Many people own life insurance, but let’s face it. It’s probably not a purchase that most people brag about to their friends like they might if they had just purchased a new Corvette, but they made the purchase anyway because they love their families and want their family to carry on living their current lifestyle in the event of the primary breadwinner’s untimely death. While this article doesn’t apply to people who own term insurance, those who bought permanent life insurance, which is life insurance with an additional savings component, will find this information very important.

To understand the problem, I will first give you a brief primer on life insurance, and then explain how something that seems like a sure bet can go so wrong. Life insurance can be separated in to two basic types, term and permanent life insurance. With term insurance a person pays a certain amount of money, called a premium, for a period of time, from one year up to 30 years. During the specified period of time, as long as the insured person is paying the premium, the insurance company is obligated to pay a certain amount of money, called a death benefit, to the insured person’s beneficiary in the event the insured person dies during that time period. If the person does not die in that time period the insurance company keeps the money as well as the earnings on that money. While there are different types of term insurance nowadays, including “return of premium” term which returns the insureds premium dollars at the end of the term(but not the earnings on the money), the general jist of term insurance is that a person is covered during a certain period of time. If they want coverage beyond that time period they have to buy another policy. Term insurance is really not the focus of this article so if that’s what you have you can stop reading now if you wish, and rest assured that as long as you pay the premium, and the insurance company remains financially solvent, your family will be paid in the event of your untimely death.

The other type insurance is called permanent insurance. Permanent insurance is insurance that has a death benefit to it, similar to term, but also contains a savings “sidecar”, this gives the policy a value called cash value. The premiums are paid on the policy, a portion is pulled to pay for the insurance and the remainder goes into the savings sidecar. There are three primary types of permanent insurance that vary depending on what is done with the savings component. The first type of permanent insurance is Whole Life Insurance. The savings component of Whole Life Insurance is invested in the general fund of the insurance company where it earns interest. The amount of interest apportioned to a particular individual is depended on how much of the money in the general fund belongs to that individual. Some policies if they are are “participating” policies also earn dividends. Generally speaking whole life policies are not a lapse danger as the amounts that it earns are guaranteed by the insurance company. As long as the insurance company remains solvent it will pay out a death benefit. The only problems a person who owns a Whole Life policy typically runs into is overpaying for insurance, and the death benefit not keeping pace with inflation.

The second type of permanent insurance is called Universal Life Insurance. With Universal Life Insurance the savings sidecar is a separate account, as opposed to Whole Life where the savings sidecar is invested into the general fund of the insurance company. Universal Life Insurance’s main advantage is it’s flexibility. For example, if you are a landscaper in the northeastern part of the country and basically have your winter months off, you could buy a Universal Life policy, fund it heavily during the spring, summer, and fall when you’re raking in the big bucks, and then not pay anything during the winter months. As long as there is a certain amount of money in the savings sidecar (based on insurance company formulas), nothing needs to be done. Also, if you need additional insurance because you just had a child, you don’t need to buy another policy. As long as you are insurable you can increase the death benefit on your current Universal Life Insurance policy and pay the extra premium. The money in the savings sidecar of a Universal Life Insurance policy is typically invested in ten year bonds. The Universal Life policy has a guaranteed interest rate to it, as well as a current rate. The money in the sidecar typically earns the slightly higher current rate, but the policy owner is only guranateed the guaranteed amount. Keep this last thought in your mind because after I describe Variable Insurance in the next paragraph, I’m going to tie these two together in the following paragraph and that final concept is the thing that’s going wrong

The final type of permanent life insurance is Variable Life Insurance. It can be either straight Variable Life Insurance, or Variable Universal Life Insurance, which combines the versatility of Universal with Variable Life Insurance. Variable Insurance came about due to the awesome bull market in stocks that ran basically uninterrupted from 1982 through 2000. People wanted to invest as much as possible in the stock market and the thought of investing money in an insurance policy that invested in lower yielding bonds was quite distasteful to many. So the Variable Insurance Policy was built. With Variable Life the savings sidecar can be invested in insurance “sub-accounts” which are basically mutual funds within a Variable Life, or Variable Annuity. In fact, many sub-accounts exactly mirror a particular mutual fund, some mutual fund managers manage both their respective fund as well as its sub-account “sister.” So with the Variable Life policy buying insurance no longer meant leaving the high flying stock market, you could have the best of both worlds by protecting your family AND investing in the stock market. As long as the savings in the sidecar was at an adequate level things were fine. Again, remember this last line because I’m about to show you how the whole thing goes to pot.

In the heyday of Universal Life Insurance and Variable Life Insurance interest rates were high and so was the stock market, and the insurance industry had two products that were custom designed to take advantage of the times. The problem came about when the agents designing these policies for the public assumed that the high interest rates and high flying stock market would never end. You see, whenever these products are sold, several assumptions have to be made outside of the guaranteed aspect of the policies which is typically about 3-5%, depending on the insurance company. The current values are paid out based on the prevailing rates or returns of the time, and that’s exactly how the policies were designed. I can still remember when I began in the insurance industry back in 1994, when the experienced agents in my office were were writing Universal Life with a hypothetical 10-15% interest rate. Variable Universal would be written anywhere between 10-20%. Happy days were here to stay. Or were they? Unfortunately, those interest rates started heading south about the mid-1990s, and as we all know, except for a couple of years, the stock market didn’t do so swell after the 2000 tech bubble, maybe two or three “up” years out of eight and possibly nine. This is a real problem because many families’ futures were riding on the assumptions that were made in these policies. Many policyowners were told to pay during their working years and then to quit when they retired and the policy would be fine, the returns earned on the savings sidecar would keep the policy in force. There are countless Universal and Variable Life policies in bank and corporate trust accounts, as well as in dresser drawers and fire proof safes that were bought and assumed that as long as the premiums were paid, things were good to go. Many of these policies are sick or dying as we speak. Some people, or trustees will get a notice letting them know that they need to add more money or the policy will lapse, of course by this time “red line” has already been reached. The people who get this notice may even ignore it because hey, the agent said that all would be well, “pay for 20 years and the family will be taken care of when I meet my maker.” So the policy will lapse and nobody will know it till it comes time for the family to collect their money, only to find out that they will meet the same fate as Old Mother Hubbard’s Dog. If anybody reading this can picture the litigation attorneys licking their chops, waiting to let insurance agents and trustees have it with both barrels for negligence, don’t worry that onslaught has already begun. But if you have one of these policies, don’t count on the 50/50 prospect of winning a court case, do something about it!

One of the first things I do when I get a new client that has an existing permanent life insurance policy is do an “audit” of that policy. Just like the IRS does an audit to find out where the money went, I do an audit to find out where the premiums went. The way this is done is by ordering what is called an “In Force Ledger” on the policy from the insurance company. The In Force Ledger will show the status of the policy now under current conditions, as well as several other scenarios paying more or less money. It will also show if the policy is lapsed or will lapse in the future. By doing this audit the policyholder may get something that they didn’t have before, OPTIONS!

For example, take a 50 year old policyowner, who is also the insured on the policy, and the In Force Ledger showed that the policy, under current condtions is going to lapse when the policyowner is 63 assuming premium payments were going to be kept the same, and stock market conditions were going to stay the same (this was in early 2007 and this policy was a Variable Universal Life, it probably would not have lasted till 63, given what has happened in the stock market.) Since the policyowner is the family breadwinner, they have a 16 year old daughter, and their savings could not sustain the wife and daughter in the event of an early death of the breadwinner, whether or not to keep the life insurance is not even a question, life insurance is absolutely needed in this case. Now the next question is, does he keep on paying on a policy that is going to lapse or write a new one? For that I go to some business associates at an insurance brokerage I work with, and find out how we can get a new policy without a huge increase in premium, in some cases the it is possible to get an increase in death benefit and a decrease in premium. How can this be done since the policyholder is older than when the policy is written? Easy. With the advances in medicine between 1980 and 2000 (the years the mortality tables used were written), people are living longer, conditions that used to cause death such as cancer, people are surviving and even live normal lives after the cancer is eliminated. It used to be you either smoked or you didn’t. Now allowances are made for heavy smokers, social smokers, snuff users, cigar smokers etc. One company will even allow mild cannabis use. So in some cases your policy may not be lapsing, but a person may be overpaying even though they are older. Maybe they smoked socially then, but quit 5 years ago, but their policy still has them listed as a smoker paying the same premium as someone that smoked like a chimney. What happens if the solution that makes the most sense is a new policy? We do what is called a 1035 Exchange into a new policy, that allows the cash value of the current policy to be transferred to the new one without being taxed. What if the insured doesn’t want another life insurance policy but wants to get out of the one they are currently in and not pay taxes? Then we do a 1035 Exchange to an annuity, either variable or fixed. I’m currently using a no-load annuity that works great and the expenses are low. Is a 1035 Exchange right in every situation? Absolutely NOT! Many things must be explored before making the exchange, especially on a policy written before 1988 when the tax law on insurance policies changed for the worse, in the above example it proved to be the correct move, but in the end it’s up to the policyowner and family as to what direction to go.

I have been a health insurance broker for over a decade and every day I read more and more “horror” stories that are posted on the Internet regarding health insurance companies not paying claims, refusing to cover specific illnesses and physicians not getting reimbursed for medical services. Unfortunately, insurance companies are driven by profits, not people (albeit they need people to make profits). If the insurance company can find a legal reason not to pay a claim, chances are they will find it, and you the consumer will suffer. However, what most people fail to realize is that there are very few “loopholes” in an insurance policy that give the insurance company an unfair advantage over the consumer. In fact, insurance companies go to great lengths to detail the limitations of their coverage by giving the policy holders 10-days (a 10-day free look period) to review their policy. Unfortunately, most people put their insurance cards in their wallet and place their policy in a drawer or filing cabinet during their 10-day free look and it usually isn’t until they receive a “denial” letter from the insurance company that they take their policy out to really read through it.

The majority of people, who buy their own health insurance, rely heavily on the insurance agent selling the policy to explain the plan’s coverage and benefits. This being the case, many individuals who purchase their own health insurance plan can tell you very little about their plan, other than, what they pay in premiums and how much they have to pay to satisfy their deductible.

For many consumers, purchasing a health insurance policy on their own can be an enormous undertaking. Purchasing a health insurance policy is not like buying a car, in that, the buyer knows that the engine and transmission are standard, and that power windows are optional. A health insurance plan is much more ambiguous, and it is often very difficult for the consumer to determine what type of coverage is standard and what other benefits are optional. In my opinion, this is the primary reason that most policy holders don’t realize that they do not have coverage for a specific medical treatment until they receive a large bill from the hospital stating that “benefits were denied.”

Sure, we all complain about insurance companies, but we do know that they serve a “necessary evil.” And, even though purchasing health insurance may be a frustrating, daunting and time consuming task, there are certain things that you can do as a consumer to ensure that you are purchasing the type of health insurance coverage you really need at a fair price.

Dealing with small business owners and the self-employed market, I have come to the realization that it is extremely difficult for people to distinguish between the type of health insurance coverage that they “want” and the benefits they really “need.” Recently, I have read various comments on different Blogs advocating health plans that offer 100% coverage (no deductible and no-coinsurance) and, although I agree that those types of plans have a great “curb appeal,” I can tell you from personal experience that these plans are not for everyone. Do 100% health plans offer the policy holder greater peace of mind? Probably. But is a 100% health insurance plan something that most consumers really need? Probably not! In my professional opinion, when you purchase a health insurance plan, you must achieve a balance between four important variables; wants, needs, risk and price. Just like you would do if you were purchasing options for a new car, you have to weigh all these variables before you spend your money. If you are healthy, take no medications and rarely go to the doctor, do you really need a 100% plan with a $5 co-payment for prescription drugs if it costs you $300 dollars more a month?

Is it worth $200 more a month to have a $250 deductible and a $20 brand name/$10 generic Rx co-pay versus an 80/20 plan with a $2,500 deductible that also offers a $20 brand name/$10generic co-pay after you pay a once a year $100 Rx deductible? Wouldn’t the 80/20 plan still offer you adequate coverage? Don’t you think it would be better to put that extra $200 ($2,400 per year) in your bank account, just in case you may have to pay your $2,500 deductible or buy a $12 Amoxicillin prescription? Isn’t it wiser to keep your hard-earned money rather than pay higher premiums to an insurance company?

Yes, there are many ways you can keep more of the money that you would normally give to an insurance company in the form of higher monthly premiums. For example, the federal government encourages consumers to purchase H.S.A. (Health Savings Account) qualified H.D.H.P.’s (High Deductible Health Plans) so they have more control over how their health care dollars are spent. Consumers who purchase an HSA Qualified H.D.H.P. can put extra money aside each year in an interest bearing account so they can use that money to pay for out-of-pocket medical expenses. Even procedures that are not normally covered by insurance companies, like Lasik eye surgery, orthodontics, and alternative medicines become 100% tax deductible. If there are no claims that year the money that was deposited into the tax deferred H.S.A can be rolled over to the next year earning an even higher rate of interest. If there are no significant claims for several years (as is often the case) the insured ends up building a sizeable account that enjoys similar tax benefits as a traditional I.R.A. Most H.S.A. administrators now offer thousands of no load mutual funds to transfer your H.S.A. funds into so you can potentially earn an even higher rate of interest.

In my experience, I believe that individuals who purchase their health plan based on wants rather than needs feel the most defrauded or “ripped-off” by their insurance company and/or insurance agent. In fact, I hear almost identical comments from almost every business owner that I speak to. Comments, such as, “I have to run my business, I don’t have time to be sick! “I think I have gone to the doctor 2 times in the last 5 years” and “My insurance company keeps raising my rates and I don’t even use my insurance!” As a business owner myself, I can understand their frustration. So, is there a simple formula that everyone can follow to make health insurance buying easier? Yes! Become an INFORMED consumer.

Every time I contact a prospective client or call one of my client referrals, I ask a handful of specific questions that directly relate to the policy that particular individual currently has in their filing cabinet or dresser drawer. You know the policy that they bought to protect them from having to file bankruptcy due to medical debt. That policy they purchased to cover that $500,000 life-saving organ transplant or those 40 chemotherapy treatments that they may have to undergo if they are diagnosed with cancer.

So what do you think happens almost 100% of the time when I ask these individuals “BASIC” questions about their health insurance policy? They do not know the answers! The following is a list of 10 questions that I frequently ask a prospective health insurance client. Let’s see how many YOU can answer without looking at your policy.

1. What Insurance Company are you insured with and what is the name of your health insurance plan? (e.g. Blue Cross Blue Shield-“Basic Blue”)

2. What is your calendar year deductible and would you have to pay a separate deductible for each family member if everyone in your family became ill at the same time? (e.g. The majority of health plans have a per person yearly deductible, for example, $250, $500, $1,000, or $2,500. However, some plans will only require you to pay a 2 person maximum deductible each year, even if everyone in your family needed extensive medical care.)

3. What is your coinsurance percentage and what dollar amount (stop loss) it is based on? (e.g. A good plan with 80/20 coverage means you pay 20% of some dollar amount. This dollar amount is also known as a stop loss and can vary based on the type of policy you purchase. Stop losses can be as little as $5,000 or $10,000 or as much as $20,000 or there are some policies on the market that have NO stop loss dollar amount.)

4. What is your maximum out of pocket expense per year? (e.g. All deductibles plus all coinsurance percentages plus all applicable access fees or other fees)

5. What is the Lifetime maximum benefit the insurance company will pay if you become seriously ill and does your plan have any “per illness” maximums or caps? (e.g. Some plans may have a $5 million lifetime maximum, but may have a maximum benefit cap of $100,000 per illness. This means that you would have to develop many separate and unrelated life-threatening illnesses costing $100,000 or less to qualify for $5 million of lifetime coverage.)

6. Is your plan a schedule plan, in that it only pays a certain amount for a specific list of procedures? (e.g., Mega Life & Health & Midwest National Life, endorsed by the National Association of the Self-Employed, N.A.S.E. is known for endorsing schedule plans) 7. Does your plan have doctor co-pays and are you limited to a certain number of doctor co-pay visits per year? (e.g. Many plans have a limit of how many times you go to the doctor per year for a co-pay and, quite often the limit is 2-4 visits.)

8. Does your plan offer prescription drug coverage and if it does, do you pay a co-pay for your prescriptions or do you have to meet a separate drug deductible before you receive any benefits and/or do you just have a discount prescription card only? (e.g. Some plans offer you prescription benefits right away, other plans require that you pay a separate drug deductible before you can receive prescription medication for a co-pay. Today, many plans offer no co-pay options and only provide you with a discount prescription card that gives you a 10-20% discount on all prescription medications).

9. Does your plan have any reduction in benefits for organ transplants and if so, what is the maximum your plan will pay if you need an organ transplant? (e.g. Some plans only pay a $100,000 maximum benefit for organ transplants for a procedure that actually costs $350-$500K and this $100,000 maximum may also include reimbursement for expensive anti-rejection medications that must be taken after a transplant. If this is the case, you will often have to pay for all anti-rejection medications out of pocket).

10. Do you have to pay a separate deductible or “access fee” for each hospital admission or for each emergency room visit? (e.g. Some plans, like the Assurant Health’s “CoreMed” plan have a separate $750 hospital admission fee that you pay for the first 3 days you are in the hospital. This fee is in addition to your plan deductible. Also, many plans have benefit “caps” or “access fees” for out-patient services, such as, physical therapy, speech therapy, chemotherapy, radiation therapy, etc. Benefit “caps” could be as little as $500 for each out-patient treatment, leaving you a bill for the remaining balance. Access fees are additional fees that you pay per treatment. For example, for each outpatient chemotherapy treatment, you may be required to pay a $250 “access fee” per treatment. So for 40 chemotherapy treatments, you would have to pay 40 x $250 = $10,000. Again, these fees would be charged in addition to your plan deductible).

Now that you’ve read through the list of questions that I ask a prospective health insurance client, ask yourself how many questions you were able to answer. If you couldn’t answer all ten questions don’t be discouraged. That doesn’t mean that you are not a smart consumer. It may just mean that you dealt with a “bad” insurance agent. So how could you tell if you dealt with a “bad” insurance agent? Because a “great” insurance agent would have taken the time to help you really understand your insurance benefits. A “great” agent spends time asking YOU questions so s/he can understand your insurance needs. A “great” agent recommends health plans based on all four variables; wants, needs, risk and price. A “great” agent gives you enough information to weigh all of your options so you can make an informed purchasing decision. And lastly, a “great” agent looks out for YOUR best interest and NOT the best interest of the insurance company.

So how do you know if you have a “great” agent? Easy, if you were able to answer all 10 questions without looking at your health insurance policy, you have a “great” agent. If you were able to answer the majority of questions, you may have a “good” agent. However, if you were only able to answer a few questions, chances are you have a “bad” agent. Insurance agents are no different than any other professional. There are some insurance agents that really care about the clients they work with, and there are other agents that avoid answering questions and duck client phone calls when a message is left about unpaid claims or skyrocketing health insurance rates.

Remember, your health insurance purchase is just as important as purchasing a house or a car, if not more important. So don’t be afraid to ask your insurance agent a lot of questions to make sure that you understand what your health plan does and does not cover. If you don’t feel comfortable with the type of coverage that your agent suggests or if you think the price is too high, ask your agent if s/he can select a comparable plan so you can make a side by side comparison before you purchase. And, most importantly, read all of the “fine print” in your health plan brochure and when you receive your policy, take the time to read through your policy during your 10-day free look period.

If you can’t understand something, or aren’t quite sure what the asterisk (*) next to the benefit description really means in terms of your coverage, call your agent or contact the insurance company to ask for further clarification.

Furthermore, take the time to perform your own due diligence. For example, if you research MEGA Life and Health or the Midwest National Life insurance company, endorsed by the National Association for the Self Employed (NASE), you will find that there have been 14 class action lawsuits brought against these companies since 1995. So ask yourself, “Is this a company that I would trust to pay my health insurance claims?

Additionally, find out if your agent is a “captive” agent or an insurance “broker.” “Captive” agents can only offer ONE insurance company’s products.” Independent” agents or insurance “brokers” can offer you a variety of different insurance plans from many different insurance companies. A “captive” agent may recommend a health plan that doesn’t exactly meet your needs because that is the only plan s/he can sell. An “independent” agent or insurance “broker” can usually offer you a variety of different insurance products from many quality carriers and can often customize a plan to meet your specific insurance needs and budget.

Over the years, I have developed strong, trusting relationships with my clients because of my insurance expertise and the level of personal service that I provide. This is one of the primary reasons that I do not recommend buying health insurance on the Internet. In my opinion, there are too many variables that Internet insurance buyers do not often take into consideration. I am a firm believer that a health insurance purchase requires the level of expertise and personal attention that only an insurance professional can provide. And, since it does not cost a penny more to purchase your health insurance through an agent or broker, my advice would be to use eBay and Amazon for your less important purchases and to use a knowledgeable, ethical and reputable independent agent or broker for one of the most important purchases you will ever make….your health insurance policy.

Lastly, if you have any concerns about an insurance company, contact your state’s Department of Insurance BEFORE you buy your policy. Your state’s Department of Insurance can tell you if the insurance company is registered in your state and can also tell you if there have been any complaints against that company that have been filed by policy holders. If you suspect that your agent is trying to sell you a fraudulent insurance policy, (e.g. you have to become a member of a union to qualify for coverage) or isn’t being honest with you, your state’s Department of Insurance can also check to see if your agent is licensed and whether or not there has ever been any disciplinary action previously taken against that agent.

Many Americans rely on their automobiles to get to work. No automobile means no job, no rent or mortgage money, no food. A single parent, struggling to make ends meet in the suburbs with 100,000 miles on the odometer, would presumably welcome the guaranteed opportunity for low-priced insurance that would take care of every possible repair on her auto until the day that it reaches 200,000 miles or falls apart, whichever comes first. Especially if the insurance is valid regardless of whether she even changes the oil in the interim.

So why aren’t the auto insurance companies writing such coverage, either directly or through used auto dealers? And given the importance of reliable transportation, why isn’t the public demanding such coverage? The answer is that both auto insurers and the public know that such insurance can’t be written for a premium the insured can afford, while still allowing the insurers to stay solvent and make a profit. As a society, we intuitively understand that the costs associated with taking care of every mechanical need of an old automobile, particularly in the absence of regular maintenance, aren’t insurable. Yet we don’t seem to have these same intuitions with respect to health insurance.

If we pull the emotions out of health insurance, which is admittedly hard to do even for this author, and look at health insurance from the economic perspective, there are several insights from auto insurance that can illuminate the design, risk selection, and rating of health insurance.

Auto insurance comes in two forms: the traditional insurance you buy from your agent or direct from an insurance company, and warranties that are purchased from auto manufacturers and dealers. Both are risk transfer and sharing devices and I’ll generically refer to both as insurance. Because auto third-party liability insurance has no equivalent in health insurance, for traditional auto insurance, I’ll examine only collision and comprehensive insurance — insurance covering the vehicle — and not third-party liability insurance.

Bumper to Bumper

The following are some commonly accepted principles from auto insurance:

* Bad maintenance voids certain insurance. If an automobile owner never changes the oil, the auto’s power train warranty is void. In fact, not only does the oil need to be changed, the change needs to be performed by a certified mechanic and documented. Collision insurance doesn’t cover cars purposefully driven over a cliff.

* The best insurance is offered for new models. Bumper-to-bumper warranties are offered only on new cars. As they roll off the assembly line, automobiles have a low and relatively consistent risk profile, satisfying the actuarial test for insurance pricing. Furthermore, auto manufacturers usually wrap at least some coverage into the price of the new auto in order to encourage an ongoing relationship with the owner.

* Limited insurance is offered for old model autos. Increasingly limited insurance is offered for old model autos. The bumper-to-bumper warranty expires, the power train warranty eventually expires, and the amount of collision and comprehensive insurance steadily decreases based on the market value of the auto.

* Certain older autos qualify for additional insurance. Certain older autos can qualify for additional coverage, either in terms of warranties for used autos or increased collision and comprehensive insurance for vintage autos. But such insurance is offered only after a careful inspection of the automobile itself.

* No insurance is offered for normal wear and tear. Wiper blades need replacement, brake pads wear out, and bumpers get dings. These aren’t insurable events. To the extent that a new car dealer will sometimes cover some of these costs, we intuitively understand that we’re “paying for it” in the cost of the automobile and that it’s “not really” insurance.

* Accidents are the only insurable event for the oldest automobiles. Accidents are generally insurable events even for the oldest autos; with few exceptions service work isn’t.

* Insurance doesn’t restore all vehicles to pre-accident condition. Auto insurance is limited. If the damage to the auto at any age exceeds the value of the auto, the insurer then pays only the value of the auto. With the exception of vintage autos, the value assigned to the auto goes down over time. So whereas accidents are insurable at any vehicle age, the amount of the accident insurance is increasingly limited.

* Insurance is priced to the risk. Insurance is priced based on the risk profile of both the automobile and the driver. The auto insurer carefully examines both when setting rates.

* We pay for our own insurance. And with few exceptions, automobile insurance isn’t tax deductible. As a result, the fear of increasing insurance rates due to traffic violations and/or accidents changes our driving behavior and we sometimes select our automobiles based on their insurability.

Each of the above principles is supported by solid actuarial theory. Although most Americans can’t describe the underlying actuarial theories, most everyone understands the above principles of auto insurance at the intuitive level. For sure, as indispensable automobiles are to our lifestyles, there is no loud national movement, accompanied by moral outrage, to change these principles.

Unsustainable Market

In contrast, similar principles are routinely violated in health insurance. To demonstrate this, let’s return to the same suburban mother from the opening paragraph. She’s busy working, driving to and from work, and driving her kids to school and activities. She ends each day exhausted, sitting on the couch with fast food. She’s obese, has a sedentary life, a bad diet, and hasn’t taken the time to go to the doctor in years. After a simple injury doesn’t heal for weeks, she turns up at the emergency room and learns she has type II diabetes. Although type II diabetes is controllable, changing diet and exercise habits and properly tracking her condition takes time and effort and she’s never quite successful in implementing the necessary lifestyle changes.

So the initial emergency room visit is only the first of a long list of health care related to non-controlled diabetes and other problems associated with obesity. Whether she has individual or group insurance, her insurance pays for each episode of care, without singling her out for a premium increase, and without charging her any more cost sharing than is charged to the healthiest and most medically diligent insureds. Her coverage continues until she voluntarily changes insurance companies and/or employers or becomes eligible for Medicare. If she’s covered under group insurance she may not even pay any premium. Her insurance continues unabated, even though the disease was caused by neglecting her body and she maintains her poor lifestyle even after the disease becomes known.

This just wouldn’t happen in auto insurance. This scenario is the auto insurance equivalent of guaranteed access to low-priced auto insurance that takes care of every possible repair, including damage already done, until the day the car falls apart so completely it’s unsalvageable (death) or reaches 200,000 miles (Medicare), regardless of whether she even changes the oil (takes care of herself) in the interim.

As a society, we don’t expect this in private-market auto insurance, but we expect it in private-market health insurance. Furthermore, there’s a chorus of national and state interests, which continuously pushes us further away from the auto insurance principles.

The current private health insurance market isn’t sustainable. Prices have been consistently increasing faster than inflation for decades. Each year, insureds use more health care than ever before and more people have no insurance at all. Most actuaries and other people in the private health insurance market don’t want national health insurance with its bureaucracy and one-size-fits-all benefits. Yet, we’re trying to sustain a private insurance system, which violates the very principles we know are necessary for private insurance markets.

Yes, health insurance involves the sacredness of human life and is therefore different from auto insurance. But if we’re to sustain a private-market solution to health insurance, actuaries need to explain to the larger society, in terms that society understands, the rationale for the following principles:

* As sacred as health care is, it’s still an economic transaction that has to be balanced by individuals and societies, against other economic choices. It can’t be unlimited. Sometimes it will be secondary to other choices. On a given day, for example, the mother in our scenario may value her car more than her health.

* Insurance premiums should be paid by the individual and tied to controllable risk factors. This will provide the best incentive for the control of risk factors.

* Although it’s hard to draw the line between abuse, neglect and ignorance, self-abuse shouldn’t be insured and we need to draw that line somewhere.

* The private market can’t provide unlimited, self-directed health insurance.

* Routine care and ongoing treatments of chronic conditions can be pre-funded, can even be subsidized, but they don’t constitute “insurable events.”

* Insurance can’t be expected to keep every human body in pristine condition. No amount of health care will prevent everyone’s ultimate death.

* Comprehensive, unlimited, non-subsidized private-market coverage isn’t possible for people with severely impaired health.

* The private health market can provide limited non-subsidized health insurance, such as protection from accidents, to even health-impaired individuals.

* Individuals who can afford to do so and who take good care of themselves should be able to “buy up” to better coverage. People have the option of buying up for everything else in life.

Discussion of these principles is lacking from most of the current health insurance debate. If society can intuitively understand how similar principles apply to health insurance, then they should be able understand the principles in the health insurance context. We need to initiate the debate.

Insurance for Your Business

September 14th, 2014

The importance of insurance cannot be over-emphasized and neither can the danger of paying for insurance you don’t need. It is strongly recommended you solicit the advice of an in-dependent business insurance agent. Don’t forget to SHOP! Talk to three or four independent agents and compare notes and prices. An insurance agent will lay out a vast array of insurance coverage much of which you simply may not need. Your situation will be unique and you must consider each insurance element carefully to ensure comprehensive coverage.

Whatever your final insurance program looks like, you should review it at least every six months. Your business can change rapidly, especially in the first few years and insurance needs change with it. Keep your program up to date by calling in your agent and reviewing your coverage. Make changes where necessary.

LIABILITY INSURANCE

This is probably the most important element of your insurance program. Liability insurance provides protection from potential
losses resulting from injury or damage to others or their property. Just recall some of the big cash awards you have read about that have resulted from lawsuits concerning liability of one kind or another and you will understand the importance of this insurance. Your insurance agent can describe the various types of liability insurance coverage that are available. If you will end up with a comprehensive general policy, make certain that the general policy does not include items you don’t need. Pay for only the insurance you need. For example, your business may not need product liability insurance.

Do not confuse business liability coverage with your personal liability coverage, both of which you need. Your personal coverage will not cover a business-generated liability. Check to be certain.

Compare the costs of different levels of coverage. In some cases a $2 million policy costs only slightly more than a $1 million policy. This economy of scale is true with most forms of insurance coverage. That is, after a certain value, additional insurance becomes very economical.

KEY PERSON INSURANCE

This type of insurance is particularly important for the sole proprietorship or partnership where the loss of one person through illness, accident, or death may render the business inoperative or severely limit its operations. This insurance, although not inexpensive, can provide protection for this situation. Key person insurance might also be necessary for others involved in your business.

SGC was a small firm run by three partners, a software programmer, marketer, and a general manager. Their product was a complex computer program used by aerospace firms. Al, the programmer, was involved in a severe automobile accident, became totally disabled, and SGC lost their programming capability. The problem was that the computer program written by Al was essentially the company’s sole product. Modifications to accommodate the customer became impossible and the time to bring another programmer up to speed was excessive. SGC lost considerable business as a result of this situation. These losses could have been offset by key person insurance.

DISABILITY INSURANCE

You, as a business owner, should be covered by disability insurance whether or not you decide on key person insurance. This insurance, along with business-interruption insurance, described below, will help ensure your business will continue to operate in the unfortunate situation where you are unable to work. Your disability insurance policy needs to provide satisfactory coverage. Particular attention should be paid to the definition of “disability,” delay time until payments start, when coverage terminates, and adjustments for inflation.

FIRE INSURANCE

Fire insurance, like all insurance is complicated and you should understand what IS and IS NOT covered. For example, a typical fire insurance policy covers the loss of contents but does not cover your losses from the fact that you may be out of business for 2-months while your facility is rebuilt. Fire insurance is mandatory whether you’re working out of a home office or you have a separate facility. You should discuss a comprehensive policy with your agent. Take the time to understand the details. For example, will the contents be insured for their replacement value or for actual value at the time of loss?

Consider a co-insurance clause that will reduce the policy cost considerably. This means that the insurance carrier will require you to carry insurance equal to some percentage of the value of your property. (Usually around 85%.) With this type of clause it is very important that you review coverage frequently so you always meet the minimum percentage required. If this minimum is not met, a loss will not be paid no matter what its value.

If you are working out of your home, your existing homeowner’s policy may not cover business property. If this is the case, have your insurance agent to add a home-office rider to your policy.

AUTOMOBILE INSURANCE

You probably already have automobile insurance but it might not include business use of your vehicle. Make sure that it does.

WORKER’S COMPENSATION INSURANCE

If you make the decision to hire employees, you will be required, in most states, to cover them under worker’s compensation. The cost of this insurance varies widely and depends on the kind of work being performed and your accident history. It is important that you properly classify your employees to secure the lowest insurance rates. Work closely with your insurance agent.

BUSINESS INTERRUPTION INSURANCE

This protects against loss of revenue as the result of property damage. This insurance would be used, for instance, if you could not operate your business during the time repairs were being made as a result of a fire or in the event of the loss of a key supplier. The coverage can pay for salaries, taxes, and lost profits.

CREDIT INSURANCE

This will pay for unusual losses as the result of nonpayment of accounts receivables above a certain threshold. As with all policies, you must thoroughly understand the details so discuss it with your insurance agent. One of the largest providers of this coverage is American Credit Indemnity, Baltimore, MD. (800) 879 1224.

BURGLARY/ROBBERY/THEFT INSURANCE

Comprehensive policies are available that protect against loss from these perils, including by your own employees. Make certain you understand what is excluded from coverage.

RENT INSURANCE

This policy covers the cost of rent for other facilities in the event your property becomes damaged to the extent that operations cannot continue in your normal location.

DISABILITY INSURANCE

This insurance will pay you an amount each month slightly less than your current salary in the event you become disabled and are unable to work. Cost for this coverage varies considerably depending on your profession, salary level, how quickly benefits start, and when they end. Benefits paid are tax-free only if you, not your company, pay the premiums.

This list could be continued since it is possible to purchase insurance for just about any peril you can imagine … if you can pay the premium! When considering your insurance coverage, use the following checklist:

INSURANCE COVERAGE CHECKLIST:

o Can you afford the loss?

o What coverage is required by Federal, state, or local law?

o What SPECIFIC items are covered by the policy?

o Are items to be insured for their replacement cost or original value?

o What SPECIFIC items are EXCLUDED by the policy?

o If there is a co-insurance clause, do you have adequate coverage?

o Have you chosen deductibles wisely in order to minimize costs?

o Do any of the policies you are considering duplicate or overlap one another?

o Do you need any insurance based on location, e.g., flood, earthquake?

Use the following checklist to review your insurance plans:

INSURANCE PLAN CHECKLIST:

o Employ an independent insurance agent rather than going to individual insurance companies. Ensure the agent shops for your insurance.

o Talk to and get quotations from at least THREE agents and pick the best one for you.

o Use money saving comprehensive policies, if possible.

o Perform periodic (every 6-months) reviews of your insurance program.

o Have business assets professionally appraised to determine coverage needs.

o Ensure existing personal insurance coverage includes business-related activities and add riders as necessary or obtain additional coverage.

http://www.TotalBusiness.com is a Website that provides business owners with the information they need in order to successfully start, manage, grow, and sell their businesses.

The site features over 3,000 articles and 60 guides on business topics such as starting a business, financing a business, sales and marketing, building a website, setting up an office, hiring employees, and selling a business. The site also contains articles on legal and accounting issues affecting businesses and allows business owners and entrepreneurs to get free expert advice from local lawyers or accountants. The site contains over 1,000 business forms and agreements that are helpful to business owners and provides a business directory with over 1,700 merchants who provide services specifically for small businesses.