Texas Connection - August 2013

More “News, Satire & Opinions for Independent Agents from Independent Agents” at www.PIATX.org

Texas Connection Affordable Care Act & Insurance Agents?

Contents OUTWIT, OUTLAST, OUTPLAY ......... 6 LEARN ABOUT THE M ARKETPLACE IN YOUR STATE ................................. 12 WHAT IS THE SHOP M ARKETPLACE? ................................................... 12 CAN I USE AN AGENT OR BROKER TO BUY HEALTH INSURANCE IN THE M ARKETPLACE? .......................... 14

DO I HAVE TO OFFER HEALTH COVERAGE TO MY EMPLOYEES? .... 16 THE GOLD BENEATH YOUR FEET .. 24 INSURANCE NEWS AND THOUGHTS ... ERROR! BOOKMARK NOT DEFINED.

Nearly half of brokers ready to exit Tarrant County United Way nabs $6M Obamacare grant The $5.9 million grant was the nation’s largest navigator grant.

Texas overall will receive $10.9 million.

The editorial content is valuable information but as always you should do your own due diligence and evaluation. The content is meant to be for informational purposes only and does NOT warrant an endorsement by the Texas Professional Insurance Agents in any form or fashion

Obamacare to pay 'navigators' $20 to $48 an hour, provide free translators Tens of thousands of health care professionals, union workers and community activists hired as "navigators" to help Americans choose Obamacare options in the Health Insurance Marketplace starting Oct. 1 will be paid up to $48 an hour, more than six times the federal minimum wage of $7.25, according to new regulations issued recently.

Texas PIA’s Texas Connection

Page 1

The 63-page rule covering navigators, drawn up by the Centers for Medicare & Medicaid Services, also said the government will provide free translators for those not fluent in English -- no matter what their native language is.

It is still not clear how many navigators will be required.

California, however, provides a hint. It wants 21,000.

That could be an expensive proposition, since every one of them must be paid a minimum of $20 an hour. According to the new regulations, navigators and assistants will earn $20 an hour, while navigator project leaders will earn $29 an hour. Navigator senior executives will be paid $48 an hour.

Continued on page 4 August, 2013

Solutions for Very Hard-to-Place Risks An Excess and Surplus Lines Carrier 1-800-257-5590 www.primeis.com

More “News, Satire & Opinions for Independent Agents from Independent Agents” at www.PIATX.org

Obamacare Navigators Continued from page 1 The rules allow navigators to come from the ranks of unions, health providers and community action groups such as ACORN and Planned Parenthood. They are required to provide unbiased advice.

Navigators are only required to complete 30 hour online Federal training and certification unless your state Insurance Commissioner was successful in passing legislation that requires Navigators to undergo statespecific licensure and criminal background checks.

Georgia’s Insurance Commissioner Ralph Hudgens was successful. Louisiana Insurance Commissioner Jim Donelon was not.

Navigators are not required to have an Insurance Agency License nor carry E&O Insurance.

Should they be required to be licensed?

Not according to the NAIC. The National Association of Insurance Commissioners’ “Producer Licensing Model Act” requires people to be licensed if they “sell, solicit, or negotiate” insurance. [i] “Negotiate” is defined as offering advice about a particular contract of insurance by someone who “sells insurance or obtains insurance from insurers for purchasers.” People who provide general information about insurance but are not paid commissions are not required to be licensed, under the NAIC model.

The Marketplace will also tell you if you qualify for free or low-cost coverage available through Medicaid or the Children's Health Insurance Program (CHIP).

The Health Insurance Marketplace is sometimes known as the health insurance "exchange."

You can apply for Marketplace coverage three ways: online, by mail, or in-person with the help of a Navigator or other qualified helper. Telephone help and online chat will be available 24/7 to help you complete your application.

Open enrollment starts October 1, 2013. Plans and prices will be available then. Coverage starts as soon as January 1, 2014.

In-Person Assistance in the Health Insurance Marketplace Starting October 1, 2013, consumers in all states will be able to choose new affordable health insurance options through a new Health Insurance Marketplace.

Some states are setting up a State-based Marketplace, other states will work with the federal government in a State Partnership Marketplace and the remaining states will have a Federally-facilitated Marketplace.

No matter what state they live in, consumers can get help as they apply for and choose new insurance options. You can help provide that assistance in a number of different ways: by becoming Navigators, inperson assistance personnel, or certified application counselors. In addition, agents and brokers can also help consumers enroll in new insurance options.

NAVIGATORS

What is the Health Insurance Marketplace?

The Marketplace is a new way to find health coverage that fits your budget and meets your needs.

With one application, you can see all your options and enroll.

What you'll learn when you apply in the Health Insurance Marketplace When you use the Health Insurance Marketplace, you'll fill out an application and see all of the health plans available in your area. You'll find out if you can get lower costs on your monthly premiums for private insurance plans. You'll learn if you qualify for lower out-of-pocket costs.

Texas PIA’s Texas Connection Page 4

Navigators have a vital role in helping consumers prepare electronic and paper applications to establish eligibility and enroll in coverage through the Marketplaces and potentially qualify for an insurance affordability program. They will also provide outreach and education to raise awareness about the Marketplace, and will refer consumers to health insurance ombudsman and consumer assistance programs when necessary. Navigators will play a role in all types of Marketplaces, be funded through state and federal grant programs, and must complete comprehensive training.

CERTIFIED APPLICATION COUNSELORS The Federally-facilitated Marketplace will designate organizations to certify application counselors who perform many of the same functions as Navigators and non-Navigator assistance personnel—including educating consumers and helping them complete an application for coverage.

Continued on page 6

August, 2013

Some Agents Have Seen It All. That's When They Call On Us. workers' comp insurance American Interstate Insurance Company Silver Oak Casualty Inc. Toll Free: 1.800.381.9348

|

Fax: 1.800.450.1091

|

Amerisafe.com

More “News, Satire & Opinions for Independent Agents from Independent Agents” at www.PIATX.org

http://www.hrsa.gov/about/news/2013tables/outreachandenrollment An online application is available for organizations who want to become Marketplace-designated organizations that can certify application counselors.

These groups might include community health centers or other health care providers, hospitals, or social service agencies.

We anticipate that many consumers will want to obtain professional advice from agents and brokers when applying for and selecting a qualified health plan.

Outwit, Outlast, Outplay With all the new regulations and changes under the Patient Protection and Affordable Care Act — and everything that goes along with it — many brokers are having a hard time seeing the light at the end of the tunnel.

$150 million in grant awards to 1,159 health centers across the nation will enable them to help uninsured Americans gain affordable health insurance coverage.

AGENTS AND BROKERS CMS expects agents and brokers to play a key role in the new Marketplaces. To the extent permitted by states, agents and brokers will play an important role in educating consumers about Marketplaces and insurance affordability programs, and in helping consumers receive eligibility determinations, apply for premium tax credits and cost-sharing reductions, compare plans, and enroll in coverage. In particular, CMS anticipates that agents and brokers will play a critical role in helping qualified employers and employees enroll in coverage through the Small Business Health Options Programs (SHOPs).

Texas PIA’s Texas Connection

Some are getting out of the business; some are admitting defeat to the massive health overhaul.

But there’s always a way to win... http://www.benefitspro.com/2013/06/25/brokers-andppaca-outwit-outlast-outplay Fact Sheet: Helping Consumers Apply & Enroll through the Marketplace on pages 7, 8, 9, &10

Page 6

August, 2013

Assistance Roles to Help Consumers Apply & Enroll in Health Coverage Through the Marketplace Starting October 1, 2013, consumers in all states will be able to apply for new affordable health coverage options through the Health Insurance Marketplace for coverage beginning as soon as January 1, 2014. Some states are setting up a State-based Marketplace, other states will work with the federal government in a State Partnership Marketplace, and the remaining states will have a Federally-facilitated Marketplace. No matter what state they live in, consumers will be able to get live in-person help as they go through the process of applying for and choosing new coverage options in the Marketplace.

Individuals can help provide that assistance in a variety of roles. They can become Navigators, non-Navigator assistance personnel, or certified application counselors. In addition, agents and brokers can also help consumers enroll in new coverage options.

Below is a description of the activities, required training, and funding for each type of consumer assistance.

What are the different consumer assistance roles?

Navigators: Navigators will have a vital role in helping consumers prepare electronic and paper applications to establish eligibility and enroll in coverage through the Marketplace. This includes steps to help consumers find out if they qualify for insurance affordability programs (including a premium tax credit, cost sharing reductions, Medicaid and the Children’s Health Insurance Program), and if they’re eligible, to get enrolled.

Navigators will also provide outreach and education to consumers to raise awareness about the Marketplace, and will refer consumers to ombudsmen and other consumer assistance programs when necessary. Navigators can play a role in all types of marketplaces. They’ll be funded through state and federal grant programs, and must complete comprehensive training.

Non-Navigator assistance personnel: Non-Navigator assistance personnel (also known as in-person assistance personnel) will perform generally the same functions as Navigators but will exist in either a State-based Marketplace or a State Partnership Marketplace.

Non-Navigator assistance personnel will serve as a part of an optional program that the state can set up before its Marketplace is economically self-sustaining, and before its Navigator program is fully functional. Though they perform the same functions as Navigators, non-Navigator assistance personnel will be funded through separate grants or contracts administered by a state. They must also complete comprehensive training.

Certified application counselors: The Federally-facilitated Marketplace will designate organizations to certify application counselors who perform many of the same functions as Navigators and non-Navigator assistance personnel—including educating consumers and helping them complete an application for coverage. An online application will be available at the end of July 2013 for organizations who want to become Marketplace-designated organizations that can certify application counselors. These groups might include community health centers or other health care providers, hospitals, or social service agencies. To be notified when the online application is available, visit Marketplace.cms.gov and sign up for email notifications and updates. If you have questions about other ways to partner with the Marketplace, contact partnership@cms.hhs.gov.

A State-based Marketplace may choose to certify application counselors directly rather than designate organizations to do so. Certified application counselors and Marketplace-designated organizations won’t receive new federal grant money through the Marketplace. The counselors and organizations could, however, receive federal funding through other grant programs or Medicaid to help support their consumer assistance and enrollment activities. Examples of possible certified application counselors include staff at community health centers, hospitals, other health care providers, or social service agencies. In states that already have their own certification programs, staff at consumer non-profit organizations may also be certified as application counselors by Marketplace-designated organizations.

All certified application counselors are required to complete comprehensive training.

Agents and Brokers: To the extent permitted by a state and if all Marketplace requirements are met, licensed health insurance agents and brokers may enroll individuals, small employers, and employees in coverage through the Marketplace. Agents and brokers will be compensated by the issuer or by the consumer to the extent permitted under state law. Federal and state training and certification requirements will apply to agents and brokers who enroll or assist consumers in the Marketplace.

What kind of assistance will be available through the Marketplace?

Navigators

Non-Navigator assistance personnel

Certified application counselors

Agents and Brokers

State-based Marketplace

Yes

Optional for states

Yes

Optional for states

State Partnership Marketplace

Yes

Yes

Yes

Yes, if a state permits it

Federallyfacilitated Marketplace

Yes

Not applicable; Navigators provide this assistance

Yes

Yes, if a state permits it

How are these roles funded?

Navigators

Non-Navigator assistance personnel

State-based Marketplace

State-based grant program

State-based grants or contracts, which can be funded

by Exchange Establishment grants

State Partnership Marketplace

Federal grant applications are being reviewed and awards will be announced in late summer 2013

State-based grants or contracts, which can be funded in states with consumer partnerships

by Exchange Establishment grants

Federallyfacilitated Marketplace

Federal grant applications are being reviewed and awards will be announced in late summer 2013

Not applicable

Certified application counselors

Agents and Brokers

Certified application counselors will not receive new federal grant money through the Marketplace.

Federal funding through other grant programs or Medicaid may be available.

Some examples of possible application counselors include staff at community health centers, hospitals, other health care providers, or social service agencies.

Agents and brokers can be compensated by insurance companies or consumers, consistent with state law.

What training and certification is required?

Navigators

Non-Navigator assistance personnel

Certified application counselors

Agents and Brokers

State-based Marketplace

State training and certification (state may choose to use federal training)

State training and certification (state may choose to use federal training)

State training and certification (state may choose to use federal training)

State training and certification (state may choose to use federal training)

State Partnership Marketplace

Federal training and certification, which may be supplemented by the state

Federal training and certification, which may be supplemented by the state

Federal training and federal designation of organizations, which may be supplemented by the state

Federal training and registration

Federallyfacilitated Marketplace

Federal training and certification

Not applicable

Federal training and federal designation of organizations

Federal training and registration

CMS Product No. 11647-P July 2013

Texas PIA Membership has More Advantages!

Here’s what you get for only $300.00 per year: Free Online CE Free Classroom CE Free Micro-Mobile Site & QR Code Marketing Strategy. Scan this QR Code for a current example. This could be your agency!

Free registration to Annual Convention Free Report complete with improvement tips on Your Agency’s Online Visibility If your website looks like this on a Smartphone

It could look like this for Free

Free Agency Website: No set up fee, no contract, $35 per month hosting & maintenance. Check it out at www.GetITC.com Free 30 second Agency Promotional Video. Click here to enjoy the one I created for Texas PIA Connections 2013. This could be your agency!

Free Customizable Business Forms: These documents are free to download and customize for your own professional use.

Free Mentoring: Whether you are a start-up or an existing business, our mentors will help you reach customers and achieve your goals with confidential, valuable advice.

Free Small Business Handbook: Everything you need to know to run your business, from equity to employees.

Free Marketing Templates: Sets of templates with a coordinated design including letterhead, envelopes, business cards, brochures, etc.

Free Office Poster Software: Templates to create your own custom office posters, all without any knowledge of design or graphical skills needed.

Free Disaster Planning Toolkit: At least one in four small businesses that close because of a major disaster never reopen. Here’s a new tool for your agency (& your commercial policyholders).

Free “How To” Booklets on Agency Management, Buy / Sell / Evaluate an Independent Agency, Internet Marketing & Social Media Free Monthly CSR Online Training using interactive quizzes, videos and worksheets Free Monthly Agency Owner’s Tips ‘n Tools Free HR Policy & Compliance Guidelines

Main Street Store Available to all A1 (Agent) members in addition to State Level Benefits Agency Revenue Tools Flood Insurance through The Hartford (to sell) Voluntary Products Offered By the PIA Services Group Insurance Fund

Free Claims Apps for Policyholders Free Agency Valuation Consultation

All this & much, much more for only $300.00 per year

Join today Online at www.PIATX.org

More “News, Satire & Opinions for Independent Agents from Independent Agents” at www.PIATX.org

Compare options in the Health Insurance Marketplace

To find out how much savings you're eligible for, you'll need income information, like the kind you get on your W-2, current pay stubs, or your tax return. Use this checklist to get started.

Insurance plans in the Marketplace are offered by private companies, and they cover the same core set of benefits called essential health benefits. No plan can turn you away or charge you more because you have an illness or medical condition. They must cover treatments for these conditions. Plans can't charge women more than men for the same plan.

Set your budget. There will be different types of health plans to meet a variety of needs and budgets.

You'll need to figure out how much you want to spend on premiums each month.

Learn about the Marketplace in your state While all insurance plans are offered by private companies, the Marketplace is run by either your state or the federal government.

The Marketplace simplifies getting health coverage The Marketplace simplifies your search for health coverage by gathering the options available in your area in one place. You can compare plans based on price, benefits, quality, and other features important to you before you make a choice.

In the Marketplace information about prices and benefits will be written in simple language. You get a clear picture of what premiums you'd pay and what benefits and protections you'd get before you enroll.

Compare plans based on what's important to you, and choose the combination of price and coverage that fits your needs and budget.

How can I get ready to enroll in the Marketplace?

To prepare to enroll, you can learn about types of health coverage, research your questions, and figure out what you need to know before open enrollment begins.

Open enrollment starts October 1, 2013. Coverage can start as soon as January 1, 2014.

How to get ready now Learn about different types of health coverage.

Through the Marketplace, you'll be able to choose a health plan that gives you the right balance of costs and coverage. You can be better prepared if you understand the types of coverage you'll choose from.

Make a list of questions you have before it's time to choose your health plan.

Make sure you understand how coverage works, including things like premiums, deductibles, out-ofpocket maximums, copayments, and coinsurance. You'll want to consider these details while you're looking for health insurance.

Gather basic information about your household income. Most people using the Marketplace will qualify for lower costs on monthly premiums or out-of-pocket costs.

Ask your employer if it plans to offer health insurance in 2014. If not, you may need to get insurance through the Marketplace or from other sources in 2014. If you don’t have coverage, you may have to pay a fee.

Explore current options. You may be able to get help with getting coverage now through existing programs.

Learn more about health insurance for adults up to age 26 and programs for people and children in families with limited incomes including Medicaid and the Children’s Health Insurance Program (CHIP). Medicare covers people who are 65 and older or who have certain disabilities.

Find out which Marketplace will serve you. If your state runs the Marketplace, you'll use its website to compare your options and enroll in coverage instead of this one. If your state doesn’t run the Marketplace, you’ll use this website, www.HealthCare.gov.

What is the SHOP Marketplace?

The Small Business Health Options Program (SHOP) is a new program that simplifies the process of buying health insurance for your small business.

For 2014, the SHOP Marketplace is open to employers with 50 or fewer full-time-equivalent employees (FTEs). The advantages of using SHOP include: You control the coverage you offer and how much you pay toward employee premiums.

You can compare health plans online on an applesto-apples basis, which helps you make a decision that's right for your business.

You may qualify for a small business health care tax credit worth up to 50% of your premium costs. You can still deduct from your taxes the rest of your premium costs not covered by the tax credit. Beginning 2014 the tax credit is available only for plans purchased through SHOP. Compare plans and apply online The Small Business Health Options Program (SHOP) is designed for small employers with 50 or fewer full-time equivalent employees. With one online application, on your own or with the help of an agent, broker, or other assister, you can compare price, coverage, and quality of plans in a way that's easy to understand.

Continued on page 14

Texas PIA’s Texas Connection

Page 12

August, 2013

Your clients deserve more than just insurance.

Offer them the added security of TicketProtect™ including emergency roadside services.

Even good drivers make mistakes.

Good drivers need protection against those times when a small driving error results in being issued a hefty summons.

That’s why we’re offering a product that combines legal fee reimbursement with emergency roadside service.

TicketProtect™ can keep driving mistakes from becoming financial disasters.

TicketProtect™ affords good drivers a safety net. Simple driving mistakes shouldn’t end up costing anyone a fortune in penalties. Ticket Protect™ will reimburse members for citations received up to $150, legal fees reimbursement up to $200, and up to $250 for defensive driving courses. This legal fee reimbursement benefit pays back members for most non-reckless vehicle citations.

Clients also receive Emergency Roadside Service and other valuable benefits!

For more protection we’ve added Emergency Roadside Service featuring: • Towing • Fluid Delivery • Tire Change • Jump Starts • Lock-Out • Concierge Services Additional benefits include: • Hotel discounts • Car rental discounts • Trip Routing

Ask your carrier if they have TicketProtect™ For more information:

1.888.920.0091 Ext. 2005

Vehicle Administrative Services, Ltd. • 4287 Beltway Drive, Box #198 Addison, Texas 75001 • info@vehicleadminservices.com

TicketProtect™ powered by

MOTOR CLUB

More “News, Satire & Opinions for Independent Agents from Independent Agents” at www.PIATX.org

Small Business Health Options Program Continued from page 12 You can enroll starting October 1, 2013 for coverage starting as soon as January 1, 2014. You can also enroll and begin coverage any time after January 1, 2014.

You decide what you'll pay toward employee premiums, and then your employees can enroll.

There will be a SHOP Marketplace in each state. You must have an office or employee work site within the SHOP's service area to use that particular SHOP. The online application will guide you to the right SHOP for you.

How to know if you qualify for the SHOP Marketplace In 2014, SHOP is open to employers with 50 or fewer full-time equivalent (FTE) employees. Beginning in 2016, all SHOPs will be open to employers with up to 100 FTEs: If you're self-employed with no employees, you can get coverage through the individual market Health Insurance Marketplace, but not through SHOP. If you plan to use SHOP, you must offer coverage to all of your full-time employees–generally those working 30 or more hours per week on average.

In many states, at least 70% of your full-time employees must enroll in your SHOP plan. See “How many of my employees must enroll in SHOP?” on the dropdown menu below for more information.

Can I use an agent or broker to buy health insurance in the Marketplace?

You will be able to use a licensed agent or broker to provide help or handle your SHOP business. You won’t pay more if you use a SHOP agent or broker.

Get SHOP help from experienced agents or brokers A licensed agent or broker can help you: apply for insurance for your employees review and compare price, coverage, quality, and other important features choose a plan that works for your budget, business, and employees Using your own health insurance broker You can continue using your current licensed agent or broker to buy health insurance in the SHOP.

If you're self-employed with no employees, you're not considered an employer. You can use the individual Marketplace to find coverage that fits your needs.

How to know if you’re "self-employed" If you run an income-generating business with no employees, then you're considered self-employed (not an employer) and can get coverage through the Marketplace. You’re not considered an employer even if you hire independent contractors to do some work.

If you have employees (generally, workers whose income you report on a W-2 at the end of the year) you’re considered an employer. Then you could get coverage for yourself and your employees through the SHOP Marketplace. Learn more about how to determine if you have employees.

New options for the self-employed If you're self-employed, you'll have more health coverage options in 2014.

Starting October 1, 2013, you can use the Marketplace to find health coverage that fits your budget and meets your needs. You can compare important features of several plans side-by-side, all of them offering a full package of essential health benefits. You can see what your premium, deductibles, and out-ofpocket costs will be before you decide to enroll.

You can't be denied coverage or charged more because you have a pre-existing health condition.

If you currently have individual insurance--a plan you bought yourself, not the kind you get through an employer--you may be able to change to a Marketplace plan. Learn more about changing individual insurance plans.

What are some of the key things an employer needs to know about the new healthcare law?

The key things an employer needs to know about the new healthcare law.

Lower costs for coverage Starting in 2014, you may qualify to get lower costs on your monthly premiums when you buy private health insurance in the Marketplace.

When you fill out a Marketplace application, you'll learn if you qualify for these lower costs. Depending on your income, you may also qualify to for lower out-ofpocket costs, so you won't have to pay as much for deductibles, copayments, and coinsurance.

You pay the same, with or without a broker The premiums you pay will be the same with or without the help of agents or brokers. Agents and brokers are usually paid by the insurance companies whose policies they sell.

What if I'm self-employed?

Texas PIA’s Texas Connection

Medicaid and CHIP When you fill out a Marketplace application you'll also learn if you or your children qualify for free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP). You may qualify for these programs right now.

Continued on page 16 Page 14

August, 2013

What’s the quickest way to ease that empty feeling?

Vacant Property and Builder’s Risk programs in a five-minute phone call.

Vacant Property

Builder’s Risk

• • • •

• Ground up and renovation projects eligible • $5,000 job-site theft coverage available

Commercial buildings and dwellings eligible Low deductibles Liability option to $1 million $200 minimum premium for monoline property and $250 for package • No limit on length of vacancy

Both Programs • Telephone quotes and binders • New lower rates • One to 12 months policies

Call. Quote. Bind.

The TAPCO Service Pledge • “A”-rated non-admitted carrier

• Quick claims handling

• Competitive pricing

• $10 credit to your personalized TAPCO EZ Bucks Visa debit card with each policy

• Fast policy turnaround • In-house financing available

1,000 Strong

• Visa, MasterCard and ACH payments accepted

More than 1,000 classes of P&C business written under binding authority.

877-TAPCO-99 (877-827-2699)

www.gotapco.com

More “News, Satire & Opinions for Independent Agents from Independent Agents” at www.PIATX.org

What if I have a pre-existing health condition?

Do I have to offer health coverage to my employees?

Starting in 2014, health insurance plans can't refuse to cover you or charge you more just because you have a pre-existing health condition.

No employer has to offer coverage. Some large businesses that don't offer coverage meeting certain standards may have to make a shared responsibility payment in 2015.

Being sick doesn't keep you from getting coverage

If you have fewer than 50 full-time equivalent (FTE) employees, you are not subject to the Employer Shared Responsibility parts of the law. You may use SHOP to offer coverage for your employees.

Starting in 2014, being sick won't keep you from getting health coverage. An insurance company can't turn you down or charge you more because of your condition. It can't refuse to cover treatment for preexisting conditions.

Businesses with fewer than 50 full-time employees are not required to provide health insurance for their employees under Obamacare. 95% of businesses in this size-range already provide health insurance for their employees, but the cost is usually high and coverage is often slim.

This is true even if you have been turned down or refused coverage due to a pre-existing condition in the past.

The only exception is for grandfathered individual health insurance plans--the kind you buy yourself, not through an employer. If you have one of these plans you can switch to a Marketplace plan during open enrollment and get coverage for your pre-existing condition.

Currently, small businesses pay about 18% higher health insurance premiums than large companies. This is because the insurance risk is spread only among the employees in that company. As a result, small companies with female employees, older employees, or employees with a chronic illness pay higher premiums.

This will change under Obamacare because the employer group will be part of a large, state-wide group.

You can apply for Health Insurance Marketplace insurance when open enrollment starts on October 1, 2013. Coverage starts as soon as January 1, 2014.

Be sure not to miss open enrollment

To keep premiums down, many employers have been forced to choose lousy health insurance plans with high deductibles and co-pays. Before Obamacare, some companies even offered plans with very limited coverage caps such as $100,000. This will never happen under Obamacare.

Open enrollment ends on March 31, 2014. Outside of open enrollment, you can't enroll in Marketplace coverage unless you have a qualifying life event.

Find out what you can do now to get ready to enroll.

Pre-existing conditions with Medicaid and CHIP

Since 2010, 360,000 small businesses have taken advantage of tax credits for providing health insurance.

The tax credits total 35% of what the employer paid towards their employees’ health insurance costs. The tax credit goes up to 50% in 2014.

Medicaid and the Children's Health Insurance Program (CHIP) also can't refuse to cover you or charge you more because of a health condition.

What is considered a small business?

If you have 50 or fewer full-time equivalent (FTE) employees you're considered a small business under the health care law.

As a small business, you may get employee insurance through the SHOP Marketplace. This applies to non-profit organizations too.

If you have fewer than 25 employees, you may qualify for the Small Business Tax Credit. Non-profit organizations can get a smaller tax credit.

Beginning in 2016, the Small Business Health Options Programs (SHOP) will be open to employers with 100 or fewer FTEs. If you're self-employed and have no employees, you can buy insurance through the individual Health Insurance Marketplace. You would not use the SHOP.

Texas PIA’s Texas Connection

COMPANIES WITH 24 OR FEWER EMPLOYEES The business owner, his partners and family members are not included in the employee number. This is important because the employer might make a lot more money than his employees – and he might pay his wife and kids more than he pays his non-family employees.

Full Time Equivalent (FTE): 40 hours is considered full-time. Two employees who each work 20 hours are considered 1 FTE. To receive the tax credit the employer must pay 50% of the of his employees’ health insurance premiums.

Employee salaries must average less than $50,000 per year.

Continued on page 18

Page 16

August, 2013

Great American Insurance Agency

provides the best possible products and customer service for GA’s and Insurance Agents in Texas. Our goal is to assist our business partners in finding the most cost effective solutions for their clients. We accomplish this by conducting business with the highest level of honesty, integrity, and loyalty thereby building long term relationships essential to the success of both GAIA and our business partners.

Primary Employer’s Indemnity $1,000 to $500,000 SIR’s (Self Insured Retention) available Combined Single Limit - $300,000 to $5,000,000 per person per occurrence Per occurrence Aggregate – 10 X CSL (up to $25 mil) NO Annual Policy Aggregate TPA service included at no additional cost on policies with SIR’s of $25,000 and below Medical payments are made directly to providers after SIR has been met Medical only SIR for all polices with SIR’s of $25,000 and below Monthly Premium Payments available One, Two, or Three year benefit periods available Automatic renewal Duty to Defend – Defense costs are paid by the carrier and do not erode Policy limits

PEI Provides Protection for : Restaurant Owners Transportation Industry Retail Businesses Manufacturers Health Care/Home Health/Nursing Homes Hotel/Motel Owners

14350 Proton Road, Dallas, TX 75244 (800) 299-5250 (972) 931-2026

Great American Group Claims

is a third party administrator that has specialized in the administration of claims for non-subscribing employers since 2002. GAGC responds to the needs of the employer with customized services tailored to meet the requirements of their occupational injury benefit plan. The experience and caring attitude of the well-trained staff at GAGC ensures that your injured workers get the best care available.

The Great American Group Claims Advantage includes: Customized Service tailored to meet the needs of employer Maximizing your savings with medical cost containment and bill re-pricing at no additional cost on polices with SIR’s below $50,000 Access to established relationships with specialists and case managers that can speed a seriously injured employee’s return to work Claim investigation to identify potential fraud and pre-existing conditions A system that automatically tracks payments as they accumulate toward the self insured retention Established relationships with occupational accident medical providers in your area before an injury occurs Staff experienced in resolving serious claims through negotiations prior to litigation P.O. Box 2309, Addison, TX 75001-2309 (866) 930-9493 (972) 930-9493

More “News, Satire & Opinions for Independent Agents from Independent Agents” at www.PIATX.org

COMPANIES WITH FEWER THAN 10 EMPLOYEES Employee salaries must average less than $25,000 per year.

have as many choices as the feds have, but they will have more choice than they do now or will have in 2014.)

COMPANIES WITH 50 OR MORE EMPLOYEES

SHOP: Small Business Health Options Program To get tax credits, employees must enroll through the SHOP. Insurance agents/brokers can help employees enroll through the SHOP. In 2015, the SHOP will be expanded to provide employees with more than one choice for health insurance. When this happens, employees who work for small companies will have several plans on a “menu”, just like federal employees now have. (Well, they won’t

There is a website that answers questions about health insurance options for small businesses. You can find it here: http://business.usa.gov/healthcare

Texas PIA’s Texas Connection

These companies are required to provide health insurance to their employees, but not until 2015.

NO MANDATE FOR SMALL BUSINESSES If small businesses do not offer health insurance, their employees can go to the state health insurance exchange (as of October 1st) to enroll in a plan. Those who make less than $45,960 as a single person, or $62,040 as a couple, or $78,120 as a couple with one child, will get help with their premiums. (See the income chart.)

Here is a link to the IRS web page that addresses how to count FTEs, average wages, and tax credits: http://www.irs.gov/uac/Small-Business-HealthCare-Tax-Credit-Questions-and-Answers:-DeterminingFTEs-and-Average-Annual-Wages Page 18

August, 2013

Centurion Medical Liability Protective JOIN OUR TEAM TODAY! We have been providing premium relief to Physicians for the last 10 years We offer the best customer service and commissions in Texas Our Company is owned and operated by Physicians Financial Stability Rating of A, Exceptional A.M. Best “A� Rated Reinsurance The most competitive rates in Texas

518 Peoples St Corpus Christi, TX 78401 www.cmlpins.com Phone: 512-377-1757 Fax: 512-628-3373 info@cmlpins.com

FOCUS

on

Health Reform JULY 2012

EXPLAINING HEALTH CARE REFORM: Questions About Health Insurance Subsidies Good health insurance is expensive, and its cost is out of reach for many lower and moderate income families, particularly if they are not offered health benefits at work. To make coverage obtainable for families that otherwise could not afford it and to encourage broad participation in health insurance, the Patient Protection and Affordable Care Act (PPACA) includes provisions to lower premiums and cost-sharing obligations for people with low and modest incomes. The adequacy of this assistance will be a key determinant of how many people will gain coverage and whether or not lower income people will be able to use the health insurance they obtain.

This summary describes the financial assistance provided under PPACA for people purchasing coverage on their own through health insurance exchanges. Expanded coverage for low income people through Medicaid and CHIP and new tax credits for small businesses offering health insurance are addressed in other reports.

What types of subsidies does PPA CA provide to people buying health insurance?

New eligibility rules enacted under PPACA – as revised by the recent Supreme Court decision on the law – give states the option of extending coverage in Medicaid to most people with incomes under 138% of poverty. For people with somewhat higher incomes (up to 400% of poverty), PPACA provides tax credits that reduce premium costs. People with incomes up to 250% of poverty also are eligible for reduced cost sharing (e.g., coverage with lower deductibles and copayments) paid for by the federal government. The premium tax credits and cost-sharing assistance will begin in 2014.

Who is eligible for premium tax credits?

Citizens and legal residents in families with incomes between 100% and 400% of poverty who purchase coverage through a health insurance exchange1 are eligible for a tax credit to reduce the cost of coverage. People eligible for public coverage are not eligible for premium assistance in exchanges. In states without expanded Medicaid coverage, people with incomes less than 100% of poverty will not be eligible for exchange subsidies, while those with incomes at or above poverty will be.

People offered coverage through an employer are also not eligible for premium tax credits unless the employer plan does not have an actuarial value of at least 60%2 or unless the person’s share of the premium for employer-sponsored insurance exceeds 9.5% of income. People who meet these thresholds for unaffordable employer-sponsored insurance are eligible to enroll in a health insurance exchange and may receive tax credits to reduce the cost of coverage purchased through the exchange.

What is the amount of the tax credit provided to people?

The amount of the tax credit that a person can receive is based on the premium for the second lowest cost silver plan 3 in the exchange and area where the person is eligible to purchase coverage. A silver plan is a plan that provides the essential benefits 4 and has an actuarial value of 70%. (In PPACA, a 70% actuarial value means that on average the plan pays 70% of the cost of covered benefits for a standard population of enrollees.) The amount of the tax credit varies with income such that the premium that the premium a person would have to pay for the second lowest cost silver plan would not exceed a specified percentage of their income (adjusted for family size), as follows: Income Level

Premium as a Percent of Income

Up to 133% FPL

2% of income

133-150% FPL

3 – 4% of income

150-200% FPL

4 – 6.3% of income

200-250% FPL

6.3 – 8.05% of income

250-300% FPL

8.05 – 9.5% of income

300-400% FPL THE HENRY J. KAISER FAMILY FOUNDATION

9.5% of income

Headquarters: 2400 Sand Hill Level Road (FPL) Menlo CA 94025 650.854.9400 Fax: for 650.854.4800 Note: The Federal Poverty wasPark, $10,830 for an individual and $22,050 a family of four through early 2010. For more Washington Officesplease and Barbara Conference Center:and 1330 G Street, NW Washington, DC 20005 202.347.5270 Fax: 202.347.5274 information, see theJordan Department of Health Human Services Poverty Guidelines, available at http://aspe.hhs.gov/poverty/09poverty.shtml.

The Kaiser Family Foundation is a non-profit private operating foundation, based in Menlo Park, California, dedicated to producing and communicating the best possible analysis and information on health issues.

www.kff.org

FOCUS

on

Health Reform

A person who wants to purchase a plan that is more expensive would have to pay the full difference between the cost of the second lowest cost silver plan and the plan that they wish to purchase.

An example shows how the premium tax credits work. Assume: • Pat is 45 years old and has an income in 2014 that is 250% of poverty (about $28,735) 5 • The cost of the second lowest cost silver plan in the exchange in Pat’s area is projected to be about $5,733 • Under PPACA, Pat would not be required to pay more than 8.05% of income, or $2,313, to enroll in the second lowest cost silver plan.

The tax credit available to Pat would be $3,420 ($5,733 premium minus the $2,313 limit on what Pat must pay).

Because health insurance premiums have typically grown more rapidly than income, PPACA adjusts the percent of premium that people are required to pay to reflect the excess of the premium growth over the rate of income growth.

Beginning in 2019, if aggregate premiums and cost-sharing subsidies exceed 0.54% of GDP, the premium percentages would be further adjusted to reflect the excess of premium growth over CPI.

How will premium subsidies be provided?

Premium tax credits would be refundable and advanceable. A refundable tax credit is one that is available to a person even if he or she has no tax liability. An advanceable tax credit allows a person to receive assistance at the time that they purchase insurance rather than paying their premium out of pocket and waiting to be reimbursed when filing their annual income tax return.

PPACA requires exchanges to provide information to prospective enrollees about their eligibility for premium tax credits.

The process through which people apply for premium tax credits will likely be established by the Secretary of Treasury through regulation.

How will cost-sharing subsidies be structured?

Cost-sharing subsidies protect lower income people with health insurance from high out-of-pocket costs at the point of service. PPACA provides for reduced cost sharing for families with incomes at or below 250% of poverty by making them eligible to enroll in health plans with higher actuarial values. The premium tax credits, discussed above, generally are based on a plan with an actuarial value of 70%. PPACA provides that people with lower incomes have their cost sharing reduced so that plan on average pays a greater share of covered benefits. The amount of additional protection varies with income, as follows: Income Level

Actuarial Value

100-150% FPL

94%

150-200% FPL

87%

200-250% FPL

73%

PPACA sets maximum out-of-pocket spending limits (discussed below), but otherwise does not specify the combination of deductibles, copayments, and coinsurance that plans must use to meet the actuarial value requirements. So, for example, one plan may choose to have relatively higher deductibles but relatively low copayments for office visits and other services, while another plan may choose a lower deductible but higher copayments or coinsurance for each service. The Secretary of Health and Human Services may choose to address this issue through rulemaking.

2

QUESTIONS ABOUT HEALTH INSURANCE SUBSIDIES

FOCUS

on

Health Reform

As just noted, PPACA limits the total amount that people must pay out-of-pocket for cost sharing for essential benefits.

Generally, the limits are based on the maximum out-of-pocket limits for Health Savings Account-qualified health plans ($5,950 for single coverage and $11,900 for family coverage in 2010), which will be indexed to the change in the Consumer Price Index until 2014 when the provision takes effect.6 After 2014, the limits will be indexed to the change in the cost of health insurance. People with incomes at or below 400% of poverty have their out-of-pocket liability capped at lower levels, as follows: 7 Income Level

Reduction in Out-of-Pocket Liability

100-200% FPL

Two-thirds of the maximum

200-300% FPL

One-half of the maximum

300-400% FPL

One-third of the maximum

The limits on out-of-pocket maximum amounts means that a person with income of 150% of poverty purchasing coverage in the exchange would have the limit on their out-of-pocket spending reduced to at least two-thirds of the generally applicable maximum value (for example, if the provision were in effect in 2010, the out-of-pocket maximum for single coverage for such a person would be about $1,981 for single coverage and $3,963 for family coverage).

In combination, the two cost sharing provisions require health plans offering coverage to lower income people in the exchange to increase the actuarial value of the coverage of the plans that they receive, and to do so in a way that caps enrollee out-of-pocket liability within the specified levels.

How do subsidies affect the cost of reform?

The Congressional Budget Office (CBO) estimates the direct cost of premium and cost-sharing subsidies to be $350 billion from 2010 to 2019, and $8 billion in indirect costs.8 The cost of the subsidies is a function of the number of people that are eligible for subsidies, and how generous the subsidies are.

CONCLUSION Subsidies to make insurance more affordable and increase insurance coverage are a key element of the Patient Protection and Affordable Care Act. Premium and cost-sharing subsidies of varying levels will be available to individuals and families with low to moderate incomes, making coverage and care more affordable. While many of the details on how they will be administered are forthcoming, most premiums subsidies will be delivered in the form of advanceable and refundable tax credits, while cost-sharing subsidies will increase the actuarial value of health plans. The Congressional Budget Office estimates that the subsidies will cost roughly $350 billion between 2010 and 2019, although the overall effect of the Act is estimated to reduce the deficit over the same time period. These subsidies will provide assistance for low to moderate income families, enabling them to purchase coverage and gain better access to care.

For more information about the Patient Protection and Affordable Care Act, see the summary of the new health reform law at www.kff.org/healthreform/8061.cfm.

QUESTIONS ABOUT HEALTH INSURANCE SUBSIDIES

3

FOCUS

on

Health Reform

FOCUS

Resources

on

Health Reform

Center for Health System Change – Living on the Edge: Health Care Expenses Strain Family Budgets: www.hschange.org/CONTENT/ 1034/?topic=topic05 Kaiser Family Foundation, Kaiser Commission on Medicaid and the Uninsured – Approaches to Covering the Uninsured: A Guide: www.kff.org/uninsured/upload/7795.pdf Kaiser Family Foundation, Kaiser Commission on Medicaid and the Uninsured – President Obama’s Campaign Position on Health Reform and Other Health Care Issues: www.kff.org/uninsured/kcmu112508oth.cfm Kaiser Family Foundation, Kaiser Commission on Medicaid and the Uninsured – The Coverage and Cost Impacts of Expanding Medicaid: www.kff.org/medicaid/7901.cfm Kaiser Family Foundation – Health Reform Side-by-Side: www.kff.org/healthreform/upload/healthreform_tri_full.pdf Kaiser Family Foundation – Tax Subsidies for Health Insurance: www.kff.org/insurance/upload/7779.pdf

ENDNOTES 1

Kaiser Family Foundation, “Explaining Health Care Reform: Questions About Health Insurance Exchanges.” Available at www.kff.org/healthreform/7908.cfm.

2

For definition of Actuarial Value, please see “Glossary of Key Health Reform Terms,” available at www.kff.org/healthreform/7909.cfm.

3

For more information about the silver plan and other plans available in the exchange, please see “Explaining Health Care Reform: Questions About Health Insurance Exchanges,” available at www.kff.org/healthreform/7908.cfm.

4

Essential benefits must include at least the following general services: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health benefits and substance use disorder services, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease managements, and pediatric services including oral and vision care.

5

Poverty projected based on projected change in consumer price index, available at www.cbo.gov/budget/econproj.shtml.

6

See 26 U.S.C. §22 3(g).

7

PPACA provides that the Secretary can adjust the maximum out-of-pocket limits if they would result in plans exceeding the specified actuarial values.

This could happen if an out-of-pocket limit is too low to allow a deductible and other cost sharing that is consistent with the specified actuarial value.

8

Congression Budget Office, “H.R. 4872, Reconciliation Act of 2010 (Final Health Care Legislation),” March 20, 2010, available at www.cbo.gov/ftpdocs/113xx/doc11379/Manager%27sAmendmenttoReconciliationProposal.pdf. While CBO is required to project the costs over a ten-year time period, the subsidies will not be available until 2014.

This publication (#7962-02) is available on the Kaiser Family Foundation’s website at www.kff.org.

THE HENRY J. KAISER FAMILY FOUNDATION Headquarters: 2400 Sand Hill Road Menlo Park, CA 94025

www.kff.org

650.854.9400

Fax: 650.854.4800

Washington Offices and Barbara Jordan Conference Center: 1330 G Street, NW Washington, DC 20005 202.347.5270 Fax: 202.347.5274 The Kaiser Family Foundation, a leader in health policy analysis, health journalism and communication, is dedicated to filling the need for trusted, independent information on the major health issues facing our nation and its people. The Foundation is a non-profit private operating foundation, based in Menlo Park, California.

More “News, Satire & Opinions for Independent Agents from Independent Agents” at www.PIATX.org

Become a LegalShield Independent Sales Associate Today!

We offer our members legal service products that provide assistance with legal issues no matter how trivial or traumatic. Our Associates are proud to offer LegalShield products, to their policyholders, friends, family and community empowering them to speak to an attorney about any issue without worrying about the cost.

At LegalShield, Insurance Agencies benefit big.

At LegalShield, we believe every insurance agency should have access to legal coverage and every insurance agency should be able to afford it. With all the fine print and legalities of running an insurance agency today, legal protection is a necessity, but it doesn’t have to be unaffordable.

For one low monthly cost, you can lead your insurance agency with peace of mind knowing you’ll have access to legal advice when you need it most.

From legal consultations and contract reviews to debt collection and more, we’ll help you and your business with any legal matter, big or small.

Some of Our Insurance Agency Services Include: Legal consultation on unlimited matters Business law expertise Contract and document review Debt collection assistance Legal correspondence Trial defense services More information at http://www.legalshield.com/hub/rickrpegram

THE GOLD BENEATH YOUR FEET Most agents don’t mind hard work. They love clients and prospects that come to the agency looking for information, advice and even quotes. They enjoy being busy. But most agents also draw the line when THEY, not the prospect, must do something proactively to promote sales in the agency. For the most part, agents have admitted that although they may know their products and carriers inside-out, they do not know how to attract customers nor are they comfortable in the “sales” role instead of in the “consulting” role.

The best salespeople in the world understand that selling is more about GAINING TRUST and MAKING FRIENDS than it is about what you know. Having a strong knowledge base makes you better and more valuable than your competitors, but it doesn’t get you in front of more prospects and it doesn’t convince them of your sincerity, honesty and trustworthiness. Those three traits, HONESTY, SINCERETY AND TRUSTWORTHINESS win you the “opportunity.”

KNOWLEDGE converts the opportunities into clients.

I’m in the process of replacing the roof of the Agency Consulting Group building. I called several roofers, all referrals from others, I had trepidation because of the lousy reputation that contractors, in general, have in our area. Each of the roofers I invited to inspect the property was assumed to be knowledgeable, but one of the criteria of our interview was whether they seemed to know their business or were just blowing smoke. They all certainly seemed to know their job and products, but I’m always leery because I don’t know much about roofs. So my decision was based more on which one I trusted more.

Insurance agents are appropriately proud of their knowledge base and insurance expertise. It is certainly what separates some independent insurance from their competitors. But the insurance-buying public is less interested in our knowledge than in the package in which that knowledge is wrapped. And most of us have ‘lousy’ packages.

A sales personality can make friends, gain trust and influence people to use their services and products. The sales personality without the knowledge will sell product and services, but they do not do a very good job in protecting the client’s assets. These are the sales pros that seem to be more ‘fluff’ than substance. Yet, they sell a lot of insurance because of their personalities.

The insurance professional without a sales personality can do a wonderful job assessing risk, but will not often get the prospect to move because he doesn’t necessarily elicit confidence and trust.

The insurance agents in the world who have neither the sales personality nor the insurance professional skills are usually the ‘maintenance men’ of the industry.

They don’t sell much and count their new business each year on two hands. Yet they are always busy ‘servicing’ their clients. They try to retain the customer base built by others and acquired through agency acquisitions, external perpetuation and internal succession plans.

Most of the roofers I encounter, like many agents, have a mix of sales personality and some knowledge about their trade. The ones that impress me enough for me to spend thousands of dollars on their services had both traits in abundance and instill a sense of trust that they will do as good a job as they claim. The roofers who are basically ‘hammer swingers’ know how to lay a roof.

Continued on page 25

Texas PIA’s Texas Connection

Page 24

August, 2013

More “News, Satire & Opinions for Independent Agents from Independent Agents” at www.PIATX.org

Gold … Continued from page 24 They neither have the in depth knowledge of their profession nor the personality to cause a trust relationship. They abound after a storm and can’t get customers in the off season times when they have to count on their personalities to win clients. We also have a lot of ‘hammer swingers’ in the insurance agency industry. They are the ones who start every conversation with, “Let me give you a quote. I can probably get it for you cheaper.”

When rates are escalating, it’s not hard to get insurance buyer’s attention. Whether or not you instill trust is secondary to potentially saving them thousands of dollars. However, without that relationship, your longevity with that client is limited. Facing a better sales personality when the agent does not pay attention to an existing client relationship will find that they lose the customer to another agent with a better personalities and can match or beat their pricing.

However, when rates are stable and pricing leverage doesn’t drive prospects to your agency, that flow of business doesn’t occur and agents either learn how to evolve relationships with prospects or they wither on the vine.

Unfortunately, for the industry, we are not replacing retiring insurance professionals with even the same knowledge base in their successors. Luckily for the insurance professionals still in the business and the younger insurance professionals who are being trained properly to assume control, lack of expertise will allow them to easily reach the client base that is smart enough to seek professional services instead of trying to buy insurance out of “the box” or from the gecko. However, unless our existing and arising insurance professionals also hone their sales personalities, they will not become the Insurance Sales Professional – the entire package – that will insure their success in the future of their agencies.

I selected my roofer today. He came highly recommended. He visited me and walked me through the needs, the products he would use, and the time it would take to do the roof. The next time we speak, you should ask me how the results measured up to the proposal! The price wasn’t even an issue until he was sure I understood 1) that he knew his business, 2) that I understood the products he would use, 3) that he was proud of his work, and 4) that he would make me a priority. Of course if he was way above (or way below) the other proposals, I may have had other questions. But he clearly told me how much the material would cost and how much the labor would cost – summing up the costs to a final price.

Similarly, the Sales Personality in the insurance agency industry immediately gets past the cost issue, telling the prospect that we wouldn’t make a change unless the pricing indicated that it would be the best course of action for the client.

Texas PIA’s Texas Connection

That permits the agent to probe and identify the real issues that are the ‘hot buttons’ for that prospect and responding to each of those issues in a way that makes it perfectly clear that the agent understands the client’s pain and can respond to it appropriately.

Finding the prospects to hone your sales personality is also not complicated. It is NOT an issue of cold calling or mass marketing. Your prospects are already in your files and systems. They are your clients with whom you should be establishing an on-going and lasting relationship. Once you build a strong client relationship, you will find they refer people to you or you can request their friends and families as referrals for them. If you don’t believe me, ask yourself and the close agent friends where they got their best and longest lasting accounts. Invariably, they will admit those customers were or became their FRIENDS and that they are also the source of their most valuable referrals. Word of mouth is the best type of referral.

We encourage you to call us or visit our website and investigate the Asset Protection Model of Relationship Selling that re-teaches us to build trust relationships in order to grow our customer base. We do these ourselves and have found that it works with insurance agents referring us to other insurance agents as well as it works for insurance clients referring YOU to other insurance clients. We can be reached at 856-779-2430 and our website is www.agencyconsulting.com. The Asset Protection Model can be accessed in the Archive Section of the PIPELINE. Simply search for Asset Protection and you’ll get dozens of papers covering all sections of this program. If you have concerns or would like to discuss the Asset Protection Model, give me or David a call.

(P.S. This week, subsequent to the new roof, it rained more in one day than it EVER rained in recorded history (8+ inches) and Agency Consulting Group, Inc. is D R Y!!)

AGENCY CONSULTING GROUP, INC. THE PIPELINE | Copyright © 2013 Agency Consulting Group, Inc.| 800-779-2430 | Visit The Pipeline | Subscribe to The Pipeline

Page 25

August, 2013

More “News, Satire & Opinions for Independent Agents from Independent Agents” at www.PIATX.org

A certificate of insurance is just a “snapshot in time”, but some outside the insurance industry are trying to make it more than it really is. The problem is exacerbated when large customers demand certain information on an insurance certificate and if they can’t get it, will threaten to go to somebody who may be willing to comply. The NCOIL model, if enacted, would prevent this practice.

Dear PIA Affiliates, Attached is a copy of the NCOIL certificates model.

PIA National supports this model as a solution to the problem agents have with improper demands for fraudulent certificates. If you are seeing these problems in your area, please consider offering this model as a solution to your state legislators. During the most recent NCOIL meeting, the legislators heard from ACORD, lender, and p-c industry representatives, including PIA, on recent developments related to a proposed “enhanced” insurance binder, tentatively dubbed an ACORD 875. I testified that PIA will continue to work through the ACORD process to address the concerns raised by the lenders regarding adequate evidence of coverage, however in the meantime; we strongly support the NCOIL certificates model.

I also attached some talking points in favor of the NCOIL model you may wish to use. Several states are currently in various stages of the process in considering the NCOIL model language including KY, NJ, NM, TN and WI. In addition, Montana and New York have already passed certificates laws based on the NCOIL model, with the Montana bill written by State Sen. Fred Thomas, a former PIA National President, and the New York bill adopted following an intensive lobbying effort by PIA of New York.

Please let me know if you would like any further information.

Thank you.

Sincerely, David Eppstein Assistant Vice President, PIA National PIA Supports NCOIL Certificates of Insurance Model Professional Insurance Agents strongly support the NCOIL Certificates of Insurance Model because it is a vital piece of consumer protection legislation, and will help clarify the purpose and use of certificates of insurance. The problem we are having now is that insurance agents are receiving demands from large companies, even government agencies, to issue so called “long form” certificates of insurance that are produced by noninsurance entities demanding certain coverage information or other rights.

If these fraudulent certificates are permitted to continue to enter the marketplace unabated, chaos could ensue. Some consumers may mistakenly rely on the information contained on the certificate and not realize that it is the policy documents that govern coverage information and policyholder rights. This proposed legislation makes it illegal for someone to request or issue a fraudulent certificate of insurance. In states that have passed similar legislation we have seen great success in dramatically reducing the number of inaccurate or outright fraudulent certificates. After nearly two years of deliberation, this language was unanimously adopted by the National Conference of Insurance Legislators (NCOIL). Many legislators active in NCOIL chair or are members of the committees responsible for insurance in their respective state houses across the country and we are confident they got this model legislation exactly right.

The purpose of this legislation is to clarify limitations on the use of certificates of insurance in order to promote a transparent system that discourages fraud and misuse and we respectfully urge you to support it.

Background There are many situations where a person or business may be required to show proof of insurance.

Proof of insurance may include an insurance policy or insurance binder, which is in effect until the policy is issued, or a certificate of insurance. Certificates of insurance are simple descriptions of the policy, but they are fundamentally different than insurance policies. An insurance policy is the sole source of contractual rights, and only policies can grant these rights.

Problems have arisen because some third parties demand certificates that attempt to alter the policy language.

We worked together with insurance companies and others in 2008 on legislation in Louisiana and subsequently in other states that would help alleviate most, if not all, the problems agents have been having concerning third party demands on certificates. For example, some parties request certificates that try to expand insurance coverage beyond the terms of the policy. Sometimes they demand the inclusion of unreasonable terms and conditions; or otherwise attempt to force insurance agents to issue certificates that are deceptive and misleading.

Continued on page 27

Texas PIA’s Texas Connection

Page 26

August, 2013

More “News, Satire & Opinions for Independent Agents from Independent Agents” at www.PIATX.org

Common requests also include adding additional insureds that may not be covered under the policy or adding notification of cancellation rights that do not exist in the policy. According to the agents in Louisiana and the department of insurance, their legislation and subsequent regulation largely resolved the problem, so we are using this experience to help us in other jurisdictions that may be seeing the same problems.

Certificates of Insurance are “for information only” for good reason. They are issued to third parties who have no relationship to the insurance company or agent that issues the certificate, typically at no cost to the requester. The certificate is a document that summarizes what the insurance policy says and contains very basic information such as who is covered, when the coverage was purchased and what the coverage limits are. These documents are issued as a matter of convenience to people that need certain coverage information, not the whole policy.

The certificate is for information only, because it is merely a summary of the contract, which is the policy. As those of us in the insurance industry know, it is impossible to summarize a complex commercial property policy on one or two pages. The certificate of insurance is not the proper document, for example, for a commercial lender to rely upon as evidence of coverage, and it certainly should not be relied upon to specify what is covered and what isn’t. The policy is the best document to rely upon for this purpose, but if the policy is not available, the binder is the proper document to use as evidence of coverage until the policy is available. A policy is a legal contract, and since insurance agents are not attorneys, we should not be asking insurance agents to make legal interpretations of contracts. The reason policy language and certificate language is standardized is because each word and coverage clause has been tested in court and therefore have clear meaning and intent. If we start using new language, we are adding uncertainty as to what the ultimate coverage decision may be in court.

The certificate is referred to as a “snapshot in time” because it is accurate at the time of issuance, but the policy terms may change or be cancelled after the certificate has been issued. If certificates were not “information only,” it would completely change the nature of insurance transactions because we could have competing documents that say different things. Merely having a card that says you have insurance may help prove you purchased this insurance at one time but does not prove you have that insurance today.

Agents and carriers could issue multiple certificates relating to the same policy. But if there are discrepancies, which document would prevail? Today, it is the policy that prevails and that’s how it should be.

Nothing on the certificate can change the policy terms. If certificates of insurance were not merely for information only, agents and companies would probably not issue them, but would likely send a copy of the policy. This Texas PIA’s Texas Connection

could inhibit commerce and make things more complicated because people who want certificates do not want a copy of the policy, they just want a summary.

If certificates could substitute for the policy or the binder, there would be a great deal of contract uncertainty in the industry and this uncertainty is bad for business and consumers. We believe that eventually electronic verification of insurance would help largely resolve these matters.

NCOIL Model We support the NCOIL model legislation because it ensures that certificates will be used for their intended purpose, fostering transparency and certainty, while helping prevent their misuse.

The model has been carefully crafted to avoid unintended consequences as it relates only to certificates of insurance. In addition, this model does not alter or impair the rights that any person has under an insurance policy.

The only parties that would be adversely affected by the provisions in this model are those who would illegally demand or issue certificates that do not accurately depict the underlying insurance coverage.

Ideally, rules governing certificates should be uniform across the country. It doesn’t serve anyone’s interest to have different certificates with different meanings within or among the states. This is yet another reason we support this language; it will provide more uniformity across the country.

This Certificates of Insurance Act will curtail fraud in the insurance marketplace by: Prohibiting anyone from issuing or demanding a certificate form that has not been filed with the insurance department or that includes any false or misleading information; Making it clear that certificates are not insurance policies and cannot be used to alter an insurance policy; Declaring certificates prepared in violation of this act null and void; Codifying existing law that reflects longstanding case law and standard business practices; and Authorizing the insurance commissioner to enforce the Act, including issuing cease and desist orders.

This Certificates of Insurance Model Act ensures that certificates would be used for their intended purpose and helps prevent their misuse in the marketplace. These clarifications benefit everyone who utilizes proof of insurance documents, including consumers, insurance agents, commercial lenders and insurance companies.

Thank you for all your efforts to help us prevent fraud and confusion in the property and casualty industry by focusing on this important issue.

Page 27 August, 2013

NATIONAL CONFERENCE OF INSURANCE LEGISLATORS Certificates of Insurance Model Act

Adopted by the NCOIL Property-Casualty Insurance and Executive Committees on November 18, 2012. Sponsored for discussion by Rep. Steve Riggs (KY) Section 1. Short Title This Act shall be known as the “Certificates of Insurance Model Act.” Section 2. Definitions For purposes of this Act: A. “Certificate of insurance" means a document or instrument, regardless of how titled or described, that is prepared or issued by an insurer or insurance producer as evidence of property or casualty insurance coverage. The term does not include a policy of insurance, insurance binder, policy endorsement, or automobile insurance identification or information card.

B. “Insurance producer" means a person required to be licensed under the laws of this state to sell, solicit, or negotiate property or casualty insurance.

C. “Insurer" means any organization that issues property or casualty insurance.

D. “Person” means any individual, partnership, corporation, association, or other legal entity, including any government or governmental subdivision or agency.

Section 3. Certificate Forms A. A person may not prepare, issue, or request or require the issuance of a certificate of insurance on property, operations, or risks located in this state unless the certificate of insurance form has been filed with the commissioner by or on behalf of an insurer.

B. The commissioner of insurance shall prohibit the use of a certificate of insurance form if the form: (1) Is unfair, misleading, or deceptive, or violates public policy; or (2) Violates any law, including any regulation promulgated by the commissioner of insurance.

C. The current edition of standard certificate of insurance forms promulgated and filed with the commissioner by the Association for Cooperative Operations Research and Development (ACORD), the American Association of Insurance Services (AAIS), the Insurance Services Office (ISO) are not required to be filed by individual insurers. Additionally, certificate of insurance forms whose specific content and wording are established by Federal law or regulation, or any law or regulation of this State, are not required to be filed by individual insurers.

D. A certificate of insurance is not a policy of insurance and does not affirmatively or negatively amend, extend, or alter the coverage afforded by the policy to which the certificate of insurance makes reference. A certificate of insurance shall not confer to any person new or additional rights beyond what the referenced policy of insurance expressly provides.

Section 4. Limitations on Use A. A person may not: (1) Alter or modify a certificate of insurance form filed with the commissioner; (2) Prepare, issue, or request or require the issuance of a certificate of insurance that contains any false or misleading information concerning the policy of insurance to which the certificate of insurance makes reference; or (3) Prepare, issue, or request or require the issuance of a certificate of insurance that purports to affirmatively or negatively alter, amend, or extend the coverage provided by the policy of insurance to which the certificate of insurance makes reference.

B. A certificate of insurance may not warrant that the policy of insurance referenced in the certificate comply with the insurance or indemnification requirements of a contract and the inclusion of a contract number or description within a certificate of insurance may not be interpreted as doing such.

Section 5. Notice Requirements A person is entitled to notice of cancellation, nonrenewal, or any material change, and to any similar notice concerning a policy of insurance only if the person has such notice rights under the terms of the policy of insurance or any endorsement to the policy. The terms and conditions of the notice are governed by the policy of insurance or endorsement and may not be altered by a certificate of insurance.

Section 6. Applicability A. The provisions of this Act shall apply to all certificates of insurance issued in connection with property, operations, or risks located in this state, regardless of where the policyholder, insurer, insurance producer, or person requesting or requiring the issuance of a certificate of insurance is located.

B. A certificate of insurance or any other document or correspondence prepared, issued, requested, or required in violation of this Act shall be null and void.

Section 7. Enforcement and Penalties A. The commissioner of insurance shall have the power to examine and investigate the activities of any person that the commissioner reasonably believes has been or is engaged in an act or practice prohibited by this Act.

2

B. The commissioner of insurance shall have the power to enforce the provisions of this Act, including the authority to issue orders to cease and desist and to impose a fine of up to [insert amount] per violation against any person who violates this Act up to [insert amount] per violation.

C. The commissioner of insurance may adopt reasonable rules and regulations as are necessary or proper to carry out the provisions of this Act. Section 8. Effective Date This Act shall take effect 90 days after enactment.

Š National Conference of Insurance Legislators (NCOIL) K:NCOIL/2012 Docs/2007709c.doc

3

More “News, Satire & Opinions for Independent Agents from Independent Agents” at www.PIATX.org

Interested in learning more about the Affordable Care Act? Want to learn about agent registration and training?

The U.S. Department of Health and Human Services (HHS) will be conducting a FREE, live webinar for PIA th members on Friday, September 27 from 1:00pm EDT – 2:30pm EDT. Not only will HHS take your questions, but this agent-focused webinar will cover an array of topics including registration, training, and individual and group enrollment.

Federally-facilitated Marketplace and Federallyfacilitated SHOP registration: identity proofing and obtaining a user ID Online training and testing Pathways for application and enrollment of individuals, employers, and employees in the Federallyfacilitated Marketplaces and Federally-facilitated SHOP Registration information will be e-mailed to Texas PIA Members in good standing.

The IRS has launched a new Affordable Care Act Tax Provisions website at IRS.gov/aca to educate individuals and businesses on how the health care law may affect them. The new home page has three sections, which explain the tax benefits and responsibilities for individuals and families, employers, and other organizations, with links and information for each group. The site provides information about tax provisions that are in effect now and those that will go into effect in 2014 and beyond.

Advertise in the Texas Connection Attention: Insurance Companies, MGA’s, Premium Finance Companies & Insurance Industry Vendors:

Topics include premium tax credits for individuals, new benefits and responsibilities for employers, and tax provisions for insurers, tax-exempt organizations and certain other business types.

Check out the rates for the most cost effective method of keeping your message in front of your customers …

Visitors to the new site will find information about the law and its provisions, legal guidance, the latest news, frequently asked questions and links to additional resources.

The Independent Insurance Agent.

Several other federal agencies have a role in implementing the health care law, including the Department of Health and Human Services, which has primary responsibility. To help locate additional online resources from the Department of Health and Human Services, the Department of Labor and the Small Business Administration, the IRS has issued a new Web-based flyer - Healthcare Law Online Resources (Publication 5093).

Visit IRS.gov/aca for more information regarding the tax provisions of the Affordable Care Act.

Texas PIA’s Texas Connection

Ad Size

Monthly

Pre-Pay 6 Issues

Full Page (7.5” x 10”)

$175.00

$900.00

Half - Page (7.5” x 5”)

$100.00

$500.00

Quarter-Page (3.75” x 5”)

$75.00

$375.00

1/8 - Page (3.75” x 2.5”)

$50.00

$250.00

Questions? Contact Eddie K. Emmett at eddie@piatx.org or (770) 312-2342.

Page 31

August, 2013

More “News, Satire & Opinions for Independent Agents from Independent Agents” at www.PIATX.org

WINDSOR, Conn., July 11, 2013 — Recently, LIMRA asked more than 2,000 Americans a series of ten true/false questions to gauge their understanding and basic knowledge of health insurance. The results were grim: · Nearly 8 in 10 consumers failed the test — answering five or fewer questions correctly · Only 1 in 10 consumers correctly answered at least seven questions

Membership & General Information

· Uninsured consumers, on average, answered less than 3 in 10 questions correctly

Joe Tipton

“Overall, Americans expressed a great deal of confusion about how health insurance plans work,” said Anita Potter, assistant vice president, LIMRA Group Insurance Research. “Not surprisingly, insured Americans had a better understanding of health insurance than those uninsured – but not by a large margin.”

Membership Director PO Box 700877, Dallas, TX 75370 TEL: 972-862-3333

FAX: 972-307-7888

Cell: 972-965-2025

Joe@PIATX.org

PIA National

www.pianet.com

E&O Solutions Renewing your E&O every year isn’t much fun, is it?

Don’t you want to make sure that you’re getting the best price for the best coverage you can get on your renewal?

Why not compare with another company for your peace of mind?

It costs you nothing and you don’t have to be a member of PIA of Texas to move your coverage. Go to the E&O Program link at www.PIATX.org and print the applicable application and e-mail or fax it to us.

Do you want higher E&O limits but your carrier won’t quote what you want? That’s not a problem. Go to the E&O Program at www.PIATX.org and print the umbrella application from the link shown. Fill out the application and send it to us.

E&O Contacts

E&O Contacts

Houston area

Dallas area

Bob Dixon

Ray Reyes

bdixon@piatx.org

ray@piatx.org

866-577-7428

214-618-2365

832-375-0787 LIMRA Tests Americans’ Health Insurance IQ — Only 1 in 10 Americans Demonstrate a High Level of Knowledge About Health Insurance

Texas PIA’s Texas Connection

LIMRA found consumers with low levels of health insurance knowledge more likely to be younger, less affluent, less educated, more likely to be a student, unemployed or uninsured. The survey results also revealed that while consumers are more knowledgeable about what health insurance is and how to access care, many showed a tremendous lack of knowledge about plan features, the costs involved, and how various types of plans work.

The study found that few consumers (14 percent) understand how the public health exchanges, established by PPCA, will work. For uninsured consumers — who are most likely to use these exchanges — less than 1 in 10 know what types of plans will be available.

LIMRA also asked consumers to identify the deciding factor that would influence how they chose a health insurance plan. While cost is the number one criterion for both insured (36 percent) and uninsured consumers (60 percent) deciding on a plan, LIMRA found insured consumers are nearly as likely to consider how comprehensive the plan is as they are to consider its cost.

“Our survey confirms that consumers need help determining what types of coverage are available and what they should buy to best meet their need,” noted Potter. “Our industry can help by engaging and educating consumers now – so when they ultimately choose their health care insurance, it is done prudently.”

No one surveyed answered all ten questions correctly. (Take the quiz and compare your knowledge). http://www.limra.com/public/businessanalytics/default .aspx?tbid=39b78cbf-4c4f-4a80-bdc5-a5644cf7b6fe

Page 32

August, 2013

More “News, Satire & Opinions for Independent Agents from Independent Agents” at www.PIATX.org

This information from PIA is designed to be used in conjunction with the information and instructions that you receive from your NFIP WYO carrier.

We will also be adding: FROM: Richie Clements, PIA National Vice President / Treasurer & PIA representative to the National Flood Insurance Program (NFIP)

· Special NFIP bulletins, when the number or nature of the NFIP information is significant (as today’s set is).

RE: Next set of changes & reforms to National Flood Insurance Program (NFIP)

· Guides to additional informational materials that we have vetted, are still current and on-point. · A monthly column in PIA Connection, speaking more in-depth on particular areas, authored by PIA’s expert NFIP team. · A redesigned flood resource area on www.PIANET.com organized by subject area.

DATE: August 16, 2013 Ever since the passage of the Biggert-Waters Flood Insurance Reform Act in July 2012, which was preceded by additional reforms (H.R. 5740) in May, 2012, the National Flood Insurance Program (NFIP) has been in the midst of the longest running implementation of revisions to NFIP since the program began in 1968.

· Links in all our communications to source and additional reference documents. ·

This continuing onslaught of changes to NFIP creates a need for accurate information on the part of PIA members and affiliates.

This memo is the first in what will be a series of memos that detail these changes, provide links to the appropriate FEMA/NFIP bulleting regarding the changes and provide other important information.

Please Note: These changes can be confusing, due to the way they are being rolled out. While it would make sense to implement all of these changes at one time (following an education process), that is not what is happening. Due to pressure by Congress to issue these changes quickly, they have been coming out in periodic spurts. NFIP regularly issues a number of bulletins at a time, and some are revisions or updates that modify or rescind previously issued bulletins. This can get very confusing for PIA members and may cause them to rely on outdated information.

This is why the PIA NFIP Team has been formed, to help guide you through this maze. As best we can, we will keep you up to date, advising you of what information/materials need to be set aside and directing you to review and use the current information.

Texas PIA’s Texas Connection

We also offer to PIA affiliates qualified instructors and programs on NFIP topics, for your on-site PIA member CE programming.

NEW NFIP BULLETINS for October 1, 2013 Changes

In addition, PIA along with FEMA/NFIP FloodSmart and our nationally sponsored WYO partner, The Hartford Flood, have formed an expert PIA-NFIP Team to expand our communications, information and education outreach.

PIA members need to make sense of the onslaught of all the changes being made to the NFIP. They also need this to be organized in a manner that is manageable for agency operations. As our members assist their customers, the PIA-NFIP Team is here as a resource to support and assist our PIA affiliates and members.

Subject-specific webcasts.

The following bulletins comprise a major portion (but are not complete) of NFIP’s second major set of changes to be effective October 1, 2013. These are attached, posted on www.PIAnet.com and can be found on the NFIP site http://www.nfipiservice.com/bulletin_2013.html w-12059 Implementation of HR 5740 Section 2 This begins the first set of reform changes NFIP issued to be effective 01-01-2013. w-13026 Clarifications and Revisions to the 10/1/13, Program Changes issued 5/3/13 w-13038 Further Clarifications and (more) Revisions to the October 1, 2013, Program Changes issued June 25, 2013 These begin the second set of reforms for 10-012013, and relate to the actual 10-01-13 Manual changes. Attached is the cover letter summarizing the May clarifications and the complete bulletin for June revisions. These form the guide to use when moving through the balance of the materials. w-13043 October 1, 2013, Program Changes Impact on NFIP Grandfather Procedures NFIP attempts to clarify confusion about NFIP grandfathering provisions as to what still applies and aspects that no longer exist and/or evaporate due to change in policyholder status and/or lapse in coverage. w-13045 October 2013 Revisions to the NFIP Flood Insurance Manual

Page 33

August, 2013

More “News, Satire & Opinions for Independent Agents from Independent Agents” at www.PIATX.org

w-13047 Supplemental Revisions to the October 1, 2013, Program Changes w-13046 Final Letter Related to Processing Renewals of Certain Pre-FIRM Subsidized Policies that are New, Lapsed, or Assigned w-13048 Sample Letters Related to Processing Renewals of Certain Pre-FIRM Questions?: Please call on us and share your NFIP related questions, comments, concerns and / or suggestions through our team contact (patbo@pianet.org).

PIA Members Are Invited to Attend Series of Webinars on Biggert-Waters Changes to the National Flood Insurance Program presented by The Hartford Every Wednesday – from Wednesday, August 21, 2013 to Wednesday, September 25, 2013 – PIA National’s flood insurance partner The Hartford Flood will conduct a free informational webinar on the October 2013 changes to the NFIP mandated by the BiggertWaters Act of 2012 (BW12). PIA members are invited to attend.

Topic: BW12 October 2013 Changes Host: Marcia Eden Date: Every Wednesday, from Wednesday, August 21, 2013 to Wednesday, September 25, 2013 Time: 2:00 pm, Eastern Daylight Time (New York, GMT-04:00) Session number: 493 417 502 Registration password: This session does not require a registration password.

------------------------------------------------------To register for this session ------------------------------------------------------Go to https://thehartford.webex.com/thehartford/k2/j.php?ED=2 2106668&UID=0&HMAC=34f7a95c3cb04d54da0d56aea 1d6025e076e3186&RT=MiMxMQ%3D%3D and register.

Once the host approves your registration, you will receive a confirmation email with instructions for joining the session.

------------------------------------------------------For assistance ------------------------------------------------------You can contact Marcia Eden at: marcia.eden@thehartford.com

Texas PIA’s Texas Connection

Page 34

August, 2013

HARTFORD FLOOD NOW AVAILABLE TO PIA MEMBERS EASY ENROLLMENT. COMPETITIVE COMMISSIONS. EXCEPTIONAL SERVICE. The Hartford and PIA have joined together to provide PIA member agents the opportunity to offer your customers flood insurance through The Hartford.

The program is available to PIA members and their policyholders in all 50 states and Puerto Rico.

The PIA Advantage® As a participant in PIA National’s official flood insurance program, you have the power of PIA behind you. Our dedicated staff is here to help should you need assistance.

Furthermore, participating PIA members have access to the Flood Insurance Marketing Support Center – a PIA member-only benefit.

Contact Us For questions or more information about the program and how it can fit your agency, contact Joe Surowiecki, Hartford Flood Program Director, at 860-547-5006, Monday through Friday, 8:30 a.m. to 5:00 p.m. EST or learn more at www.pianet.com/floodinsuranceprogram.

Through its national flood insurance service center, The Hartford offers the most advanced Internet services available including: • Flood Zone Determinations • Claims Reporting • Policy Database Download and Maintenance • Electronic Application Submission • Electronic Movement of Premium Commission Funds • Rating Software Download • Production Reports • Assistance in Obtaining Elevation Certificates • Repetitive Loss Review

108389 Printed in U.S.A. © November 2012 The Hartford Financial Services Group Inc. Hartford, CT 06155 All Rights Reserved

More “News, Satire & Opinions for Independent Agents from Independent Agents” at www.PIATX.org

President’s Message Unintended Consequences from New Limited Auto Policy Law The squall that is limited forms is no different than TWIA, texting and driving, homeowners and a wealth of other insurance oriented bills that are presented in each session. There has been, and always will be change concerning insurance forms, processes, etc. We should not be surprised or hiding in the bushes worried about the next thing down the line as there will always be something new. In the same way that with one consumer complaint, we could be fighting a battle for agency fees or higher commissions and beyond. The good news is, that for the next two years we can continue to pursue the market with limited forms offering a competitive advantage in a wealth of situations.

Since I was curious to see how Empower and Old American was going to handle this issue I contacted Don Owens and he explained that Empower and Old American pushed this bill because it requires less of agents than they were already requiring in their underwriting guidelines. As with a review of the Empower forms, you can note, that verbal review of the endorsements is much more demanding than the simple statement required under the bill. Currently the signed portion of the disclosure is: The policy changes and limitations outlined here and referenced on the declarations page of my policy have been fully explained to me by my agent. I understand that I will receive my policy in the mail in a few days and should study the policy carefully. If I desire any changes to my coverage's or have any questions, I will contact my agent or the company at that time.

As you will note under the new law, the only requirement now is to just say a few words with no demand to cover the endorsements in full: WARNING: A NAMED DRIVER POLICY DOES NOT PROVIDE COVERAGE FOR INDIVIDUALS RESIDING IN THE INSURED’S HOUSEHOLD THAT ARE NOT NAMED ON THE POLICY. Further, as I know with Empower, if your loss ratio falls in a certain range, and you ask, you can print forms before binding. This solves any fear over the accepting payment before disclosure. You would think that other companies will adopt this method.

I spoke with Don about online sales and how this will work. They have discussed this with law makers and a simple audio file will play and the insured will select a box saying they heard the message. If they do not have speakers, there is a number they can call to audibly hear the verbal message, and again, check the box once heard. This will satisfy this simple concern. Empower will have all of their forms and online actions active long before the January due date.

The case of so called, “abuse” was one loss in North Texas where a Fred Loya client hit a State Farm customer of Rep. Ed Thompson.

Executive Director Eddie Emmett is contacting Texas Department of Insurance for more guidance and will share more on this topic in the September edition of Texas Connection.

Tony Harper President of PIA Texas

Texas PIA’s Texas Connection

Page 36

August, 2013

More “News, Satire & Opinions for Independent Agents from Independent Agents” at www.PIATX.org

Texas PIA’s Texas Connection

Page 37

August, 2013

More “News, Satire & Opinions for Independent Agents from Independent Agents” at www.PIATX.org

Contact Rick Pegram at http://RickRPegram.LegalShield.com

Texas PIA’s Texas Connection

Page 38

August, 2013

More “News, Satire & Opinions for Independent Agents from Independent Agents” at www.PIATX.org

Contact Rick Pegram at http://RickRPegram.LegalShield.com Texas PIA’s Texas Connection

Page 39

August, 2013

More “News, Satire & Opinions for Independent Agents from Independent Agents” at www.PIATX.org

Texas PIA’s Texas Connection

Page 40

August, 2013

More “News, Satire & Opinions for Independent Agents from Independent Agents” at www.PIATX.org

Texas PIA’s Texas Connection

Page 41

August, 2013

More “News, Satire & Opinions for Independent Agents from Independent Agents” at www.PIATX.org

Enjoy the video & more pictures at http://animoto.com/play/Axzf0KfWqV9jB1NInLwGYA

See you next year at San Antonio Texas PIA’s Texas Connection

Page 42

August, 2013

More “News, Satire & Opinions for Independent Agents from Independent Agents” at www.PIATX.org

Texas PIA’s Texas Connection

Page 43

August, 2013

AccuAuto Southern States Convention Hard Rock Hotel & Casino, Biloxi, MS

th

Sunday, October 13 – Tuesday, October 15

th

http://www.hardrockbiloxi.com Rooms only $109.00 for Sunday – Tuesday Call 1-877-877-6256 (1-877 U R ROCKN) and use Group Code AccuAuto

Sunday, October 13

th

1:00 p.m. – 5:00 p.m.:

Registration & Exhibit Setup

The Ledge

2:00 p.m. – 5:00 p.m.:

“Localize, Mobilize, Socialize”: 3 hours non- CE

Rock & Roll

5:00 p.m. – 7:00 p.m.:

Welcome Reception w/ Exhibitors

The Ledge

7:00 p.m. – 11:59 p.m.:

Hospitality

Entertainers Suite

9:00 a.m. – 12:00 p.m.:

“Insurance for Insurance Agents”: 3 hours non-CE

Rock & Roll

12:00 p.m. – 2:00 p.m.

Lunch on your own

2:00 p.m. – 5:00 p.m.

“Insurance Legislation Matters”: 3 hours non- CE

Rock & Roll

5:00 p.m. – 7:00 p.m.:

Prize Drawing w/ Exhibitors

The Ledge

7:00 p.m. – 11:59 p.m.:

Hospitality

Entertainers Suite

9:00 a.m. – 12:00 p.m.:

Internet Marketing Boot Camp (non-CE)

Rock & Roll

12:00 p.m. – 2:00 p.m.

Lunch on your own

2:00 p.m. – 5:00 p.m.

Social Media Boot Camp (non-CE)

Rock & Roll

5:00 p.m. – 11:59 p.m.:

Hospitality

Entertainers Suite

Monday, October, 14

Tuesday, October 15

th

th

Rock & Roll Meeting Room

The Ledge

Entertainers Suite

Enjoy Hard Rock Casino, Pool & Golf until 5:00 p.m. if you’re not attending the seminars Contact Jim St. Clair at (800) 229-2009 or (770) 242-6832 x 202 for info on Grand Bear Golf Course

Agents / CSRs pay $75.00 if registered by 09/13/2013 Exhibit Tables only $495.00

Online Registration at http://hardrock2013.eventbrite.com