IMA Participates in Lee National Denim Day®

You don’t fight breast cancer with a pink ribbon alone. Friday October 4th is Lee National Denim Day® - one of the largest single-day fundraisers for breast cancer.  Today gives us the chance to honor those who have been touched by breast cancer and as you all know many of us have.   Lee National Denim Day has raised over $89 Million over the past 18 years. 

 

Where your donations go…

· Access to mammograms for women in need

· helps fund national research grants that are working to find a cure

 
IMA is proud to participate in this important event. 

If you would like to make a donation to our team page, please click on the link below.   

Team Page Online Donation
 

This year there are 2.9 million people is the US that are living with a history of breast cancer.

One out of every two women with a new breast cancer diagnosis will reach out to the American Cancer Society for help and support. 

 

 

Knowing Your Fiduciary Responsibilities Under a Group Health Plan

Offering and administering a group health plan require certain actions and involve specific responsibilities.  To meet the responsibilities as plan sponsors, employers need to understand a few basic rules, specifically the Employee Retirement Income Security Act (ERISA).  ERISA sets standards of conduct for those who manage an employee benefit plan and its assets (called fiduciaries).  An ERISA-covered group health plan is an employment–based plan that provides coverage for medical care, including dental, vision and disability insurance.  
  

ERISA requires plan administrators to provide plan information to participants and beneficiaries and to submit reports to government agencies.

The following documents must be automatically provided to participants and beneficiaries.

The Summary Plan Description (SPD) – a document that is an explanation of the plan and must be comprehensive enough to apprise participants of their rights and responsibilities under the plan.  It also informs participants about the plan features and what to expect of the plan.  Among other things, the SPD must include basic information such as:

       §    Plan name, address, and contact information;

      §    What the plan benefits are;

      §    How to get the benefits; and

      §    Duties of the plan and/or employee.

More specific information must also be provided, including:

        § The plan’s claims procedure (either in the document or as a separate

           attachment);

       §    A participant’s basic rights and responsibilities under ERISA

         (model language is  provided in the SPD rules);

§  Information on any applicable premiums, cost-sharing, deductibles,

  co-payments, etc.;

§  Any caps (annual or lifetime) on benefits;

§  Procedures for using network providers (if PPO/HMO) and composition

   of network;

      §   Conditions regarding pre-certification;

 

     §   A description of plan procedures governing Qualified Medical

       

        Child Support Orders; and

 

     §   Notices and descriptions of certain rights under the Health Insurance

        

        Portability and Accountability Act (HIPAA) and other health coverage

       

        laws, described below.

This document is given to employees within 90 days after they are covered by the plan.  SPD’s must also be redistributed every 5^th year and provided within 30 days of a request.  The SPD must be current within 120 days.

The benefit summary, Summary of Benefits and Coverage (SBC) and/or Certificate of Coverage (COC) that you receive from the insurance carrier does not satisfy this requirement.  All employers must provide a Summary Plan Description to plan participants.

The Summary of Material Modification (SMM) – apprises participants and beneficiaries of material changes to the plan or to the information required to be in the SPD.  The SMM or an updated SPD for a group health plan must be provided automatically to participants within 210 days after the end of the plan year in which such material change was adopted.  However, if the changes to the plan or changes to the required information in the SPD result in a material reduction in covered services or benefits, then the SMM must be distributed no later than 60 days from the date the change was adopted.  A material reduction is any plan change that eliminates benefits, reduces benefits payable, increases premiums, deductibles, coinsurance or co-payments, reduces the service area covered by an HMO, or establishes new conditions or requirements (such as pre-authorization) for obtaining services or benefits.

A Summary Annual Report (SAR) – Outlines in narrative form the financial information in the plan’s Annual Report, the Form 5500 and is furnished annually to participants in plans that are required to file the Form 5500.  A group health plan with fewer than 100 participants that is either fully insured or self-funded (or combination of both) does not need to file an annual report.  Plans with 100 or more participants that are fully insured or self-funded (or a combination) are required to file a report.  There are penalties for failing to file required reports and for failing to provide required information to participants.

There are other provisions in ERISA, as well as other Federal and State laws that affect group health plans.  A fiduciary’s responsibilities include making sure the plan complies with ERISA, which includes the COBRA, HIPAA, and other group health plan provisions in the law.

The Affordable Care Act (ACA) provides additional protections for benefits under an employment-based group health plan.  Many of the protections are in effect now including the extension of dependent coverage until age 26, ban on lifetime limits on coverage for most benefits.  Additional protections will be effective in 2014.

Penalties for non-compliance can be costly.  There may be law suits under ERISA enforcing ERISA’s document requirements, including requiring one where none exists.  The penalty for failing to provide an SPD within 30 days from request is $110/ day.   Department of Labor audits are being performed and they have increased staff to focus on compliance.

Limiting Your Liability

With fiduciary responsibilities comes potential liability.  Fiduciaries that do not follow the standards of conduct may be personally liable.  However, in certain situations you can limit your liability.  Fiduciaries can demonstrate that they have carried out their responsibilities properly by documenting the processes used to carry out the fiduciary responsibilities.  Another way is to hire a third party administrator (TPA) to handle fiduciary functions, setting up the agreement so that the person or entity then assumes liability for those functions selected.  If an employer contracts with a TPA to manage the plan, the employer is responsible for the selection of the TPA, but is not liable for the individual decisions of that provider.  However, an employer is required to monitor the TPA periodically to assure that it is handling the plan’s administration prudently.

For more detailed information, please go to Compliance Assistance Guide… Health Benefits Coverage Under Federal Law.

 

 

 

 

 

         

 

    

 

 

 

Hurricane Sandy

It is hard to turn on the television, open a newspaper, or even look at your favorite website without seeing some news about Hurricane Sandy making its way up the east coast.  As an insurance agent, we receive a lot of alerts on disaster preparedness from the insurance companies we represent.  Here are links to a few of them, as well as links to a few non-insurance resources that are worth looking at:

American Red Cross
Download this Hurricane App:
http://www.redcross.org/mobile-apps/hurricane-app
 or search "Redcross" in the App Store.  The app provides local weather updates, shelter locations, and helps you set up an emergency plan.  Even better?  The app has options personalize weather alerts for places where your family and friends reside, and an "I'm Safe" feature that posts to social media with one click.  You can follow the American Red Cross on Twitter at @RedCross

Massachusetts Emergency Management Agency

http://www.mass.gov/eopss/agencies/mema/

MEMA also has a mobile app available here to send instant notifications about circumstances near you. 

Chubb Insurance

Preparedness for Commercial Customers

Preparedness for Personal Lines Customers

Philadelphia Insurance

Windstorm Checklist

Rainstorm Emergency Checklist

C.N.A. Insurance

ACT NOW! Emergency Preparedness Website

If you need to report a claim

Visit our Agency Website at www.imaagency.com  and click on the "Claims" tab.

Be prepared, stay safe, and have a great weekend!

Sprinklers In Action

It is common knowledge that sprinklers can help minimize fire loss.  But how much of a difference can it make? 

Below is a video of a demonstration that Affiliated FM recently conducted for guests of a Broker Engineering Forum at their research center in Connecticut. Two identical warehouse setups were created and simultaneously set ablaze.  One had an approved sprinkler system above it; the other did not. The difference in the amount of damage suffered is dramatic. 

Video courtesy of Affiliated FM/FM Global

May is Disability Awareness Month

According to the U.S. Census Bureau, 67% or 100 million American workers don’t have long term disability insurance through their employers, leaving them – and their paychecks – vulnerable.  Workers risk severe financial hardship without basic life and disability insurance. 

There are many misconceptions that drive lack of coverage.  The majority of wage earners believe they have only a 2 percent or less chance of being disabled for three months or more during their working careers.1 However, the actual odds of a worker being disabled for at least six months is 33 percent.2

One reason for this discrepancy could be what workers think causes a disability,” Koll says.  “Lifelong ailments aren’t the main cause of disabilities.  The vast majorities – 91 percent – are caused by common illnesses or health conditions such as cancer, childbirth or heart attack.3 That means many disabilities aren’t covered by workers’ compensation.”

Most workers don’t have the financial resources to sustain a hit like a disability or death, which removes your ability to maintain your family’s current standard of living.  61 percent of American workers live paycheck to paycheck.4  In a recent Colonial Life survey, 65 percent of employers said they didn’t think their employees would be able to maintain their current standard living if they were unable to work for two or three months because of an illness or accident.5

So what’s holding people back from buying?  Not all employers offer these benefits to their employees.  This is where you come in.  You as the employer can play a key role in providing access to this protection and helping your employees understand the need for coverage.  Employers can offer voluntary life and disability insurance.  Voluntary insurance plans allow employers to offer cost-effective protection at little or no direct cost to the business. 

Most carriers will handle the enrollment from beginning to end.  That means providing you with the marketing materials, meeting with the employees as a group or one-on-one and when enrollment is completed they provide you with a report of the employees that purchased a benefit and the deduction amount based on the payroll frequency.  So, what’s holding you back now? 

If you would like more information about offering voluntary life and disability insurance or to obtain a quote, please call us at (508) 753-7233 or 1-800-649-6655.  

    

1 Council for Disability Awareness Disability Divide proprietary research, March 2010.

2 Social Security Administration Fact Sheet, March 18, 2011.

3 Council for Disability Awareness, “The Disability Guide, CDA 2010 Consumer Disability Awareness         Survey,”March 2010.

4 CareerBuilder.com survey, April 2011.

5 Colonial Life insurance and disability insurance survey, October 2011.

Check on your properties

Do you have a second home? Do you have someone that checks on that home frequently? You should. Recently a clean up/restoration company came into the agency and shared some devastating photos of a home that suffered a water leak, that sat for three weeks. The mold was everywhere. Walls, ceilings, tables and chairs were covered. In all my years of being in insurance I had never seen anything like this. Please check on your properties.

Explaining the Massachusetts Auto Policy

So, you have a Massachusetts auto policy, but what does that mean?  What events does each part of the policy cover?  Hopefully, after reading this you will understand your auto policy better, and be able to determine if you should increase or enhance your coverage!

Part 1: Bodily Injury to Others

·         This coverage pays for damages to any person injured or killed by your vehicle only in an accident that happens in Massachusetts.  The limit for this coverage is a maximum of $20,000 per person and $40,000 per accident.  Injuries to you as the driver or your passengers are not covered by this coverage.  You can and should buy additional Bodily Injury to Others coverage in part 5.

Part 2: Personal Injury Protection

·         This coverage also known as PIP pays a maximum of $8,000 to you or any person who you allow to drive your vehicle, passengers, and pedestrians, regardless of fault.  PIP pays medical bills (not covered by your health insurance), replacement services, and 75% of lost wages.  A PIP deductible is available; you should discuss this deductible option with your agent.

Part 3: Bodily Injury Caused by an Uninsured Auto

·         This coverage protects you, any person you allow to drive your vehicle, household members and passengers (unless they are covered by another Massachusetts auto policy) from losses caused by an unidentified or uninsured operator.  This does not cover property damage or damage to your vehicle.

Part 4: Damage to Someone Else’s Property

·         This part of the Massachusetts auto policy pays for the damage to someone else’s personal property and the costs related to the loss of use of the property, when you, a household member, or another driver with permission to drive your vehicle causes an accident.

Part 5: Optional Bodily Injury to Others

·         Part 5, extends and increases your liability protection from part 1 up to the amount of insurance you purchase.  This coverage protects you in the event that the accident happens outside of Massachusetts, but inside the United States, its territories and possessions or Canada.  This coverage also pays for injuries to guests in vehicle as a result of an accident.

Part 6: Medical Payments

·         This covers medical expenses for you, your household members, and passengers, in excess of the PIP coverage regardless of fault in the accident.

Part 7: Collision

·         Part 7, provides coverage for damage to your vehicle, minus the deductible regardless of fault in the event of a collision. 

Part 8: Limited Collision

·         Limited collision coverage can be chosen in place of part 7 collision coverage.  This would also cover a collision, however, it will only pay if you are less than 50% at fault and the owner of the other car must be identified.

Part 9: Comprehensive

·         This coverage pays for damage or loss of your vehicle, minus the deductible, as a result of fire, theft, vandalism, and hitting an animal.  This coverage does not protect your personal property unless it is permanently installed in your vehicle.

Part 10: Substitute Transportation

·         This coverage reimburses you when your vehicle is undergoing collision or covered repairs up to the limit of coverage you chose for a temporary vehicle or transportation costs (tax, bus, train fare). 

Part 11: Towing and Labor

·         Part 11 covers towing and labor expenses up to your chosen limit (usually $50 or $100) each time your auto is disabled.  The Massachusetts auto policy will only pay for labor done at the scene to the extent that the labor was needed to get your car moving.  This does not cover the cost of repair parts.

Part 12: Bodily Injury Caused by an Underinsured Auto

·         This coverage protects you, any person you allow to drive your vehicle, household members and passengers (unless they are covered by another Massachusetts auto policy) from losses caused by an operator without enough bodily injury coverage.  Part 12 pays you up to the difference between the total amount paid from the bodily injury liability insurance covering the owner and driver of the other vehicle and the limits of your Massachusetts auto policy.