, one area where carriers may see specific exposure is event cancellation (see above). When basketball and now even golf tournaments are canceled (or postponed), there may well be valid claims, depending on what type of coverage the organizers bought (if any). For example, "if the Olympics were to be canceled, Moody’s asserts that “losses could become material for some insurers,” with industry experts estimating insurance coverage for the games to be around $2 billion."

That's a lot of gold.

Business: Interrupted (COVID-19 edition) [Updated]

[Scroll to bottom for update]

We've blogged on the subject of Business Interruption coverage before, most recently here:

"[W]hen a business must temporarily close its doors due to damage to or destruction of business property, Business Interruption insurance coverage pays for business income lost while the property is rebuilt. This coverage is intended to help keep the company in business while recovery is underway."

In that case, it was a burned up food truck, but we've also addressed weather and even civil unrest-related cases. But what about health-related ones, specifically as they may arise from businesses deciding to (temporarily?) close their doors "out of an abundance of caution?"

Well, got this from one of my P&C gurus:

"In the event of my absence, if anyone for commercial lines calls and asks if there is any business income coverage due to their business shutting down during the Coronavirus outbreak, the answer is "No"."

And why is this?

"No direct physical loss."

Which makes sense, since the physical premises haven't actually been affected.

But what if the government mandates that your business close up (at least temporarily)?

Still outta luck.

Why?

Same reason.

The key is that the coverage is tied to the physical premises, not the business itself.

Caveat: This is true at least in Ohio; as always, consult with your own agent about your specific coverage.

UPDATE: I asked my two gurus "if BI coverage doesn’t extend because no physical loss, is there some kind of policy/coverage an owner can but that would?"

Both told me no.

I did point out to a Twitter follower that perhaps such coverage might be available through a Lloyd's syndicate, but that it would likely be prohibitively expensive (especially now, in the middle of the pandemic).
[Hat Tip: FoIB Teresa S and Bill M]

COVID-19 vs Nonna & Nanno

Shot:

"It is a fact that we will have to choose [whom to treat] ...  prioritizing younger, otherwise healthy patients over older patients or those with pre-existing conditions."

So, essentially a death sentence for Italian Bubbeh's and Zaydie's.

Chaser:

"Coronavirus patients who refuse to self-isolate face murder charges in Italy"

#EmptyThreat, no?

HSA vs COVID-19

This is big:

"The Internal Revenue Service today advised that high-deductible health plans (HDHPs) can pay for 2019 Novel Coronavirus (COVID-19)-related testing and treatment, without jeopardizing their status."https://t.co/ItIWGHrpEu

— Joe Kristan (@joebwan) March 11, 2020

Here's why:

HSA-compliant health insurance plans must include certain features (and are proscribed from including others). In general, so-called first-dollar benefits are strictly prohibited. Waiving co-pays and deductibles for CV-19 testing would seem to fall into this category, so the IRS has pro-actively gone on record waiving the potential fines:

"To facilitate the nation’s response to the 2019 Novel Coronavirus (COVID-19) ... a health plan that otherwise satisfies the requirements to be a high deductible health plan (HDHP) ... will not fail to be an HDHP ... merely because the health plan provides health benefits associated with testing for and treatment of COVID-19 without a deductible, or with a deductible below the minimum deductible (self only or family) for an HDHP."

Sweet.

Promises Broken: TomTom edition

On the one hand, we had a pretty good experience with the TomTom folks a few years back:

"Over the next few days, I called tech support a number of times, and they could not have been more helpful, professional or courteous."

But that was then, and this is now; via email from "Dave @ TomTom" (likely not his real name):

"Hi there,

We have been trying to contact you [ED: NO, THEY HAVEN'T] about the end of product support for your TomTom XL IQR.

The last compatible map update for your TomTom XL IQR was released around 09/01/2018, which means your current map might be 26 months old, missing 9 map updates. Therefore, me and my colleagues here highly recommend to no longer use your beloved TomTom XL IQRand consider replacing your device."

[ed: 'me and my colleagues.' Ever heard of Grammarly®, Dave?]

I replied:

"So the contractual obligation that comes with Lifetime Map Updates (see attached) is meaningless?"
 

Why the heck would I ever consider buying another product from you?

Wow."

Naturally, that email bounced:

"Thank you for contacting TomTom Customer Care. Unfortunately we are unable to respond to any messages sent to this email address."

Because of course it did.

So, I've taken this public, in the hopes of helping others avoid my fate by purchasing a product with explicit features and promises that the company can arbitrarily decide to cease providing.

#CaveatEmptor

#CheatinTomTom

Truth in Advertising

Got a LinkedIn invite recently from a gentleman (whose identity I've redacted) asking to be added to my network:

"Hi Henry,

I’m looking to grow my community with leaders that are interested in giving their members a better healthcare experience. If you think your members deserve more while paying less, then we should connect and chat. (Don’t worry, I’m not selling health insurance!)

Thanks,
[Redacted]"

It's that last bit that caught my eye:

"Don’t worry, I’m not selling health insurance!"

Why?

Well, because he's a regional poobah for Sedera Health.

And what is Sedera health, you ask?

Well, it's a "cost sharing community" ('community' now being the more politically correct version of 'ministry,' one supposes) to which one may subscribe. As we've noted in the past, these sharing ministries/communities/whatever are ACA-compliant, and generally much less expensive than ObamaPlans (particularly for folks who don't qualify for a subsidy or cost-sharing).

What they are not, however, and as my would-be associate notes, is insurance. That's because "Members agree to share one-another’s medical expenses through an act of voluntary giving." That's very different from a government-regulated (and enforced) insurance contract.

Which is not to absolve the carriers of their various and sundry shenanigans, oft-reported here at IB. But in those cases, there are avenues of redress: arbitration, litigation, and even criminal prosecution.

Not so with these plans.

Does that make them evil (or carcinogenic, or fattening)?

Of course not!

But certainly food for thought if one is considering signing up.

About your LTCi plan and the Stock Market

As the stock market continues its roller coaster ride, this seems like a good time to remind folks about the folly of self-insuring Long Term Care expenses:

Even though her #investments are down about 20%, my mother-in-law's #longtermcare insurance policy will pay the full cost of her assisted-living facility this month just like it did last month. #bearmarket #personalfinance #RetirementPlanning

Thank you, @johnhancockusa! https://t.co/aVzSy4Nit2

— Scott A. Olson, CLTC (@LTCShop) March 10, 2020

That is, regardless of how the market does (or doesn't do), once you're on-claim, you're on-claim for the duration of your policy's benefit period.

 

On the other hand, if you've chosen to self-insure, that certainty becomes a lot less ... certain.

Just sayin'.

Laundry time (Again)

So, another two years has rolled by, and it's time to re-certify for Anti-Money Laundering. This entails a brief, but silly, online course about the perils and pitfalls, Red Flags and Due Diligence as a result of the USA Patriot Act and our government's concern about money laundering and identity theft.

Or, as a good friend puts it, a very helpful "How To" guide on the subject.

Last time out, I remarked on the apparent xenophobia suffered by the good folks who wrote the course.

This time, it's a different (but oh so timely!) political cynicism:"

"Enhanced Due Diligence

A client’s location, affiliation, or type of business may raise red flags that indicate a need for increased scrutiny. For example, regulators have identified senior political figures as individuals that require greater due diligence. This enhanced due diligence will be conducted by the carrier."

Heh.

[Emphasis added]

CMMS vs COVID-19

Via email from CMMS:

"[This past Friday], the Centers for Medicare & Medicaid Services (CMS) took additional actions to ensure America’s patients, healthcare facilities and clinical laboratories are prepared to respond to the 2019-Novel Coronavirus (COVID-19).

CMS has developed a second Healthcare Common Procedure Coding System (HCPCS) code that can be used by laboratories to bill for certain COVID-19 diagnostic tests to help increase testing and track new cases. In addition, CMS released new fact sheets that explain Medicare, Medicaid, Children’s Health Insurance Program, and Individual and Small Group Market Private Insurance coverage for services to help patients prepare as well."

This seems especially crucial given the increased risk favors faced by those on Medicare (seasoned citizens).

The agency also released 3 helpful publications:

■ Medicare Fact Sheet Highlights

■ Medicaid and Children’s Health Insurance Program (CHIP) Fact Sheet Highlights

■ Individual and Small Group Market Insurance Coverage

#Kudos!

[The entire press release is also available here]

Chilling, but #TruthWillOut

We generally don't do partisan politics here at IB, but this particular example of (inadvertent?) truth-telling is important:

Biden tells crowd he wants to increase premiums and make sure that healthcare is 'not quality, but only affordable'... pic.twitter.com/fNhtcW7kxx

— Sean Hannity (@seanhannity) March 6, 2020

"[W]e’ll make sure it’s not quality, but only affordable”

And that, in a nutshell, is the whole premise of a "Public Option" (or any "universal care" scheme, really).

But what, exactly, is the problem with a Public Option?

"The "Public Option" is a euphemism for Single Payer, the obvious end-game for the ObamaTax from the get-go. And how do we know this?"The [Obama] administration still intends to control medical costs by ... a single payer mechanism"

And there you have it: full circle.

#Medicaid4All

[Hat Tip: Mr Jones]

One step forward?

On the one hand:

"As the Board of Directors for America’s Health Insurance Plans, we are fully committed to help America’s powerful health care system meet the challenges posed by the Coronavirus strain COVID-19 ... We are taking decisive action to help prevent the spread of this disease, to ensure that people have coverage for and access to needed testing, and to help patients who are infected receive the care and treatment they need."

They go on to say that this includes coverage for diagnostic testing, as well as easing up on network issues (ie no "surprise billing"), and sharing information among different health care stakeholders (such as hospitals and physicians). It's pretty comprehensive.

But (and you knew there'd be a 'but' here, right?):

First, this is a promise from a trade group, not a specific contract waiver from any given carrier. In fact, I received an email the other day from Anthem saying that their "clinical team is actively monitoring external queries and reports from the Centers for Disease Control and Prevention to help us determine what, if any, action is necessary on our part."

And, of course, given AHIP's history, skepticism is absolutely warranted here.