From the Claims Corner
HDHPs – Not as Scary as You Might Think
League Welcomes New Risk Control Consultant
Don’t Let Cough and Cold Season Get You Down – Teledoc Can Help
League Class Offerings
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Sometimes the work done by Claims really can result in a treasure being preserved. In the case of Nies v Emerald Isle, Gregory and Diane Nies owned a piece of oceanfront residential property in the town of Emerald Isle. When the Town passed a 20 ft. easement to be able to pick up trash and drive emergency vehicles on the dry sand beach, this retired couple sued claiming that the town had “taken” the dry sand beach in front of their home seaward of the sea oats dune to the mean high tide line. The Nies contented that they should have been compensated for the loss of their property.
This case went through the Superior Court, The NC Court of Appeals and the NC Supreme Court and the Nies lost at every level. Just prior to the NC Supreme Court argument, the Nies sold the home and moved away, but the Pacific Legal Foundation picked up the case and argued before the NC Supreme Court that the rights to the dry sand beach was one of the great, unsettled issues of North Carolina law.
After the NC Supreme Court ruled that the dry sand beach had belonged to the public at large since time immortal, the Pacific Legal Foundation appealed this case to the United States Supreme Court. When one of the justices expressed an interest in learning more about the case, before the nation’s high court decided on which cases it might hear next term, NCLM along with Brian Edes, Attorney for the Town, felt it necessary to prepare a reply brief for justices to read before their discussion.
After receiving the brief, the U.S. Supreme Court declined to hear the case. This was a huge case for every citizen who walks on and enjoys the beaches of North Carolina. If the right to enjoy the beaches had been taken away, it would have been disastrous for every coastal community and to the tourists who have enjoyed the long-standing tradition of enjoying the qualified right to enjoy the beaches in North Carolina.
This is another example of the Claims department fighting for its member municipalities.
J. Steven Lee, Director of Claims
This month the League’s Risk Management Services staff has been traveling the state, holding Lunch and Learn meetings with member cities and towns to discuss which insurance options are available, what coverage our members want and need, and answer any questions folks have about health insurance and risk management. During these Lunch and Learns, attendees have been interested to learn that the League’s Health Benefits Trust offers High Deductible Health Plans, and that this type of coverage isn’t as scary as they initially thought.
HDHPs can seem extreme if you don’t understand how they work, but can save you money if you do. A lot of the fear surrounding HDHPs stems from horror stories of huge deductibles that leave employees on the hook for all their own medical payments, but over the last few years, new requirements have emerged to protect employees from those scenarios.
The League’s Health Benefit Trust offers HDHPs that limit deductibles and provide employee protections through out-of-pocket maximums and other safeguards. For example, a qualified HDHP plan can have a deductible as low as $1,350 per individual and $2,700 per family; and maximum out of pocket expenses are capped at $6,650 per individual and $13,500 per family.
Our Lunch and Learn attendees were pleasantly surprised to learn that HDHPs allow for lots of plan design flexibility, such as pharmacy copays and optional co-insurance after the deductible is met. HDHP plans also cover age related cancer screenings and other wellness benefits at 100%. The League takes this benefit one step further and does not have age or frequency limitations, an unlimited benefit that is unique to the League and not offered by any other provider in North Carolina. HDHP plans also cover preventative drugs at 100% (e.g. cholesterol, blood pressure, and others), to encourage participants to take their prescribed medications as directed by their physician.
So what is a HDHP in reality? It’s a health insurance plan that has a higher deductible and lower premium than traditional plans. Qualified HDHPs can include a Health Savings Account where an individual or family – and/or their employer – contributes money into an account that can be used for medical expenses.
Health Savings Accounts (HSAs) are assuming greater popularity in retirement planning as anticipated retiree health costs rise. The accounts, which are only available to those with a qualified HDHP plan, have several advantages for employees:
- They offer a “triple tax” benefit where fund contributions can be payroll deducted pre-tax, account balances can grow tax-free with no maximums/limitations, and funds can be spent tax-free on eligible expenses.
- HSAs are portable and can travel with an employee who changes jobs.
- Unlike a Flexible Spending Account, HSAs are not a “use it or lose it” product.
- Funds can be invested like an IRA or 401(k) plans and can help employees build wealth.
While there are no balance limits to HSAs, there are annual contribution limits for individuals and households. The 2018 HSA maximum contribution limit for an individual with self-only coverage will be $3,450. The 2018 HSA maximum contribution for an individual with family coverage will be to $6,900.
For employers, HDHPs can make a lot of sense when considering premiums and risk exposure. Depending on which HDHP plan design an employer chooses, there is a significant savings over a traditional plan. For example, a traditional plan that the Health Benefits Trust offers might run $582 per employee, per month, while an HDHP 5000 plan would run $442 per employee, per month – that’s $140 in savings per employee, per month, which can really add up. Premium saved in moving to a HDHP can be contributed to employees’ HSA accounts to offset their out of pocket expense.
As far as risk exposure goes, HDHPs shift claims expenses to the employee until the deductible is met, which reduces risk. Also, employee wellness can still remain a priority for managing risk and expense – employers can reward employees for wellness efforts and the Health Benefits Trust wellness requirements would remain.
But, the most important piece of the employer savings is that consumerism happens! Employees will have more control over their healthcare spending and decision-making. Generally, employees will seek out lower cost facilities and prescriptions, and begin asking questions that are important to their budgets and health.
While HDHPs and HSAs may not be a product that is right for every employer, they can be a great option for many cities and towns that are looking for ways to save money and provide high-quality, flexible coverage to their employees. If you have questions about what a HDHP might look like for your employees or if just would like more information about how these plans work, we’re here to help. Contact Julie Hall, the League’s Director of Health Programs at (919) 715-4000.
The League welcomed Matt Reid as our newest risk control consultant in October 2017. Matt has over 20 years of experience in risk management and comes to us from the Virginia Municipal League Insurance Programs, where he worked as a Senior Safety Consultant. His work involved advising and training municipal officials on risk management and loss control issues to help mitigate liability exposures. He was also responsible for analyzing employee injury and illness statistics, advising and assisting in the development and implementation of risk management and occupational safety and health programs. Matt holds a bachelors degree in Safety and Risk Administration from Virginia Commonwealth University and a masters degree in Safety Sciences from the Indiana University of Pennsylvania.
“I am excited to be working with the NC League of Municipalities and look forward to leveraging my years of experience in municipal risks to help our members mitigate liability exposures and reduce their costs,” he said.
Matt is a resident of Zebulon, and he will be serving our members in the central part of the state, as part of the new four-territory field service structure. He is available to help members with their risk management needs including:
- Hazard identification
- Risk mitigation
- Safety training
- Claims analysis
- Facility inspections
- Accident and injury prevention
Members are encouraged to contact Matt for assistance with the risk control needs. He can be reached by cell phone at 919-404-1857.
Coughing, sniffling, sneezing and wheezing is common this time of year. As we head into the holiday — and head cold — season, help keep yourself and your family healthy, happy, and well with Teladoc. Our board-certified physicians are available 24/7 by app, web, or phone, and they can help diagnose and treat your illness from the comfort of your home.
Could you have an upper respiratory infection? Upper respiratory infections (URIs) are some of the most common illnesses we face each year. Did you know that colds, sinus infections, and acute bronchitis are all URIs? And fall/winter is peak season for them.
URIs are surprisingly easy to catch, because airborne germs from a cough or sneeze can travel up to six feet! The key to prevention is knowing the symptoms — in yourself as well as others — so that you can avoid coming in contact with a sick person or spreading illness if you’re under the weather. Washing your hands often is equally important in helping to deter the spread of URIs.
If thick or discolored phlegm comes up when you cough or blow your nose, it’s often a reliable sign that you may be battling more than just a seasonal allergy or passing sniffle. Other URI symptoms generally include:
- Fever
- Headache
- Tiredness or fatigue
- Coughing or wheezing
- Congested or runny nose
- Sore throat or pain when swallowing
Symptoms tend to develop over a few hours. The good news is you have a few ways to get some relief:
- Place a vaporizer or humidifier in your room while you recover: Moist air helps you breathe — and sleep — better.
- Drink lots of fluids: When you’re battling a URI, you can easily get dehydrated. (Fun Fact: hot herbal tea with honey and lemon can help soothe a sore throat; the steam from the cup can help you breathe a little easier too!)
- Get plenty of rest: Time is a key part of recovery. You also don’t want to overtax your body while it’s working to get well.
- Treat your headache with an appropriate pain reliever: No need to hurt when you don’t have to. You’ll want to make sure that the type of pain reliever that you use (e.g., aspirin, acetaminophen, ibuprofen, etc.) works best for you and isn’t already contained in any other medications you’re taking.
- Use a decongestant for a stuffy nose: A decongestant can help open nasal passages and dry up mucus.
- Avoid cigarette smoke and caffeine: Smoke irritates your upper respiratory system and can be especially bothersome when you have bronchitis. The caffeine in coffee and soft drinks can contribute to dehydration.
The not-so-good news is that URIs can get worse if they linger too long without proper medical attention. For example, bronchitis can lead to pneumonia if not treated promptly. The cause of a URI can be a virus, which is most common, or bacteria, but only a bacterial URI can be treated with antibiotic. Regardless of which type you have, Teladoc can help diagnose and treat your illness. If medication becomes medically necessary, the doctor can send a prescription to the pharmacy that you choose.
The League’s Risk Management Services Division continues to evaluate and expand the law enforcement programs available to members who participate in the Workers’ Compensation Trust and the Property and Casualty Trust. These programs were reviewed and endorsed by our Police Chiefs’ Advisory Committee. For more information about the below opportunities, contact Tom Anderson, Public Safety Risk Management Consultant, tanderson@NCLM.org or 704-517-8496.
Dangerous Crossroads Ahead: The Intersection of the First and Fourth Amendments (1-day, 4 contact hours)
In this timely class, the present-day law enforcement challenges are detailed. These include the refusal to identify, refusal to answer questions, dealing with bystanders, profanity towards officers, filming of police activity and police facilities, related officer safety concerns, weapons pat downs, and the seizure of cameras or cell phones that have recorded police activity.
Use of Force: Decision Making, De-escalation, and Passive Resisters for Police Trainers and Officers (1-day, 8 contact hours)
This training is designed to improve use of force knowledge, physical skills, decision making, and the proper documentation of the use of force encounter. In addition, this training will provide a decision-making process designed specifically for law enforcement use of force that is universal to all levels of force.
The most common type of resistance officers’ encounter, passive resistance, will be the theme used to cover the four elements taught. Understanding and recognizing the difference between a passive, active, and deadly resister improves professional knowledge and decision making. The training will also focus on de-escalation skills and physical control tactics and techniques.
Use of Force Training
2-days, 16 contact hours – For Law Enforcement Managers
3-days, 24 contact hours – For Law Enforcement Trainers and Officers
This course is designed for upper-management level and training officers who are in positions to positively impact policy, practices, development, and implementation. The training will increase the student’s comprehensive knowledge of use of force issues, conducted electrical weapons, court cases, and training. There will be a further focus on relevant recent court decisions such as the Fourth Circuit Court’s ruling regarding Taser usage in the Armstrong v/s Pinehurst Case.
