New OSHA Incident Reporting Rules

Effective January 1, 2017; certain employers are required to electronically submit injury and illness data that they already record on paper and retain onsite. Electronic date will enable OSHA to quickly analyze injury data and use its enforcement and assistance resources more efficiently. The data will also be available to the public. OSHA believes that allowing for public disclosure on incident reporting will encourage employers to improve on workplace safety and provide invaluable information for job seekers, customers and the general public.

The reporting requirement will be phased in over two years. The timeline depends on the number of employees, but generally speaking employers must submit information from 2016 on form 300A by July 1, 2017. The same employers will need to submit Information from 2017 using forms 300A, 300, and 301 by July 1, 2018. Beginning in 2019 and thereafter all information must be submitted by March 2.

You can view which establishments are effected by the new reporting rule by clicking here.

Understanding the Commercial General Liability Coverage Form (CGL)

The CGL (Commercial General Liability) covers companies from third party liability due to negligent acts, actual or alleged, committed by the insured or by someone working on their behalf.

There are 3 coverage sections under the Commercial General Liability policy:

Coverage A: Bodily Injury and Property Damage Liability

Coverage A provides protection against losses from the legal liability of insured’s for bodily injury or property damage to others arising out of non-professional negligent acts or for liability arising out of their premises or business operations.  Mental injuries and emotional distress can be considered bodily injuries, even in the absence of physical bodily harm.

Depending on the size and nature of the company different endorsements should be included that are not typically covered under a standard CGL policy.  Workers compensation and employment practices liability insurance are excluded but can be purchased as separate policies.  Liquor liability, professional liability and other risks may also be excluded.

Consult an insurance professional to determine which coverages are right for your type of business.

Coverage B: Personal and Advertising Injury

Personal and advertising injury liability protects an insured against liability arising out of certain offenses, such as:

  • Libel
  • Slander
  • False arrest
  • Copyright infringement
  • Malicious prosecution
  • Use of another’s advertising idea
  • Wrongful eviction, entry or invasion of privacy

Coverage C: Medical Payments

Limited coverage for medical payments includes payments for injuries sustained by a non-employee caused by an accident that takes place on the insured’s premises or when exposed to the insured’s business operations. Medical payments coverage can be triggered without legal action. This provides for prompt settlement of smaller medical claims without litigation. It is included in the CGL policy and pays for all necessary and reasonable medical, surgical, ambulance, hospital, professional nursing and funeral expenses for a person injured or killed in an accident taking place at the insured’s premises or arising from business operations. There is no defense or legal liability coverage—as there is with bodily injury and property damage (Coverage A) and personal and advertising liability (Coverage B), since coverage is provided on a no-fault basis.

Market Stabilization Final Rule Issued

On April 14, 2017, the Department of Health and Human Services (HHS) issued a market stabilization final rule under the Affordable Care Act (ACA). The final rule includes new reforms intended to help lower premiums, stabilize the individual and small group health insurance markets and increase choices for the 2018 plan year.

Specifically, the rule includes a variety of policy and operational changes to existing standards to stabilize the Exchanges, including changes to the annual open enrollment period and special enrollment periods.

Action Steps
The rule does not directly impact plans in the large group market. Instead, it aims to stabilize the individual and small group health insurance markets in light of pending changes that may be made to the ACA.
The changes made under the final rule are effective for the 2018 plan year.

Overview of the Final Rule
The market stabilization final rule for 2018 includes new reforms that are aimed at stabilizing the individual and small group health insurance markets. Specifically, this rule makes changes to:

  • Special enrollment periods;
  • The annual open enrollment period;
  • Guaranteed availability;
  • Network adequacy rules;
  • Essential community providers; and
  • Actuarial value requirements.

HHS also issued separate guidance concurrently with the final rule to update the qualified health plan (QHP) certification timeline.

Open Enrollment Period for 2018
The rule shortens the upcoming annual open enrollment period for the individual market (for the 2018 plan year). Under a previous final rule, HHS established an open enrollment period for the 2018 plan year that runs from Nov. 1, 2017, through Jan. 31, 2018. However, that final rule sets a shortened open enrollment period for the 2019 and later plan years.

Under the market stabilization final rule, this shortened open enrollment period will apply beginning with the 2018 plan year. Therefore, for the 2018 plan year, the open enrollment period will run from Nov. 1, 2017, through Dec. 15, 2017. This change is intended to align the Exchanges with the employer-sponsored insurance market and Medicare, and help lower prices by reducing adverse selection.

This shortened open enrollment period applies in all Exchanges. However, HHS recognizes that some state-based Exchanges may have operational difficulties this year in transitioning to the shorter open enrollment period. As a result, HHS notes that existing regulatory authority allows state-based Exchanges the option of supplementing the open enrollment period with a special enrollment period, as a transitional measure, to account for those operational difficulties.

Special Enrollment Period Pre-enrollment Verification
The final rule expands pre-enrollment verification of eligibility to individuals who newly enroll through special enrollment periods (SEPs) in Exchanges using the federal platform. Previously, HHS allowed individuals to self-attest eligibility for most SEPs—and to enroll in coverage without further verification of eligibility—in an effort to minimize barriers for individuals to obtain coverage. However, this practice led to abuses of SEPs, allowing individuals to enroll in coverage that they would not otherwise qualify for.

To curb these abuses, the final rule requires HHS to conduct pre-enrollment verification of eligibility for all categories of SEPs for all new consumers in all Exchanges using the platform. According to HHS, this change will help make sure that SEPs are available to all who are eligible for them, but will require individuals to submit supporting documentation—a common practice in the employer health insurance market. This is intended to help place downward pressure on premiums, curb abuses and encourage year-round enrollment.

Guaranteed Availability
The final rule also addresses potential abuses of the ACA’s “guaranteed availability” rules, which require insurers to offer coverage to any eligible consumer who applies for coverage. HHS previously interpreted this requirement to mean that an insurer cannot refuse enrollment to an individual even in cases where the individual has failed to pay outstanding premiums for any prior coverage. According to HHS, issuers have complained that some individuals are taking advantage of this provision by, for example, declining to make premium payments for coverage at the end of a benefit year, and then enrolling in new coverage for the next year, thereby avoiding having to pay outstanding premiums for the previous year’s coverage.

The final rule attempts to curb these abuses by allowing issuers to collect unpaid premiums for prior coverage before enrolling a patient in the next year’s plan with the same issuer. This is intended to incentivize patients to avoid coverage lapses.

Determining the Level of Coverage
The ACA requires QHPs offered through an Exchange to meet certain levels of actuarial value, referred to as “metal levels.” HHS regulations have allowed for a de minimis variation in the actuarial valuations used in determining the level of coverage of a plan to account for differences in actuarial estimates.

The final rule adjusts the de minimis range that is used for determining the level of coverage, allowing a variation of -4/+2 percentage points (rather than +/- 2 percentage points) for all non-grandfathered individual and small group market plans that are required to comply with actuarial value (except bronze plans, which can vary -4/+5 percentage points). As a result, the final rule provides greater flexibility to issuers in the actuarial value de minimis range to provide patients with more coverage options.

Network Adequacy
The final rule provides greater flexibility to states in the review of QHPs. Under the final rule, beginning with the 2018 plan year, HHS will defer to the states’ reviews in states with the authority and means to assess issuer network adequacy. According to HHS, states are best positioned to ensure their residents have access to high quality care networks.

Qualified Health Plan Certification Calendar
Finally, HHS issued separate guidance concurrently with the final rule to update the QHP certification calendar and the rate review submission deadlines. In light of the need for issuers to make modifications to their products and applications to accommodate the changes finalized in the market stabilization rule, the updated calendar and deadlines are intended to give additional time for issuers to develop, and states to review, form and rate filings for the 2018 plan year that reflect these changes.


Source: U.S. Department of Health and Human Services,
 Centers for Medicare & Medi



ACA Replacement Bill for Withdrawn, Now What?

In late March 2017, Republican leadership in the U.S. House of Representatives withdrew the American Health Care Act (AHCA) and were unsuccessful at replacing and repealing the Affordable Care Act (ACA).

Because the House was unable to pass the AHCA, the ACA remains current law, and employers must continue to comply with all applicable ACA provisions.

While the future of the ACA as a whole is currently unclear, some definitive changes have been made to some ACA taxes and fees for 2017. Employers should be aware of the evolving applicability of existing ACA taxes and fees so that they know how the ACA affects their bottom lines.

Changes to ACA Taxes
A federal budget bill enacted for 2016 made the following significant changes to three ACA tax provisions:

  • Delayed implementation of the ACA’s Cadillac tax for two years, until 2020
  • Imposed a one-year moratorium on the ACA’s health insurance providers fee for 2017
  • Imposed a two-year moratorium on the ACA’s medical device excise tax for 2016 and 2017

Changes to ACA Fees
In addition, the ACA’s reinsurance fees expired after 2016, although the 2016 fees will be paid in 2017. Reinsurance fees may be paid in either one lump sum or in two installments. Reinsurance fees paid in one lump sum were due in full on Jan. 15, 2017. Reinsurance fees paid in two installments are due as follows:

  • Jan. 15, 2017: Remit the first contribution amount of $21.60 per covered life.
  • Nov. 15, 2017: Remit the second contribution amount of $5.40 per covered life.

Retirement Needs are Likely Higher then You Think

  • Questioning Your Retirement Needs

    What haven’t I done yet? Clients may want to check a few items off their bucket list right away

  • What didn’t I have time for? With an additional 40-60 hours on hand per week, clients can take on projects that they never got around to like remodeling the kitchen
  • How can I say no to my kid? Children and grandchildren often account for many unexpected costs during retirement…i.e. adult children are laid off for a period of time, divorced, need a place to stay while their new home is built, failed to accumulate enough education funds, etc.

When it Rains it Pours

When it Rains it Pours

Umbrella Insurance Protection

Umbrella insurance is extra liability insurance.  It helps to protect you and your assets from major claims and big-ticket lawsuits.  An umbrella insurance policy provides liability above and beyond the limits of your insurance policies and may cover claims that are excluded by other liability policies.

No matter how hard you try to avoid them; accidents happen. If you were to cause a major auto accident involving property damage and or extensive injuries to other parties, your hard-earned assets could be at risk. The costs of the property damage, injuries to other parties, and or subsequent lawsuits add up quickly and may exceed the limits of your auto insurance in no time. It is not simply auto accidents you need to worry about. There are other types of accidents as well.   Imagine this: You’re having a graduation party and someone slips, falls, and is injured. Think you won’t be sued? Think again. In today’s society, lawsuits are common…and costly. A lawsuit has the potential to destroy your financial security, but an umbrella insurance policy may protect you.

Examples of umbrella insurance benefits include protection from the following:

  1. Significant property damage. Your standard auto insurance liability limit may be exhausted if you are at fault in an auto accident where you destroy another vehicle and/or other property.
  2. Serious bodily injury liability. Your homeowner’s insurance liability limit may be insufficient to cover medical and other costs related to a guest falling off a balcony at your home, or being bitten by your dog.
  3. Landlord liability. A tenant might file an expensive suit over an injury sustained while renting your property.
    Libel or slander. Lawsuits could result from something that you say or write about another person.
  4. Malicious prosecution. You may file a suit against someone and in turn be sued for wrongfully, or maliciously, prosecuting that individual.

The right umbrella limits for you depend on where you live, your profession and your aversion to risk. Liability coverage in home and auto policies rarely exceed $500,000, yet 13% of personal injury liability judgements and settlements are $1 million or more, according to a report, citing data from Jury Verdict Research. The amount of coverage you choose should bear some relation to your net worth.

When trying to determine the right amount of coverage to carry, consider these items:

Total Assets: Setting your umbrella limit based on your total assets will give you more protection than basing it off of your net worth. Instead of matching your liability coverage to your net worth, these advisors recommend coverage equal to the value of your assets without regard for your debts (this could help you avoid selling your home to pay a judgment if your net worth is your home equity, for example). Applying this to the example above, then, you’d want at least $500,000 of liability insurance, because the assets total $500,000. You may need an umbrella policy if your insurer’s basic liability coverage limit is less than $500,000.

Future Income: But that’s not all. If someone sues you and gets a judgment that exceeds your liability coverage, your future earnings may also be on the line, and could be garnished up to 25 percent. To address this, consider multiplying your income by five and adding that amount to your asset total. If your total household earnings are $100,000 a year and you have $500,000 in assets to protect, you may want a $1 million policy. You’d almost certainly want umbrella coverage.

Collateral Damage: Another facet of this examination is the potential damage to others. If you’ve got two teens entering college, plan to retire soon, or are supporting aging relatives, a financial wipeout could be catastrophic and possibly permanent. That’s another indication you might need to expand your liability insurance with an umbrella policy. If you’re young, single, broke, renting and healthy, losing everything you own would be terrible, but you’d probably recover eventually.

Like any insurance, an umbrella policy should bring you some peace of mind. With any luck, you’ll never have a circumstance where you need to use the coverage. But bad things do happen, and just knowing it’s there is one way of knowing you’re prepared to deal with a tragedy or accident beyond your control — at least from a financial aspect.


Pogol, Gina.  “Umbrella Insurance Policy: Because When it Rains, it Pours.” Quinstreet, Inc., February, 21 2017. Web. April 24, 2017.