The ACA Undergoes a New Legal Challenge

Several states have lodged a legal challenge to the entire Affordable Care Act (“ACA”) on the basis that the lack of an Individual Mandate tax makes the remaining provisions unconstitutional. While the Administration is not intervening, several other states are, defending the ACA’s sustainability without the Individual Mandate tax. No resolution to the legal questions is expected imminently, although the uncertainty that it causes could result in higher premiums now.

How will this affect employers? 

Visit our Healthcare Reform Resource Center to read more... 



25 Most Expensive Car Models to Insure

Thanks to advances in technology, cars come equipped with more capabilities than ever while also being assembled with speed and precision.  Technologies, such as blind spot detection and backup cameras, have become standard features and new concepts are being explored daily.  

Such advanced vehicles impact the type of insurance coverage needed. Among other factors, the make and model of the vehicle affects the type of coverage required. Between 2010 and 2016 car insurance premiums have increased by 33%. In a given year, insurance companies make claim payments of roughly $900 on average per vehicle. 24/7 Wall St. reviewed the 25 most expensive cars to insure and according to their analysis large or midsize luxury vehicles take the lead. The least expensive vehicles to insure are small to midsize SUVs. The data was provided by the Insurance Institute for Highway Safety, a nonprofit research organization funded by auto insurers.

Click here to check out the complete list of the 25 most expensive cars to insure.

2018 Spring Forecast: What To Expect In Commercial Insurance Pricing

After an initial spike in commercial property insurance rates due to record catastrophic losses in 2017, we are finally seeing reprieve.  This is not to say that we are not still facing upward pricing pressures on many lines of business for the remainder of 2018.

The industry's swift recovery following 2017 losses without widespread hardening or any insurer insolvencies indicates a "new level of resilience," said Joe Peiser, head of Broking, North America, Willis Towers Watson. Overall, the property/casualty marketplace remains well capitalized.

According to Willis Towers Watson's 2018 Insurance Marketplace Realities-Spring Update  report, most buyers can expect their insurance to rise in 2018, although not as dramatically as some expected last quarter. Individual lines of business are undergoing a combination of price increases and price decreases. 

The WTW spring report also acknowledges several lines of business where pricing has changed direction since their November report. For directors and officers liability, many buyers will now face increases of up to 5%. The environmental sector is experiencing its first hard market in over a decade. Buyers could face rate increases as high as 20% for site pollution liability coverage. 

"Navigating this dynamic marketplace demands a strategic approach, and buyers facing renewals should focus on creating submissions using distinguishing data and narratives to set themselves apart from their peers," advises Peiser.

Read the full article and check out spring report highlights along with price predictions for the remainder of 2018 here .


How to Safely Navigate Through a Winter Wonderland

Navigating roads during the winter season can be difficult and dangerous, especially during severe weather. Ice, snow and sleet create hazardous driving conditions for those on the road. Let's take a look at how you can keep yourself, your family and your vehicle safe when experiencing this extreme weather.

Prepare your car for the winter season

Ensuring that your vehicle is prepared for icy roads is the key and first step in making sure you are safe on the roads this winter. U.S. News & World Report, an online news magazine, suggests all vehicle owners follow several best practices to ensure their cars are ready for wintry conditions. This includes maintaining the proper inflation of tires at all times, as well as having them rotated and aligned regularly. Snow tires are also an option that should certainly be considered for the winter.   

Check those breaks! Brakes and brake pads should be regularly checked during the winter.  Not only should you guarantee your brakes and brake pads are safe, but also that all of the mechanical aspects of your vehicle are in optimal working order in case you encounter ice and heavy snow.  It is a smart idea to increase the amount of times you visit your car service center during the winter season.

Know how to handle ice

Once your car is prepared for the winter weather, it is important to know how to properly operate a vehicle on an icy road. Edmunds, an automotive publication, suggests being gentle with the brakes when you encounter ice.  Slamming on your brakes can result in total loss of vehicle. If you do begin to lose control, the website argues that you first take your foot off of the gas but not attempt to brake and allow the car to slow down. Braking is one of the most common mistakes drivers make during a slide on an icy road.

Winter roads are difficult to navigate no matter how long you have been driving. As such, Edmunds did note that taking a professional driving course that focuses on training for icy conditions can be beneficial. These courses are somewhat expensive, but can provide useful information to save your life (and your car). So consider taking a look at courses offered in your area. 

Check out the original article here.

Drive safely!!


Insurer Chubb Discontinues Participation in "NRA Carry Guard" Insurance Program

Giant insurer Chubb has joined a list of financial industry companies that are halting business deals with the National Rifle Association (NRA).  Symantec, which is a software company that offers an identity protection product called Lifelock, MetLife Inc., and  several car rental firms and banks have announced they are ending benefit offerings for NRA members. 

However, the insurer confirmed to Insurance Journal that the decision was made several months ago, before the latest mass shooting at a high school in Parkland, Florida.  "Three months ago, Chubb provided notice of our intent to discontinue participation in the NRA Carry Guard insurance program under the terms of our contract," the company stated.  Lockton, the insurance broker for the NRA-branded personal liability insurance policy for gun owners,  said it would no longer sell NRA-endorsed products. 

One gun control lobbying organization, Guns Down America, said that last November it petitioned Chubb to stop selling what it called "murder insurance" in cooperation with the NRA.  NRA Carry Guard provides coverage for gun owners who face legal or other costs for self-defense shootings.  The NRA website claims the insurance plans are for "those who lawfully carry firearms and their families" and include the cost to defend against civil and criminal legal actions and access to attorneys.  There are four plans associated with the policy: Bronze, Silver, Gold and Gold Plus with benefits ranging from $250,000 to $1.5 million in civil protection and from $50,000 to $250,000 for criminal defense costs.

To read more check out the following original articles:

Insurer Lockton will no longer sell NRA-endorsed policies

Chubb Decided to Quit NRA Insurance Program 3 Months Ago

Insurer Chubb says will stop underwriting NRA insurance for gun owners

Trump Administration Wants To Let Insurers Offer Plans With Fewer Benefits

The Trump Administration wants to allow insurance companies to offer more policies with more limited health benefits. Also, they would give these companies the authority to reject customers for pre-existing medical conditions.

These policies would not meet the legal requirements under the Affordable Care Act, as they offer only limited coverage. The argument for the relaxed requirements is that though the plans are limited, they would allow customers who cannot afford insurance now to find cheaper plans. These limited coverage plans are meant for individuals between jobs, or going through a life-transition when they cannot afford a more comprehensive plan. 

The Trump Administration also intends to extend the terms for short term plans from three months up to a year, or more. Short term plans do not have to include the minimum essential health benefits required to be an ACA-compliant policy; such as mental health care and prescription coverage. Also, insurance companies can refuse to offer coverage to someone with a preexisting condition, or charge more money if an individual is more likely to need more care.

"The expansion of short-term health insurance plans is part of a strategy to create a parallel insurance market that does not comply with the ACA's rules," Larry Levitt, senior vice president of the Kaiser Family Foundation, said on Twitter. The goal of the ACA was to ensure that everyone has access to quality health coverage without discriminating against those who have pre-existing medical conditions.

The new rules "can make these policies inexpensive, they also create plans with potentially inadequate coverage." They will also make it harder for sicker people to obtain the coverage they need, at a cost they can afford. 

The proposed rule is open for public comment for the next 60 days. Centers for Medicare and Medicaid Services, which runs the federal ACA exchange, is looking for input as to how long short-term policies should last, and whether consumers will be able to renew them, essentially turning them into permanent insurance options.

You can read more by checking out the original article written by Allison Kodjak for NPR, here.

DOL Penalties Increase for 2018

In 2015, Congress passed the Federal Civil Penalties Inflation Adjustment Act of 2015 (the “Inflation Adjustment Act”) to direct federal agencies to adjust the civil monetary penalties for inflation every year. Civil penalties ensure compliance with federal regulation by incentivizing employers not to violate federal regulation and providing federal agencies the power to ensure compliance. However, when penalties are too low, or have failed to be increased for inflation, compliance with federal regulation remains stagnant.

The Department of Labor (DOL) recently published the annual adjustments for 2018 that increase certain penalties applicable to employee benefit plans.

The updated penalties went into effect on January 2, 2018 and apply to penalties assessed after the effective date.

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Employer Action

Private employers, including non-profits, should ensure employees receive required notices timely (SBC, CHIP, SPD, etc.) to prevent civil penalty assessments. In addition, employers should ensure Form 5500s are properly and timely filed. Finally, employers facing document requests from EBSA should ensure documents are provided timely, as requested.

To read more, check out the original post on Capstone Compliance, here.

Winterizing Your Home: Prepare and Protect

Winter is snow joke. Snow, sleet, ice... there are plenty of winter perils to prepare for. Follow these simple steps and protect your home from the damage cold weather events can cause:

1.) Energy Efficient Improvements 

The very same steps you need to take to keep your heating costs down can also be viewed as protective for your home's structure and systems. These steps include:

  • Have a professional service provider inspect prepare your A/C, water, fuel, cent and other systems and pipes for the season
  • Consider replacing normal doors and windows with storm-proof products
  • Have your furnace serviced and change your filters
  • Evaluate your home for drafts and leaks. These are most common in attics, crawl spaces and basements

2.) Prevent Flooding - Roof and Drainage Updates

  • Clear all gutters of leaves and debris before the first snowfall. 
  • Remove snow from the roof after heavy accumulation
  • If your roof is sloped, place ice melt products on ice dams for safe, easy removal
  • Make sure drain pipes point away from your home to prevent flooding. Also be sure your irrigation system and lawn have been winterized

3.) Protect Your Plumbing - Prevent Bursts

  • Wrap exposed pipes and plumbing with insulation. Heat tape can be used to protect outside pipes; or those inside the home in non heated areas
  • Keep values and taps open to keep water moving. This prevents freezing and expansion, which causes cracks and damage
  • If the temperature is below freezing, keep your sinks dripping
  • When you leave your home, keep the temperature set warm enough to prevent freezing of any kind

You can read more from the original article here. 

Stay safe and warm this winter season!

Wintertime Risk Management Tips for Your Business

Snow, sleet, ice... oh my! Winter can interrupt your business operations at the drop of a snowflake. Prepare and protect your business from the perils of winter by following these risk management tips:

1.) Winterize - Deter Physical Threats

Some of the biggest risks of the season are frozen pipes and flooding. Be sure that your pipes are insulated and monitored. "Cost Helper, a website that aggregates statistics related to repairs and maintenance, states that a burst pipe can cost in excess of $3,800 if it is located in a wall or the building's foundation, while subsequent water damage can run up to $70,000."

Also, check that your building is protected from flooding. A little flood insurance never hurt anyone, and can be vital in the event of a major event. "The Federal Emergency Management Agency reports that about 40 percent of small businesses never reopen after a flood, as the average claim for one of these events is about $85,000."

2.) Watch the Walkway

Icy sidewalks and parking lots are other major risks to your business. If someone were to slip and fall outside of your building, you can be held liable for their medical bills. Some cities even penalize companies with tickets even if no one falls. Better to be safe than slippery!

3.) Have a Plan B

Make a plan in case a winter storm or other event were to endanger your employees' commute. If travelling becomes unsafe, it is important to have a contingency plan for telecommuting, if possible. If not, be prepared to possibly miss several days of productivity. 

Be sure to have a reliable way to efficiently communicate with your employees in the event of an unfavorable forecast. 

Prepare, be safe and stay warm! 



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    National Flood Insurance Program Extended to January 19th

    On Thursday, December 21, 2017, the U.S. House of Representatives voted to extend the National Flood Insurance Program once more, as part of a continuing resolution to keep the U.S. government open until Jan. 19. This vote was followed by U.S. Senate approval, and will temporarily avoid a government shutdown.

    In response to this decision, SmarterSafer* noted:“Kicking the can down the road is not a viable way to preserve the nation’s broken and bankrupt flood insurance system, especially as countless communities continue to recover from this year’s devastating hurricane season. Although we are pleased that Congress has avoided a lapse in the program, temporary extensions maintain an unsustainable status quo that resulted in a $45 billion taxpayer bailout and inadequate incentives for important mitigation measures. With the NFIP now set to expire on January 19th, we urge lawmakers to use this time to pass much-needed reforms to the NFIP, so the program can better protect lives, property and taxpayer dollars from a future of more frequent and severe storms.”

    The House adopted a bill in November to reauthorize the NFIP for five years, implementing several new forms, but the Senate has yet to vote on it. Currently, the program is about $25 billion in debt.

    To read more, visit the original article here. 

    *SmarterSafer is a a national coalition of taxpayer advocates, environmental groups, insurance interests, housing organizations and mitigation advocates

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    Legislation Updates: Healthcare Alert!

    Pennsylvania Legislation Update:

    House Bill 1553 takes on in-network balance billing. On December 11, 2017 the House Health Committee reported on House Bill 1553. This bill prevents a situation that occurs when a patient goes to an in-network hospital or emergency room wherein the provider subcontracts services such as Emergency Room Physicians, anesthesiology, to a non-network provider. In this scenario, the patients were hit with a large non-network bill.

    House Bill 1553 requires in-network billing for all services of in-network facilities. The bill has the support of 20 republican sponsors and 11 Democrats. Both the majority and minority chairs of the House Health and House Insurance Committees support this bill. 

    This bill will make many Pennsylvanians lives easier when accessing emergency care.

    More to come soon as this passes through the House and Senate!


    National Republican Tax Reform Bill:

    The final tax reform bill, set to be voted on today, includes a repeal of the individual mandate, lifting the penalty imposed on individuals who decide not to buy coverage. 

    What this will do for individuals purchasing health care currently is unclear. 

    The change takes place for 2019. I believe this will be the first step for the GOP to unravel the ACA law that it failed to repeal and replace earlier this year. 


    Daniel M McGill, CIC, CBC   Senior Vice President  Capstone Group

    Daniel M McGill, CIC, CBC

    Senior Vice President

    Capstone Group


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    2017's 10 Most Hazardous Toys

    As last-minute holiday shopping ramps up, the Boston-based nonprofit World Against Toys Causing Harm, Inc. (W.A.T.C.H.) has released its annual list of the 10 worst toys of 2017, informing shoppers of this year’s most potentially hazardous toys.

    W.A.T.C.H. says consumers are expected to spend 51% of their holiday budget online. This year’s report highlighted retail store purchases and also took close look at the impact of online purchasing when it comes to toy safety.

    According to the Consumer Product Safety Commission (CPSC), in 2015 there were over 254,200 toy-related injuries, and between 2010 and 2015, 72 children died in toy-related incidents.

    W.A.T.C.H. says consumers buying toys on the Internet are already at a disadvantage, as they are unable to touch and physically inspect a toy and its packaging at the time of sale for more obvious hazards. In some cases, limited product information on e-commerce sites can lead to misinformed, and potentially dangerous, consumer toy purchases.

    The organization's annual list provides highlighted information about the products' warning labels, specified hazards, manufacturers and sellers. 

    Click here to view W.A.T.C.H's list of 2017's most hazardous toys...

    Source: Property & Casualty 360


    Message from Aetna CEO on Proposed CVS Deal

    This week, CVS Health announced that they have agreed to buy Aetna for an estimated $69 billion in a deal that would combine one of the largest drugstore chains with one of the largest health insurers in the United States. The joining of these two healthcare giants has the potential to drastically change how consumers access and utilize care. 

    In an effort to keep our clients informed, we wanted to share the letter we received from Aetna's CEO, Mark Bertolini, regarding the transaction. As of now, the deal is set to close in the second half of 2018. Our Benefits & Compliance Teams will continue to monitor the situation and provide our clients with updates as they materializeOur Benefits & Compliance Team will continue to monitor the situation and provide updates as they come in. 

    If you have any questions on how this deal may impact you or your employees, please feel free to contact our Benefits Team at 


    10 Notable Cyber Incidents Involving Retailers

    Our partners at Advisen, Ltd. put together a list of data breaches that have cost retailers hundreds of millions of dollars. With the holiday season approaching, it's more important now than ever for retailers to take the necessary precautions to protect customer information and have the insurances to help sustain their business in the event of a large scale breach. 

    Homeowner Hacks: Prevent Damage to Prevent Claims

    Did you know that 1 in 15 insured homes will experience a property damage claim this year? Protect your home by following these 7 easy steps:

    1. Use smoke detectors - and don't forget to change the batteries!
    2. Clean dryer vents - not only will it make your clothes less linty, but failure to do so can be a fire hazard.
    3. Monitor appliances while in use - don't wander too far away while your toast is toasting!
    4. Annually review your insurance coverage - your agent will be happy to help, and it is important to check for any possible gaps. 
    5. Use a home security system - it will even get you a discount on your insurance! Other security options can be as simple as installing deadbolt locks to prevent break-ins. 
    6. Remove snow from your roof - by clearing the edges of your roof, you prevent snow from melting and then refreezing to block drains, causing seepage into your home. 
    7. Use water leak sensors - these little gadgets sound an alarm when they detect water, making it easy to detect a problem before it causes widespread damage. 

    Hack your home today!

    Read more at the original article on CNBC here. 

    Hard times & Hardened Prices - The Aftermath of Natural Disasters

    In the aftermath of the recent natural disasters, the insurance industry is facing monumental losses. Between hurricanes Harvey, Irma, Maria and recent earthquakes in Mexico, the expected losses total in the ballpark of $100 billion. According to industry executive Jonathan Reiss, group chief financial officer at Hamilton Insurance Group, insurance prices will need to harden in order to mitigate the damage. 

    “There’s no question that rates are going to harden in some lines of business,” Reiss said during a speech at InsuranceERM’s Insurance Risk & Capital Conference. “Terms and conditions are going to tighten. You can call it what you will – a market turn, a hardening.”

    Reiss says that the prolonged period or low-to-no interest rates and minimal natural disasters had previously kept prices low, not permitting much cushion for catastrophe. Combine this trend with the high frequency, high cost nature of the emerging hazards related to cybersecurity and climate change, and you have a recipe for disaster. As Reiss puts it, "This market cycle is forcing our industry to face some inconvenient truths."

    Read the original article by Ryan Smith for Insurance Business Magazine, here

    Photo source here

    Trump Halts Cost-Sharing Reductions

    On Thursday, October 12, 2017, the White House indicated that President Trump will end ACA cost-sharing reduction (“CSR”) payments to insurance companies effective immediately. This was followed up by a White House statement indicating that the payments had lacked appropriations and therefore the government could not lawfully continue making them. While the impact to insurance companies and individuals who obtain subsidized coverage in the Marketplace is expected to be significant, the direct impact to employers and employer sponsored health plans is expected to be minimal.

    Implications for Employers

    The direct impact of this decision is minimal. Applicable large employers (“ALE”) - those with 50 or more full time equivalent employees - are subject to ACA employer shared responsibility “A” or “B” penalties for failure to offer affordable and/or minimal value coverage to fulltime employees, if one or more of those employees obtain a subsidy or CSR in the exchange.

    Even if CSRs are eliminated, since a prerequisite to an individual obtaining a CSR subsidy is to qualify for a premium reduction subsidy, there should be no change to an ALE’s “A” or “B” penalty exposure since premium reduction subsidies are not impacted by this White House decision.

    Further, since an ALE must make an offer of affordable and minimum value coverage in order to avoid “A” or “B” penalties, we do not anticipate a significant increase in employees forgoing coverage in the Marketplace and enrolling in employer sponsored plans (since those individuals would generally have been ineligible for Marketplace subsidies due to the employer’s offer of affordable and MV coverage in the first place).

    Additionally, if carriers exit the Marketplace or otherwise cancel plans in light of this change in policy, employers may see an increase in requests for special enrollment in their group health plans due to the loss of eligibility for Marketplace coverage.

    The indirect implications are less clear. Stopping CSR payment will make individual insurance more expensive in the Marketplace. This may lead to carriers dropping out of the Marketplace, or if they remain, pricing plans beyond the reach of those individuals who previously benefited from CSR payments. This will likely result in an increase in the uninsured population. All payers in the health care system are affected by higher costs when there is a high uninsured population receiving uncompensated care.


    Read more:

    New Executive Order and Insight on the Employer Mandate

    President Trump signed an Executive Order (“EO”) on October 12, 2017, directing various federal agencies to take regulatory action that will “increase health care choices for millions of Americans.”

    Employers should:

    • Be aware that we are likely to see new regulations addressing AHPs, HRAs, and STLDIs in the coming months. While changes to existing AHP and HRA rules are unlikely to affect 2018 plan years, such guidance may create challenges for 2019 and beyond.
    • As the Administration signaled its intent to enforce the Employer Mandate: • Plan for compliance with the 2017 ACA reporting. The final Form 1094-C, Form 1095-C and Instructions are available.
    • Prepare to address any notices issued by the IRS regarding Employer Mandate assessments for the 2015 and 2016 calendar year.

    Read More:

    Tune In to Health Care: Exclusive Webinar

    The Capstone Group's employee benefits team invites you to tune in to an exclusive webinar presented by Keystone Insurers Group and the National Association of Health Underwriters (NAHU).

    The webinar will take place on Oct. 2nd   2PM - 4PM EDT, and will feature NAHU Vice President of Government Affairs Marcy M. Buckner. Marcy will break down the future of the ACA and health insurance politics and policy, including recent legislative and regulatory actions by Congress and the Trump Administration.

    More specifically, the session will examine the legislative actions that have been taken so far and why, political barriers and their significance, the role of the NAHU and the agent/broker community, and what we can expect for the future of healthcare and employee benefits. 

    Don't miss this opportunity to stay informed.

    Register today at:

    Upon registration, you will be asked for your Organization Name. If none, list "Keystone."



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    FEMA Could Run Out of Money by Friday

    They say lightning doesn't strike twice, but what happens when hurricanes do? With the U.S. still dealing with the devastating effects of Hurricane Harvey on Texas, and Irma right around the corner on its way to Florida, a Senate aide has disclosed that the Federal Emergency Management Agency is expected to run out of money by Friday unless more funding is approved by Congress.

    "As of 10 a.m. Tuesday morning, FEMA’s Disaster Relief Fund, which pays for the agency’s disaster response and recovery activity, had just $1.01 billion on hand. And of that, just $541 million was “immediately available” for response and recovery efforts related to Hurricane Harvey, according to a spokeswoman for FEMA who asked not to be identified by name."

    At this rate, funding will run out by the time Irma hits Florida, and as a category 5 hurricane, it is expected to do significant damage. Nearly $8 billion has been requested in additional funding, awaiting approval from Congress. 

    "The House is voting Wednesday on funding for Harvey. The Senate, which is expected to act this week as well, is considering whether to add a suspension of the federal debt limit to the measure. The legislation would then go back to the House."

    For now, spending has been restricted to "lifesaving, life-sustaining efforts for Harvey and Irma." But more money will be needed, and very soon. And the most troublesome of all? It isn't even peak hurricane season yet.

    To read more, check out the original article, written by Christopher Flavelle and Erik Wasson here.

    Photo from ABC, Inc.: