Health Insurer HealthMarkets to pay $20M settlement over violations

July 22, 2008 by · Leave a Comment
Filed under: Americas, Finance, Government, Healthcare, Insurance 

HealthMarkets, a health insurer focused on individual policies, agreed this week to pay $20 million to settle violations of insurance rules in 36 states. The fine, one of the largest of its kind, follows fines already imposed by at least seven states and lawsuits from dozens of policyholders.

Between 2000 and 2005, a handful of state regulators have been investigating the company, concerned about its communications with customers. The regulators found that HealthMarkets wasn’t training its sales agents properly, and the agents, in turn, weren’t always fully disclosing the policies’ limits to consumers. What’s more, the investigators concluded that the health plan didn’t always promptly pay for medical services.

Under the terms of the agreement, HealthMarkets need not review complaints or issue refunds, but it must establish a toll-free hotline for members who bought coverage before August 2005. The line will offer such consumers additional information about their coverage. If it doesn’t correct its practices, it could face additional fines of up to $10 million.

To learn more about the settlement:
– read this Kaiser Daily Health Policy Report item
– read the HealthMarkets press release

Four Most Important Questions To Check If Your Business Is Properly Insured

February 19, 2008 by · Leave a Comment
Filed under: Americas, Business, Insurance 

NEW YORK, February 19, 2008 — Today, businesses face greater risks than ever before. In addition to such typical risks as theft and fire, there are a host of other risks that are unique to each particular type of business. That’s why it is essential that businessowners make sure they buy the right type and amount of insurance and update their policies annually to include improvements, major purchases and increased rebuilding costs as well as any liability risks, according to the Insurance Information Institute (I.I.I.).

“One of the biggest mistakes businessowners make is that they don’t buy the right type of insurance and often have gaps in their coverage, “ said Loretta Worters, vice president, I.I.I. “Businessowners should contact their insurance agent or company representative annually to make sure that their insurance is adequate.”

A Businessowner’s Policy (BOP) is recommended for most small businesses (usually 100 employees or less), as it is often the most affordable way to obtain broad coverage. Combining both property and liability insurance, a BOP will cover your business in the event of property damage, suspended operations, lawsuits resulting from bodily injury or property damage to others, etc.

BOPs do NOT cover professional liability, auto insurance, workers compensation or health and disability insurance, however. You’ll need separate insurance policies to cover professional services, vehicles and your employees.

For medium and larger businesses, there are more comprehensive commercial policies. To properly insure your business, the I.I.I. suggests that you ask your agent or company representative these four important questions:

1. Do I have enough insurance to rebuild my business property and replace all of my merchandise and possessions?

A Building and Personal Property Coverage (BPP) policy is commonly used to cover any combination of the following three broad categories: the building, your business personal property and the personal property of others. Usually the covered building is owned by the insured. However, a lessee might insure a leased building when required to do so by the terms of the lease.

Your Business Personal Property includes seven specific categories:

  1. Furniture and fixtures
  2. Machinery and equipment
  3. Stock (i.e., merchandise held in storage, including raw materials, work in-progress and finished goods)
  4. All other personal property owned by you and used in your business
  5. Labor, materials or services furnished or arranged by you on the personal property of others
  6. If a tenant, the improvements or betterments you have made
  7. Leased personal property for which you have a contractual responsibility to insure

It is vital that the values of property are accurately reported and updated annually to reflect inflation and other increases in cost.

2. Do I have enough insurance to protect the personal property of my employees?

You will need to add Personal Effects and Property of Others coverage to your policy. This coverage permits the insured to extend up to $2,500 worth of its business personal property coverage to personal effects of the insured and its officers, partners or employees and personal property of others in the insured’s care, custody or control. The personal effects coverage does not include theft, even if theft is a covered cause of loss under the policy.

If the $2,500 limit is inadequate to cover personal property to others in the insured’s possession, a higher limit can be purchased.

3. Do I have enough insurance to keep my business open?

A business that has to close down completely while the premises are being repaired may lose out to competitors. A quick resumption of business after a disaster is essential. That’s why business interruption insurance is so important.

“Make sure the policy limits are sufficient to cover your company for more than a few days,” said Worters. “After a major disaster, it can take more time than many people anticipate to get a business back on track. There is generally a 48-hour waiting period before business interruption coverage kicks in,” she added. “Too many businessowners fail to think about how they would manage if a fire or other disaster damaged their business premises so that it was temporarily unusable.”

The price of the policy is related to the risk of a fire or other disaster damaging your premises. All other things being equal, the price would probably be higher for a restaurant than a real estate agency, for example, because of the greater risk of fire. Also a real estate agency can more easily operate out of another location.

There are typically four types of business interruption insurance. You can purchase any one of these or any combination of them that would make sense for your business:

  • Business income coverage – Compensates you for lost income if your company has to vacate its premises due to disaster-related damage that is covered under your property insurance policy. Business income insurance covers the profits you would have earned, based on your financial records, had the disaster not occurred. The policy also covers operating expenses, such as electricity, that continue even though business activities have come to a temporary halt.

    Review your annual financial records with your accountant to determine your annual net profit (total revenue minus total expenses). You should also have an approximate idea of how much profit you make (and would therefore lose) during a typical year. Purchase enough business income coverage to cover at least this amount of revenue.)

  • Extra Income Coverage – Reimburses your company for a reasonable sum of money that it spends, over and above normal operating expenses, to avoid having to shut down during the restoration period.

    In order to calculate how much extra expense coverage you will need, an appraisal of your office building or any other operating locations should be made as well as a detailed inventory, not only of your product stock but also of your existing office equipment.

  • Contingent business interruption insurance – Protects a businessowner’s earnings following physical loss or damage to the property of the insured’s suppliers or customers, as opposed to its own property. Companies today are heavily dependent on raw materials from key suppliers to make the products they sell. What happens if the supplier suffers a loss and cannot continue to deliver the product?

    Make sure to determine how much revenue would be lost if you were unable to receive your product from your main supplier or if your main customers were unable to buy from you.

4. Do I have enough insurance to protect my assets from a lawsuit?

The only way to protect your assets is to carry adequate business liability insurance. A Commercial
General Liability (CGL) insurance policy is the first line of defense against many common claims. CGL policies cover claims in four basic categories of business liability:

  • Bodily injury
  • Property damage
  • Personal injury (including slander or libel)
  • Advertising injury


In addition to covering the claims listed above, Commercial General Liability policies also cover the cost to defend or settle claims.

For more information on how to properly insure your business, access the Insurance Information Institute’s Web site at www.iii.org

INSURANCE INFORMATION INSTITUTE
Contact: Press Offices
New York: 212-346-5500; media@iii.org
Washington, D.C.: 202-833-1580