CAPSTONE GROUP NAMES ERICA HAIN PRACTICE LEADER, EMPLOYEE BENEFITS DIVISION

Spring House, PA., December 6th, 2023  – Capstone Group, a leading provider of risk management, employee benefits, and insurance brokerage services headquartered in Spring House, PA, is pleased to announce the appointment of Erica Hain as Practice Leader for the firm’s Employee Benefits Division.

In this new role, Hain will be responsible for overseeing many core functions of Capstone’s Employee Benefits Division, including but not limited to: vendor & partner relationships, product & strategy development, account management, client services, and continuing to ensure an exceptional customer experience.

“As we’ve continued to grow Capstone over the years, so too have the needs of our team and our clients.” said Kevin Fox, Managing Partner of Capstone. “We’re thrilled to be in a position to strategically invest in our leadership structure to best support our current and future team members and continue providing exceptional client experiences and outcomes.”

“Our Executive Team has known Erica for a long time,” remarked Dan McGill, Partner and EVP of Capstone. “We’ve been fortunate to cross paths over the years and have always admired her approach to the business. She is an innovative leader with a proven track record of managing high-performing teams, resolving complex challenges, and implementing forward-thinking solutions within our industry. We are very glad that timing has aligned for her to bring that experience and knowledge to our team and to our clients.”

A graduate of Lycoming College, Hain joins Capstone Group with 30 years of sales and leadership experience in the insurance industry. Prior to Capstone, Hain served in roles on both the broker and carrier sides. She also served as vice president of the benefits division for Pennsylvania and Virginia at Keystone Insurers Group Inc., Northumberland, where she worked directly with agency partners and their clients. Hain was also a broker and relationship manager with Emerson Reid & Company. Hain is actively involved in her local Society of Human Resource Management (SHRM) organization as well as the National Association of Benefits and Insurance Professionals (NABIP) where she served 4 years as the Region 2 Vice-President on the NAHU Board of Trustees. She has served in several chair positions locally, at the state level and nationally. She is the past local president of the Central Pennsylvania Chapter (2007-2009.) She is the past president of the Pennsylvania State Chapter (2005-2007.) She served twice as National Chair for the Chapter Leadership & Development Committee.

"I am honored and excited to join Capstone Group as the Employee Benefits Practice Leader,” said Hain. “I am eager to bring my expertise to a team that values innovation, employee well-being, and client satisfaction. Together, we will navigate the dynamic landscape of employee benefits, focusing on delivering strategic solutions that enhance the overall employee experience and contribute to the continued success of our clients. I look forward to collaborating with our talented team and contributing to the growth and success of Capstone.”

Contact:

Erica Hain

Practice Leader - Employee Benefits

Email: ehain@capstonegrp.com

Office: 215-542-8030

Directors & Officers Liability (D&O): Beyond the Dec Page

There are many elements to consider when choosing to first purchase or renew a directors & officers liability (D&O) policy. These include the limit of insurance you wish to carry, whether that limit will be shared with other coverages such as employment practices or fiduciary liability, and how much risk you wish to retain via a policy retention. However, there are many other provisions of a D&O policy that warrant taking a closer look at when final decisions are made. In this article, we will review retroactive dates, the duty to defend provision, and the hammer clause.

As you may be aware, a majority of D&O policies are written on a “claims-made” basis. This means that in the event of a claim, it will be the policy in place at the time the claim is made that is responsible for providing coverage (if in fact it is a covered claim). Because of this open-ended period of coverage, many insurance companies will add a “retroactive” date to the policy. This establishes a starting line for the period of coverage for incidents that could give rise to a claim. In many instances, the retro date will be the inception date of D&O coverage and will remain the same even as the policy renews each year. With this, it is very important to ensure that the retroactive date is not amended if D&O coverage is moved to a different carrier. Lastly, while retroactive dates are common when writing a claims-made policy, there are some insurance companies that will provide “full prior acts” coverage, which do not restrict past events by way of a retroactive date.

The second two coverage provisions apply to the defense of a covered D&O claim. The first is the Duty to Defend Provision, which at a high-level is simply stating who is responsible for defending a claim. This is usually the first item addressed in the Defense Section of the Policy Conditions. When a policy is categorized as “Duty to Defend,” it is the insurance company that has the right and duty to defend a claim. The other option is a Duty to Indemnify or Reimbursement Policy, where it is the responsible of the policyholder to defend a claim. The main impact of this provision pertains to which party chooses defense counsel. If a policyholder would prefer that the insurance company take charge when a claim is made, then they are well-suited with a Duty to Defend policy. However, if they would like to take ownership of defense, or have preferred legal counsel that they would like to use, subject to carrier approval, then they would be better suited with a Duty to Indemnify or Reimbursement Policy. With that said, both Duty to Defend and Duty to Indemnify policies require the policyholder to cooperate with the insurance company in the defense of claims.

The final coverage provision is the Hammer Clause. This provision is similar to coinsurance on a property policy, where it shifts more risk onto the policyholder in certain claim scenarios. It states that the insurance company must obtain consent from the policyholder to settle a claim. However, if the policyholder does not provide consent to settle, then they will be responsible for a set portion of defense costs and paid judgment beyond the original settlement offer. For example, ABC Advisors has a D&O claim, and their insurance company is recommending they settle for $100,000. ABC does not wish to settle, but also has an 80/20 Hammer Clause on their policy. If the claim eventually settles for $175,000 plus an additional $25,000 of defense expenses, then ABC Advisors would be responsible for $20,000 of the additional claim costs.

As you can see, there is much more to a directors & officers liability policy than what is listed on the declaration page. If you have any questions, or wish to discuss the coverage in greater detail, please contact a member of our Commercial Property & Casualty Team.

Contact Us:

Bill Mooney

Director, Commercial Insurance

bmooney@capstonegrp.com

Office: 215-542-8030

Capstone's Briana Scafidi Named to GPAHU Board of Directors

Capstone Group is pleased to announce the appointment of Briana Scafidi to the Greater Philadelphia Association of Health Underwriters (GPAHU) Board of Directors.

The GPAHU is the largest and most active local chapter of the National Association of Benefits and Insurance Professionals (NABIP), formerly the National Association of Health Underwriters. GPAHU represents hundreds of licensed health insurance agents, brokers, consultants and benefit professionals throughout the Greater Philadelphia region who serve the health insurance needs of employers and individuals. The GPAHU’s mission is to support initiatives and legislation that provides quality, healthcare solutions for all Pennsylvanians.

“Briana’s appointment to the GPAHU Board of Director’s only further validates her dedication to making a difference in our industry and for the clients we serve,” remarked Dan McGill, SVP of Capstone’s Employee Benefits Division. “From the moment she joined our firm, Briana has been committed to personal growth and development within our industry. Her willingness to go above and beyond continues to elevate those around her. These qualities have made her an invaluable asset to our team and are what will also make her a tremendous addition to the GPAHU Board.”

In addition to being a member of the Board of Director’s, Briana is also the Emerging Leader Program Coordinator for the GPAHU, which provides up and coming individuals in the healthcare insurance industry with personal and professional growth opportunities.

For more information on the GPAHU:

Greater Philadelphia Association of Health Underwriters

GPAHU Emerging Leaders Program

Prescriptions & Premiums: How Rising Drug Costs Impact Your Health Insurance

Prescription drug costs in the United States have been rising steadily over the past few decades, and the impact of these rising costs on corporate health insurance plans has been significant. The high cost of drugs and pharmacy services has been a major contributor to the rising cost of healthcare in the United States, and it is a problem that affects everyone, from patients to employers.

According to a recent report by the Kaiser Family Foundation, the cost of prescription drugs has been rising faster than any other component of healthcare spending in the United States. The report found that in 2019, the average cost of a brand-name prescription drug in the United States was $6,798, up from $1,869 in 2006. Generic drugs have also seen price increases, with the average cost of a generic prescription drug rising from $90 in 2010 to $140 in 2019.

These rising costs have had a significant impact on corporate health insurance plans. Employers are finding it increasingly difficult to provide affordable health insurance coverage to their employees, and many are passing on the costs of prescription drugs and pharmacy services to their employees in the form of higher deductibles and co-pays. This, in turn, has made it more difficult for employees to access the medications and treatments they need to manage their health conditions.

According to the AHIP, over 22% of all commercial health plan premiums go towards Prescription Drug costs, while only 11% go towards Doctor Visits and 3.3% towards Emergency Room Costs.

The impact of rising drug costs on corporate health insurance plans has been particularly acute for small and medium-sized businesses. These businesses typically have fewer employees and less bargaining power when negotiating with health insurance providers and pharmacy benefit managers (PBMs). As a result, they often end up paying higher prices for prescription drugs and pharmacy services than larger businesses with more flexibility and options in regards to the group health insurance offerings.

A few of the reasons for our heightened costs of prescription drugs in the United States is increased pressure for expensive R&D, and the lack of price regulation and transparency. Unlike in many other countries, the United States does not have a centralized authority that negotiates drug prices on behalf of the entire population. Instead, drug prices are set by the manufacturers, and insurers and PBMs negotiate prices with the manufacturers on a case-by-case basis.

There are some efforts underway to address the problem of rising drug costs in the United States. For example, several states have passed laws allowing the importation of prescription drugs from Canada and other countries where drug prices are lower. However, these efforts are limited in scope and may not be enough to address the larger problem of rising drug costs.

Larger employer groups and organizations that are “experience rated”, or in an alternative-funded group health arrangement, often have an opportunity to directly impact their prescription drug spend, thus directly impacting their group health insurance costs. As opposed to “fully-insured” health plans that include bundled vendors with little flexibility, many self-funded programs allow for an unbundling of services including Pharmacy Benefit Managers (PBMs), which gives the group more power to negotiate the most favorable contracts, pricing, and rebates. In addition to the PBM flexibility, these groups also have the ability to implement proactive drug advocacy and oversight programs to further control and reduce annual drug spend while still providing optimal care and coverage to their employees. We recommend speaking to your broker or consultant regarding these options, or contact a member of our Capstone Benefits Team for more information: Benefits@CapstoneGrp.com

In conclusion, the rising cost of prescription drugs in the United States continue to negatively impact corporate health insurance plans, and ultimately consumers & patients. While there are some efforts underway to address the problem, more needs to be done to ensure that everyone has access to the medications and treatments they need at a price they can afford. This will require a concerted effort by policymakers, healthcare providers, consultants, and the pharmaceutical industry to find solutions that work for everyone.

Admitted vs. Non-Admitted Insurance Carriers

In the wake of the collapse of Silicon Valley Bank, the Federal Deposit Insurance Corporation (FDIC) has been brought to the spotlight. The FDIC provides certain levels of insurance for depositors in case their bank fails, becomes insolvent, or goes out of business.

Over the last few days, our Capstone Team has fielded questions regarding similar scenarios in which insurance companies fail or become insolvent, and protections or backstops that might be available to insureds in those situations. Those questions lead to an important distinction between: Admitted vs. Non-Admitted insurance carriers.

Admitted Insurance Carriers

Admitted insurance carriers are insurance companies that are licensed by the state government to sell insurance within the state. They are required to comply with state regulations and file their rates with the state's insurance department. Admitted carriers must also participate in state insurance guaranty funds, which provide coverage and steps in the pay claims in the event the insurance company becomes insolvent; similar to the FDIC insurance we’ve been hearing about recently.

Advantages of Admitted Insurance Carriers:

1. Regulated by the state: Admitted carriers must comply with state regulations, ensuring that they follow fair and consistent underwriting practices.

2. Participation in insurance guaranty funds: Admitted carriers participate in state insurance guaranty funds, which provide protection to policyholders in the event the carrier becomes insolvent.

3. Higher level of consumer protection: Admitted carriers must comply with state regulations, providing an additional layer of protection to policyholders.

Disadvantages of Admitted Insurance Carriers:

1. Limited flexibility: Admitted carriers must comply with state regulations, which can limit their ability to tailor policies to meet specific needs.

2. Limited availability: Admitted carriers are only licensed to operate within specific states, which can limit policy options for businesses with multi-state operations.

Non-Admitted Insurance Carriers

Non-admitted insurance carriers are insurance companies that are not licensed by the state government to sell insurance within the state. They do not have to comply with state regulations and do not participate in state insurance guaranty funds.

Advantages of Non-Admitted Insurance Carriers:

1. Greater flexibility: Non-admitted carriers are not subject to state regulations, allowing them to offer more flexible policies to meet specific needs.

2. Broader coverage options: Non-admitted carriers are not limited to state-specific regulations, allowing them to offer coverage in multiple states.

Disadvantages of Non-Admitted Insurance Carriers:

1. Lower level of consumer protection: Non-admitted carriers are not subject to state regulations, providing less protection to policyholders.

2. Higher risk: Non-admitted carriers are not required to participate in state insurance guaranty funds, increasing the risk of financial loss in the event the carrier becomes insolvent.

3. More expensive: Non-admitted carriers may charge higher premiums due to their increased risk exposure and lack of state oversight.

Which Option is Right for You?

Most businesses carry several different types of commercial insurance policies. Some policies may be through an admitted carrier, others may be placed through non-admitted carriers it’s not a “all or none” situation. Deciding between an admitted or non-admitted insurance carrier will depend on a variety of factors, including the types of coverage needed, the specific needs of the business & industry in which you operate, and the organizations’ level of risk tolerance. For businesses that require coverage in multiple states or have unique or higher-hazard operations, a non-admitted carrier may offer greater flexibility. However, for businesses that prioritize consumer protection and the assurances of the state guarantee fund, an admitted carrier may be the better option.

In conclusion, admitted and non-admitted insurance carriers offer distinct advantages and disadvantages. The correct direction differs on a case-by-case, and even a policy-by-policy basis. It's essential to work closely with your trusted insurance & risk management advisor to carefully evaluate the specific needs of the business and level of risk tolerance, and understand the options available to you, before selecting an insurance carrier for all lines of coverage.

CONTACT US:

Thomas Fox, clcs

Risk Management Advisor

tfox@capstonegrp.com

Office: 215-542-8030

2023 Property & Casualty Market Outlook

Introduction

Since 2019, the commercial insurance industry has been grappling with a hardening marketplace, one characterized by increased premiums, stringent underwriting criteria, restricted terms of coverage and less competition amongst insurance carriers. This was caused by a combination of increased claim frequency and severity, increasing jury awards in liability cases, lasting complications created by the COVID-19 pandemic, evolving cyber security threats and natural catastrophes causing large-scale property damage.

Trends to Watch

As we enter 2023, developing trends such as labor shortages, supply chain disruptions, and inflation issues will continue to have a direct impact on insurance buyers. However, for the first time in three years we are seeing such volatile industry conditions begin to stabilize for organizations with above-average risk profiles or exposures. When looking ahead, there are some notable trends that are impacting insurance buyers across many industries.

Labor Shortages – Labor shortages continue to present challenges for employers, impacting businesses of all industries and sizes. A recent survey conducted by Provident Bank identified that 75% of businesses have been affected by current worker shortages. To help combat various workforce movements, many employers have adjusted their hiring and retention strategies.

Supply Chain Disruptions – While most businesses have resumed normal operations and increased production levels since the dark days of the pandemic, consumer demand in many industries continues to outweigh inventory and shipping capabilities. Rising fuel costs, the ongoing shortage of labor, and extreme weather events have only added to the supply chain bottlenecks mostly impacting employers in the manufacturing, construction, and retail sectors.

Inflation Issues – Labor shortages and supply chain disruptions have largely contributed to rising inflation concerns in the commercial insurance industry. According to recent BLS data, the 2022 consumer price index (CPI) for urban consumers increased by 9.1% year over year in June 2022, a 40-year high. The elevated CPI has driven up claim costs across several lines of insurance, inflating the total loss experience of the property & casualty industry.

Notable Coverage Lines

Certain coverage lines such as Property, Umbrella, Employment Practices Liability (EPLI), and Cyber liability will continue to drive hard market conditions while others such as Workers Compensation will provide opportunities to leverage market competition.

Property – The economic trends described above are directly impacting construction costs and property replacement values. Significant natural events including Hurricane Ian, flooding in Kentucky and Tennessee and wildfires in the Northwest have also contributed to rate increases. It’s imperative to individuals and corporations review their property coverage limits and make adjustments according to replacement costs in today’s dollars. The Council of Insurance Agents & Brokers (CIAB) Q3 2022 Property & Casualty Market Report indicated a 11.2% average increase in commercial property rates.

Auto – The auto insurance market has experienced substantial challenges in recent years stemming from surging accident frequency and severity, numerous road safety challenges, widespread driver shortages, and the increase of nuclear jury verdicts. These trends have led to poor underwriting results for insurance companies, resulting in 45 consecutive quarters of auto premium increases passed onto insureds, according to CIAB. The CIAB Q3 Property & Casualty Market Report indicated a 7.6% average increase in commercial auto rates.

Umbrella – The umbrella and excess liability markets continue to be adversely impacted by large claim trends. Social inflation, third-party litigation funding and tort reform have accelerated the frequency of large settlements and jury verdicts. The CIAB Q3 Property & Casualty Market Report indicated a 11.3% average increase in commercial Umbrella rates.

Employment Related Practices Liability (EPLI) – Labor shortages in some industries, coupled with recent mass layoffs in others, has already resulted in an uptick of Employment-related claims. In response, underwriting is beginning to tighten for both first-time buyers as well as on renewal policies. When providing information that may be perceived as unfavorable to underwriting (i.e. recent downsizing), it’s important to provide additional details of why decisions were made and the steps your company has taken to avoid potential litigation from current and former employees. Consider including a narrative attached to general application submissions.

Cyber  – Cyber insurance has been a source of pain for many employers in recent years. Ransomware attacks and data breaches have led insurers to drastically increase premiums, limit coverage, and demand greater network security requirements from employers. According to recent CIAB industry data, many insureds experienced 50%-100% rate increases in 2022. All organizations, regardless of size or industry, should continue to prioritize their cyber hygiene and network security.

Workers Compensation – Workers Compensation rates are expected to remain stable in 2023, as underwriting results have been favorable in recent years. Carrier competition for this coverage line is strong, which will continue to drive down rates and offset increases in other challenging lines. The CIAB Q3 Property & Casualty Market Report indicated a -0.7% average decrease in Workers Compensation rates.

Tips moving forward

While the insurance market outlook has been grim in recent years, we expect the turmoil to marginally stabilize in 2023. For employers, it’s important to focus on what you can control. That is, implementing solid risk management strategies to minimize claim history and improve your risk profile. It is equally important to align yourself with an experienced insurance broker who will proactively differentiate your business to the underwriting community and evaluate alternative risk financing options where appropriate.

Contact Us:

Gregory L. Chaples, CIC

Vice President - Property & Casualty

gchaples@capstonegrp.com

Office: 215-542-8030

LinkedIn

Personal Insurance - Renewal Checklist

Author: Erin Saunders, Account Executive - Personal Insurance/Private Client

Many personal insurance policies (Home, Auto, Umbrella, etc.) are set up for automatic renewals. Meaning these policies will often renew each year, or every six months, without having the opportunity to review coverages, costs, or to update personal information or report life events.

While we encourage reporting all major life events to your insurance advisor to update policies accordingly, at a minimum we recommend reviewing your policies annually to make sure you and your family continue to receive the most comprehensive and cost-effective coverage available. This is especially true today as we continue to be faced with macroeconomic challenges that could certainly have an impact on your personal insurance policies, such as:

• Increased cost of building materials - How much would it cost to rebuild your house today as compared to when the policy was first written?

• Increased interest rates - Would a loss impact your current mortgage or lease agreement?

• Supply chain & continued difficulties in procuring new and used automobiles - Does auto policy account for increased cost of vehicles? Do you need to increase rental reimbursement coverage if you can’t get a replacement right away?

To help get you thinking, here’s a list of possible questions to consider as you approach your next renewal cycle:

Automobile Checklist

• Are all vehicles you own insured; did you purchase a new car this year has it been added to your policy?

• How are your cars valued on your policy? Actual cash value, Replacement Cost, Guaranteed Value? Know the difference

• Does your policy include rental car coverage? With costs of current rental cars, you may need to increase this coverage for less out of pocket costs at the time of a claim.

• Do you have any students away at college? Possible discounts

• Do you have a teenager that is going to get their license in the next year?

• Have you recently paid off your car loan?

• If your car is towed, would you like coverage that would reimburse you for that? Did you know that towing reimbursement coverage on an automobile policy generally costs less than $10.00 per year? 

• Are you interested in adding or increasing your Accidental and Death Benefit Limits? Did you know that some of the most important coverages on an automobile policy are the least expensive, such as property damage coverage?

• Do you wish to add income loss to your policy? Have you retired and income loss need to be removed?

• Do you own a pickup or a van that contains customized equipment?

• Do you own a mini bike, moped, motorized scooter or motorcycle?

• Do you own any ATV's, boats, snowmobiles, jet skis or motorhomes?

• Do you drive a company car?

Homeowners Checklist

• Would it cost more to rebuild your home and replace its contents today than what it is insured for?

• Have you made any changes to your home; additions, added garage, or a finished basement?

• Do you own any of the following: Pool, trampoline, or recreational vehicles? Understand all exclusions

• Does your home have a sump pump or drain to remove excess water?

• Do you have a whole house generator?

• Do you own any property that you rent or lease to others?

• Do you own a second home such as a Coastal home?

• Did you know flood is excluded on most homeowners policies? Understand the risks and available coverages

• Are you running a business out of your home?

• Have you acquired any collectables (jewelry, fine art, guns, antiques)? Understand coverage limitations

• Have you added a new security or fire alarm system to your home?

• Do you own pets or animals at your home? Certain dog breed exclusions

• Have you recently updated your roof, heating, plumbing, or wiring?

• Has your mortgage changed or been paid off?

Finally, after receiving the new declaration page you may discard any prior terms or policies. No need to hold on to them. And speaking of paper, many of our carriers have paperless options, one less thing to clutter up your counter!

As an insurance advisor, I can best assist my clients and recommend coverages if I know of changes that take place between renewals. Give your agent a call so they can make sure your policies are up to date and inform you of any new coverages being offered.

Erin Saunders

Account Executive - Personal Insurance

Email: Esaunders@capstonegrp.com

Phone: 215-542-8030

Capstone Announces Promotion of Bill Mooney, Director of Commercial Insurance

Capstone Group is pleased to announce the promotion of William Mooney to the position of Director within the firm’s Commercial Property & Casualty division, effective October 1, 2022. 

Bill joined Capstone in 2016 as an Account Executive and has since been promoted to Senior Account Executive. Over the years, Bill has been involved in the onboarding and ongoing management of key accounts within the firm’s Commercial Property & Casualty division. As the team has expanded, Bill has served as a mentor for new hires and continues to be a technical resource for all team members.

“Bill joined Capstone nearly 6 years ago, when our firm was still very much in our infancy,” remarked Kevin Fox, Managing Partner of Capstone. “Since then, Bill has not only helped advance our Commercial Property & Casualty division but has helped shape our firm’s overall approach to account management and what we consider to be the optimal client experience. As we plan for our next phase of growth, Bill’s experience, technical expertise, and his passion for teaching, make him a perfect fit for this new position to help lead our Commercial P&C division moving forward.”

In his new capacity as Director, Bill will be responsible for overseeing the account management and customer service team within the firm’s Commercial Property & Casualty division. Bill will be working closely with Vice President of Commercial Insurance, Greg Chaples, to ensure the team is equipped to properly manage evolving client needs and execute on divisional growth goals and long-term initiatives.

About Capstone Group:

Founded in 2013, Capstone Group is an independent risk management, employee benefits, and insurance brokerage firm. As an emerging firm in a mature industry, Capstone's mission is to provide results-driven solutions that transcend what our clients have come to expect from traditional insurance and benefits brokers. To accomplish this goal, Capstone’s efforts begin and end with attracting and retaining the very best industry experts and client service representatives as a part of the team. To learn more about Capstone or submit an inquiry, visit: www.capstonegrp.com 

Employee Benefits: How will Rising Inflation Affect Healthcare Costs?

From gas stations to grocery stores, you've almost certainly noticed that the costs of goods and services are skyrocketing with no end seemingly in sight. The American Healthcare system is no exception, as the rising costs of inflation coupled with the unrelenting strain of the COVID-19 pandemic on both the workforce and supply chains have led to ongoing challenges. With an unpredictable future ahead, making business decisions about balancing a tighter budget while still offering a competitive employee benefits package is more difficult than ever.

Today, inflation in the United States has reached rates not seen in years. The Consumer Price Index rose by 8.6% year-over-year in May 2022. All indications lead us to believe that it is only a matter of time before healthcare prices catch up to this increase. We've heard from clients that they are surprised that there hasn't been a more immediate substantial increase in healthcare costs currently. These dramatic increases are only being delayed by the unique characteristics of the healthcare industry. While other companies can raise the price of commodities such as food, gasoline, and raw materials immediately, that's not how it works in healthcare, where prices are set by government programs or negotiated with private insurers at an earlier point in time. In healthcare services, prices, reimbursement rates, labor contracts and several other input factors are set two to three years in advance. So, while physicians, hospitals, and other healthcare providers face higher costs—mainly increases in areas with shortages such as nursing and supplies— there will likely be a lag before consumers experience the same pressures.

We see this situation ultimately playing out in two steps. First, providers will demand higher reimbursement rates. Second, payers will pass higher costs to employers and consumers in the form of higher annual premiums and an increase in out-of-pocket expenses such as copays and coinsurance.

As for health insurance premiums, Peterson-KFF Health System Tracker's 23rd annual Employer Health Benefits Survey found that single and family premiums for employer-sponsored health insurance were up 4 percent in 2021. Also, The KFF survey found that the average family premium has risen 22 percent over the last five years and an astounding 47 percent over the past ten years. This burden of higher health insurance costs is shared by employers and employees alike. In 2021, covered employees contributed an average of 17 percent of the premium for single health coverage and 28 percent for family coverage. This means employers covered 83 percent of single premiums and 72 percent of family premiums last year.

Controlling Rising Healthcare Costs

While we can't predict how the inflation rate will fluctuate in the coming years, we can assume that healthcare costs and health insurance premiums will continue to ascend. What can your organization do to mitigate these price increases without sacrificing the quality of your overall employee benefits program?

Because inflation and the increased costs charged by healthcare providers are generally outside of your control, mitigating its effects is the best option for employer groups. Now is the time to be talking to your healthcare advisors and evaluating cost control methods. Evaluating and implementing products and concepts like alternative-funded health plans (self-insurance, level-funding, group captives, and consortiums), reference-based pricing, voluntary benefit offerings, and the utilization of Tax-Advantaged Accounts (HRAs, HSAs, DCAs, FSAs, etc.) are just a few of the strategies that enable employers to better manage healthcare spending. The KFF survey referenced earlier found that 64 percent of covered workers are now enrolled in self-funded plans, and 42 percent of small firms reported using level-funded plans. Both of these numbers are an increase from previous years' surveys, providing further proof that alternative funding models are continuing to gain traction compared to traditional fully-insured health plans.

A small silver lining, the IRS recently announced higher Health Savings Account (HSA) contribution limits for 2023 to help combat the inflation surge. The annual inflation-adjusted limit on HSA contributions for self-only coverage will be $3,850, up from $3,650 in 2022. The HSA contribution limit for family coverage will be $7,750, up from $7,300. The adjustments represent approximately a 5.5 percent increase over 2022 contribution limits, a substantial increase, whereas these limits rose by about 1.4 percent between 2021 and 2022.

Our top priority is to ensure your business is taking advantage of every possible course of action to reverse the trend of annual premium increases that will allow you to reallocate and reinvest those funds into initiatives that will more directly drive business growth. If you are a business owner or decision-maker within your organization struggling with the ever-increasing costs of offering a competitive employee benefits program, please don't hesitate to reach out to me directly or our team at Capstone to start a conversation!

Contact Us:

Joseph Fox

Senior Vice President - Employee Benefits

jtfox@capstonegrp.com

Office: 215-542-8030

We’re in a Hard Market … What Now?

Introduction

The commercial insurance marketplace is cyclical. A “hard market” is characterized by rising rates and premiums and a tightening of capacity, or an insurers unwillingness to provide coverage and limits they were previously comfortable providing. For the first time in nearly 20 years, the insurance marketplace began to harden in 2019 and has only been exasperated by recent current events, i.e. supply chain issues, political & social unrest, inflation, and general economic uncertainty.

A hard insurance market impacts all consumers of traditional commercial insurance products: small and large businesses, for profit and non-profit, private, and publicly traded organizations. Some industries and lines of coverage are impacted more than others. This article is intended to educate business owners and executives on how to properly prepare and identify a few strategies to consider to best navigate these challenges.

Hardest-Hit Coverages

Coming into 2022, most analysts were predicting between 12% - 15% price increases across all lines of commercial insurance. The lines driving those increases include:

• Commercial Property: Fueled by continued increases in damages caused by weather & climate-related disasters. Especially for higher-value property schedules and higher-hazard operations.

• Umbrella/Excess Liability: Historically pricing has been lower-cost, more stable. Recent trends such as nuclear verdicts and litigation funding are resulting in exceptionally high jury awards that drastically increase claim costs.

• Management Liability (D&O and Employment Practices Liability): Driven by many socioeconomic factors, including: increased M&A activity, Pandemic-related layoffs, and “social inflation”

• Cyber Liability: Cyber insurance is experiencing a hardening market on rocket fuel. We are seeing unprecedent sharp increases in claims activity, rate increases, and coverage changes in a relatively short period of time. It’s more important now than ever to work with forward-thinking insurance advisors who understand the evolving coverage forms and have access to a broad range of cyber providers to adequately navigate these challenges. To read more on this topic, check out our article published by the Delaware Valley Family Business Center.

Navigating Choppy Waters

While the outlook may seem grim in the short-term, there is hope for those organizations willing to prioritize their risk profile and align themselves with an advisor who will strategically approach the marketplace and prepare alternative options on their behalf. The current market conditions make alternative funding options, such as large deductible or Captive arrangements, viable and attractive solutions for many organizations looking to regain control of their insurance costs.

• Prioritize Your “Risk Profile” –  As insurance carriers look to recover losses from rapidly increasing claim activity and historically underpriced polices, underwriters are under immense pressure to carefully evaluate each renewal. The carrier’s pricing and coverage offerings will be heavily influenced by your “Risk Profile”. That is, the frequency and severity of claims along with the presence of proactive risk management and loss control programs. If you have experienced claims in the past, consider what could be done to prevent such incidents from reoccurring in the future. It’s also a great time to revamp (or implement) a strategic safety & loss control program that addresses exposures unique to your organization. Best-in-class organizations, when presented as such to the insurance carrier community, receive the best pricing and coverage.

• Start Early, Have a Plan – Many organizations scramble to find alternatives after receiving unfavorable, last-minute renewal quotes from incumbent carriers. Often, these unpleasant surprises come with little warning or justification. For this reason, it’s important to start the process early, particularly when involving multiple carriers in the quoting process. Equally important is the quality of information being submitted to the insurance company when quoting. The “submission” should be detailed, accurate and complete, ultimately telling a favorable story about your organization to the underwriting community. This process creates competition amongst insurance carriers, giving you confidence that you’re receiving the best pricing and coverage terms available in the marketplace.

• Identify “Softer” Lines - Fortunately for consumers, not all lines of coverage are hardening at once. Our team continues to deliver more manageable increases, and even rate decreases, in select coverage lines that should be negotiated aggressively during annual renewals in order to help offset any unavoidable increases in the lines mentioned above.

• Consider Alternative Risk Financing

  As stated in the beginning of this article, a hard insurance market impacts all consumers of traditional, “guaranteed-cost” commercial insurance. So, what about non-traditional or alternative options?

  Alternatives such as self-insurance and Captive Insurance Arrangements (“Captives”) can certainly provide a hedge against fluctuating market cycles. On a basic level, a captive is an insurance company that is wholly owned and controlled by its insureds. Thus, giving control and potential underwriting profits back to the organizations themselves as opposed to the insurance company.

  In response to rising rates and dwindling capacity, our team has certainly seen an uptick in interest in captives, but it’s important to note that these arrangements are not a fit for all organizations. For starters, there are minimum premium thresholds for most captive programs (starting at $100,000 in combined workers compensation, general & auto liability premiums). Additionally, due to funding arrangements and the risk-sharing nature of group captives, these programs are only advantageous for financially stable, well-run organizations with a dedicated focus on safety and a favorable claims history.

Conclusion

While we hope we are starting to turn a corner in the hardening market cycle, we are still diligently guiding our clients through challenging 2022 renewals that will likely extend into next year. Please consider us a resource and feel free to reach out to discuss your organizations’ unique situation.

Contact Us:

Kevin M. Fox, CIC

Managing Partner

kmfox@capstonegrp.com

Office: 215-542-8030

Capstone Partners with Delaware Valley Family Business Center

Spring House, PA. February 15, 2022 - Capstone Group recently announced their newly-formed partnership with the Delaware Valley Family Business Center.

Since 1988, the Delaware Valley Family Business Center (DVFBC) has guided business families through the incredible natural complexities they face as they yearn for family harmony and business sustainability. The Center collaborates with family businesses to build individual and team muscle, develop structures and policies that are in alignment with their values and goals, forge commitments, and implement decisions which transform family relationships, align shareholder teams, and build sustainable enterprises.

“Kevin and Joe Fox from Capstone Group came highly recommended to us by one of our other partner sponsors, and there was no question there was total alignment between our values, cultures and philosophies since our first meeting,” said Sally Derstine, President of DVFBC. “One of our responsibilities to our Members is to select the best professional advisors in the field; advisors who are honest, experienced, collaborative, responsive, and exceptional communicators.  To date Capstone has exceeded each of these qualities and, as a sibling partnership, they bring additional insights and experiences to our Learning Community. We look forward to a long and happy relationship serving enterprising families together!”

Capstone is please to be hosting DVFBC’s kick-off 2022 Best Practice Event on February 17, which will be focused on Controlling Healthcare Costs in 2022 and Beyond.

“Having a family business dynamic here at Capstone, the work Sally and her team are doing immediately resonated with us,” said Capstone founding partner, Joe Fox. “We’ve seen the strength of the relationships they build with their members by having a lasting positive impact on their organizations, and are thrilled that they’ve chosen us as their benefits and insurance partner.”

Click Here to Learn More about the Delaware Valley Family Business Center

For additional questions & inquiries:

Sally Derstine

President, DVFBC

sally@dvfbc.com

Capstone Group Announces Hiring of Gregory Chaples, Vice President of Property & Casualty

PR Newswire - Spring House, PA., January 27th  – Capstone Group, a leading provider of risk management, insurance brokerage, and employee benefits advisory services, is pleased to announce the hiring of Gregory L. Chaples as Vice President. In his new role, Chaples will be responsible for overseeing the continued growth and evolution of Capstone’s Property & Casualty divisions.

“Greg’s experience, leadership, and reputation within our industry will have an immediate positive impact on our firm. But what ultimately led to this decision is our shared values and vision of the future for our Property & Casualty divisions,” said Kevin Fox, Management Partner of Capstone. “As a Certified Insurance Counselor, Greg has developed a technical skillset for managing complex insurance programs. That knowledge, coupled with his ‘people-focused’ mentality, make Greg a tremendous addition to our team.”

Chaples has spent the last 10 years of his career at reputable insurance institutions, where he has gained experience in the areas of: coverage analysis, risk control, customer service, business development, management, and team building.

“I look forward to working alongside Capstone’s dedicated and talented team that has already accomplished so much in a short period of time,” said Chaples. “We are very excited to build upon this foundation by continuing to align ourselves with the region’s top employers and industry professionals.”

About Capstone Group:

Founded in 2013, Capstone Group is an independent risk management, employee benefits, and insurance brokerage firm. As an emerging firm in a mature industry, Capstone's mission is to provide results-driven solutions that transcend what our clients have come to expect from traditional insurance and benefits brokers. To accomplish this goal, Capstone’s efforts begin and end with attracting and retaining the very best industry experts and client service representatives as a part of the team. To learn more about Capstone or submit an inquiry, visit: www.capstonegrp.com 

Source: PR Newswire January 27, 2022

Mental Health HRAs: A Simple & Cost-Effective Mental Health Benefit for Your Employees

Written by: Dan McGill and Joseph T. Fox

Many organizations have concluded that adding mental health benefits to their Employee Benefits Package far outweighs the cost.

The U.S. Surgeon General recently issued a public health advisory on children’s mental health and how COVID-19 pandemic-hardships have played a role in the emerging crisis. The advisory emphasized the increased rate of depression and anxiety diagnosed in children. In addition, experts say the changes the pandemic has brought upon families, like schools alternating between virtual and in-person learning, extracurricular activities being canceled, and an overall decrease in interaction have impacted children's behavior and mental health.

Changes in routine for families due to the pandemic can also affect parents' mental health, while they try to juggle work, keep their home life stable, and protect their children’s health. This mental health crisis isn’t exclusive to children and parents either, as many Americans living alone reported feelings of loneliness, depression, anxiety and stress. Millions of Americans are struggling with mental health related issues, yet seeking treatment, and even more importantly coverage for that treatment, has become a daunting task.

Americans are facing a severe shortage of available mental health professionals, with some in-network providers leaving networks as the reimbursement rates have remained consistently low from insurance carriers. The demand and lack of adequate compensation for mental health providers, including psychiatrists, psychologists, licensed clinical social workers, counselors, and marriage and family therapists, has led to a workforce crisis along with increased out-of-pocket service fees. As a result, most consumers are forced to pay out of pocket for standard therapy ranging from $100 to $250 per hour. This is a significant financial hardship for most people seeking care and treatment.  The U.S. Substance Abuse and Mental Health Services Administration found that 50 percent of those who have mental illness cited mental health care expenses as the reason they didn't obtain treatment, making it the #1 reason identified.

At Capstone Group, we are committed to tailoring solutions for clients to make mental health services more easily and readily accessible, even if those solutions hadn’t previously been established in the marketplace. For example, we have recently helped some of our most forward-thinking and innovative client partners incorporate a unique and novel product into their overall Employee Benefits program in a direct effort to address many of the issues outlined above; A Mental Health HRA.

This HRA sets aside funds for the employee or members of their family to find care without worrying about whether that specific provider is “in-network” relative to their medical insurance plan. By implementing an employer-sponsored mental health HRA, employees and their families can utilize funds set aside by the company to cover the cost of services like psychiatrist visits, Mental Health counseling, addiction counseling, Psychoanalysis with a letter of medical necessity, and other qualified Mental Health Therapy. In addition, these HRA funds can go towards services such as genetic testing through third-party vendors like Genomind PGX Express Test prescribed by a psychiatrist. These tests identify the types of medication that will work best for an individual and cut down on the trial-and-error period that most patients go through before discovering what truly works best for them.

Capstone Group, as an organization, has made Employee Wellness and Mental Health a top priority. This is reflected in our daily meetings internally and with our client partners. If you would like more information on building a strategy and implementing solutions to help your workforce navigate the mental health landscape, Capstone Group would welcome the opportunity to start a conversation. 

Contact:

Dan McGill, Sr. Vice President - Employee Benefits

dmcgill@capstonegrp.com

Office: 215-542-8030

Joseph T. Fox, Sr. Vice President - Employee Benefits

jtfox@capstonegrp.com

Office: 215-542-8030

National Cybersecurity Awareness Month 2021

October is National Cybersecurity Awareness Month. During this annual event, government and industry leaders come together to raise awareness about the importance of cybersecurity. #BeCyberSmart

2021 MLR Rebate Checks Recently Issued to Fully Insured Plans

As a reminder, insurance carriers are required to satisfy certain medical loss ratio (“MLR”) thresholds. This generally means that for every dollar of premium a carrier collects with respect to a major medical plan; it should spend 85 cents in the large group market (80 cents in the small group market) on medical care and activities to improve health care quality. If these thresholds are not satisfied, rebates are available to employers in the form of a premium credit or check.

If a rebate is available, carriers were required to distribute MLR checks to employers by September 30, 2021.

Importantly, employers must distribute any amounts attributed to employee contributions to employees and handle the tax consequences (if any).

This does not apply to self-funded plans.

CLICK HERE TO LEARN MORE:

What to do with MRL Rebate Checks?

What will the Rebate amount be?

Will there be any Communication?

What are the tax consequences?