Category Archives: INSURANCE

Public turns out for Obamacare seminars

By Ray Orndorff | Special to the County Compass

ORIENTAL — Lynn Whalen of Masters Wealth Management presented an excellent review of the Patient Protection Affordable Care Act – better known as Obamacare – during late afternoon sessions on Tuesday and Wednesday. The seminars were free and open to the public.

The information presented is both extensive and essential for all who need and want health insurance. Questions were raised regarding time lines for enrolling, subsidies and penalties. Several attendees reported having their current health insurance canceled and others reported a doubling of premiums for the new Obamacare policies.

A large portion of the public is unaware of the complexities, ramifications and effects scheduled over the next two years. Though controversial, Obamacare is the law of the land and everyone will be affected.

Those who already have coverage gain new protections. Those who need coverage must eventually tackle the problem-plagued Health Insurance Marketplace at www.healthcare.gov.

And, for those who opt out of coverage, annual fines loom.

The Marketplace is a new way to find health care coverage. All plans featured on the Marketplace must cover “Essential Health Benefits”: Ambulatory patient services, emergency services, hospitalization, maternity and new born care, rehabilitative and habilitative services and devices, pediatric services, preventive and wellness services and chronic disease management, prescription drugs, mental health and substance use disorder services, including behavioral health treatment, and laboratory.

No plan can turn an applicant away or charge more because of a “pre-existing” illness or medical condition. Plans cannot charge differently for men or women. Some applicants may be eligible for subsidies.

Whalen, the seminar leader, said applications can be submitted by mail, online, by phone, or in person. There are people available to help you at the Pamlico County Health Department in Bayboro.

Important dates for Obamacare:

  • October 1, 2013 Marketplace open enrollment started.
  • January 1, 2014 Health Coverage can start.
  • March 31, 2014 Open enrollment ends.
  • Eligibility: You must live in the United States, be a US citizen or national, and cannot be incarcerated.

    If you have job-based coverage, you are considered covered and will not have to pay the fee uninsured people must pay. Any job-based health plan you currently have qualifies as minimum essential coverage. With most job-based health insurance plans, employers pay part of the premiums.

    Be aware, you may not qualify for lower costs on your monthly premium (even if your income qualifies you) if your employer’s plan is considered “affordable” – a tricky calculation that compares an employee’s share of premiums to adjusted gross income.

    More information follows next week on Obamacare.

    Gary Mastrodonato, owner of Masters Wealth Management Group in Oriental, has extended an invitation to meet with anyone who needs health insurance counseling. Please call 252-249-0100 for an appointment.

    “Insurance Adventure” an indictment of industry

     

    By Phil and Aven Rosch | Special to the County Compass

    Editor’s note: We thank the Rosch couple for sharing their horror story in the wake of Hurricane Irene. We want to hear from more of you. E-mail jeff@compassnews360.com with as much detail as you can muster. We’ll print as many of your stories as possible.

    roschLet me start by saying both Aven and I are “sixty-something” and, with the exception of a few “senior moments”, have full use of our faculties. Our insurance nightmare started as a result of Hurricane Irene, an extremely slow-mover Category 1 hurricane that had surges at well over 11 feet, which set a new 100 year flood mark, because it spanned two high tides at “moon tide”, the worst possible time of the month..

    Insurance in eastern North Carolina is a complex mess of providers, fine print, and subtle linkages to other carrier’s policies. Each home has a homeowner’s policy from one carrier; a wind policy from NCJUA (North Carolina Joint Underwriters), essentially a risk pool; and, flood insurance from Uncle Sam (FEMA).

    In the interest of full disclosure, I should note I spent 30 years working for a Fortune 50 insurance company, but I was an “computer guy” so I really didn’t know much about insurance, which I’ll prove beyond a shadow of a doubt later on.

    Our property is on Bond Creek in Aurora. Aven and I built the house ourselves (literally) and tried to make it a fortress. The construction is 2 by 6 16-inch OC, Bosch Hurri-quake fastenings, a steel roof certified for 213 MPH and a SunPorch engineered for 120 knots. The house is 14 feet off the ground with mechanical area and workshop at ground level, and we have three out-buildings, a three-car garage, Aven’s art studio, both steel buildings on 4-inch concrete pads with double “red-heads” (fastenings) holding the buildings to the concrete, and a wooden greenhouse elevated on pilings over the 100-year flood mark.

    The surge, duration, and timing of Hurricane Irene made her “the perfect storm”. Homes in the area that had never seen flood waters in 120 years had water half way up the first floor. Many homes on the creek were simply demolished and disappeared.

    In our case, we got four feet, seven inches of water in the workshop, garage, and studio, and the greenhouse was pushed over on its pilings. We lost our swimming pool to a ‘micro-burst’ which flattened it before the flood waters rose. Our 253-feet dock simply lifted its pilings out and fell on its side like a massive centipede. Our Roadtrek RV, antique Mercedes convertible, pick-up truck, two cars, and Kubota tractor had water well over the dashboard and were total losses along with DR Field string trimmers, bush hog, mowers, garden tractors, compressors and tools.

    Everything in Aven’s studio was destroyed — cabinets, clay turning wheel, extruder, and all her art supplies and tools.

    Our boat dragged a 1,200-pound hog grate hurricane mooring, which had been in place for eight years, 100 yards up the creek. The mechanical space was devastated, including washer/dryer, water softener, freezer, compressor, and a whole house diesel generator also above the 100-year flood mark. One garage door was destroyed and two others damaged. Water rose well above the landing in the inside staircase to the house

    The bad news is between the wind and the water, we got spanked pretty well. The good news is building the house 14 feet off the ground was the smartest thing we ever did. The house and living space was secure and we sat out in the SunPorch watching the storm and destruction all around us without fear because we knew the house was way “over-built” and safe.

    Our insurance nightmare didn’t start until we filed claims. We were fat, dumb, and happy because we had an agency representing a large multiple lines insurer “on our side”, and wind, flood, and homeowners policies to cover damage.

    A rational person would think each policy would be a stand-alone entity, but we learned the hard way about the incestuous relationship between insurance carriers and line items.

    For example, I didn’t have comprehensive on our vehicles because they are somewhat long in the tooth, but I had no idea the lack of comprehensive on an auto policy from our homeowners carrier would negate coverage on our flood policy where I have over $75,000 in “personal property” coverage.

    Had the implications of comprehensive been properly disclosed — even the fact that I’d be covered if a deer jumped out in front of me — I would have said comprehensive is worth doing and put it on.

    I don’t recall ever seeing the actual flood policy, but not having to wade through legalese and boilerplate of insurance policies is why people use the agency system. Consequently, all our vehicles were a total un-covered loss.

    The lengths a company will go to in order avoid a claim is also a travesty. Aven and I watched a micro-burst flatten our little above ground pool before the flood waters rose, and we told this to the adjustor.

    But they hired an engineer from Raleigh to drive down and back and write a report that was full of teckno-babble, using weather metrics from Morehead City. I’m sure it cost them more for the consultant than it would have cost to pay the claim. First, Morehead City is 50 miles away and there were many micro-bursts and local tornadoes spawned by the storm and secondly, we watched it happen!

    Second, “wind pointing finger at flood” claiming the flood caused the damage is absurd because there is no fetch in Bond Creek, therefore no waves, and if the flood waters rose over the pool, the structure would have had equal pressure on both sides and been perfectly safe as our neighbors pool one-quarter mile down the driveway.

    Another ludicrous response from the wind folks was on the greenhouse. They came back to us and said the physical greenhouse wasn’t covered because “it was on pilings over the water.” I sent them a picture showing we mow grass around it and it was 153 feet from the water. Still no response.

    Contents coverage was another issue. My thinking was the house was a fortress well off the ground, so we didn’t have contents coverage. Each time we added another out-building my agent said they were covered as long as I could live within the $26,000 designated as “outbuildings” and I said we were good at that number. Again, the implications between the policies weren’t disclosed.

    The flood insurance would only cover things that were part of the house and they did cover the water heater, but wouldn’t cover the generator, compressor, or the water softener (plumbed in) because the water softener “wasn’t necessary” according to them. Of course, having a hardness level in the Beaufort County water system of 60 grains does warrant a water softener.

    I could live with no coverage on the washer/dryer or freezer, but the generator pumps electricity through the house just as the water heater provides hot water in the pipes. Not covering the generator as part of the house infrastructure is absurd.

    At this point in the missive, we should note virtually all of the adjustors we dealt with were superb. The flood adjustor told us in writing that since we were well over one-quarter mile from a town road, we’d be covered for hiring dumpsters and they would pay up to $1,000 for us to do our own clean-up.

    Later, the “guvment” said no compensation for dumpsters and clean-up because what went in them was “contents,” which were uncovered. In actuality, we were about a foot deep in downed trees, marsh grass, and rubble from the creek all over the property.

    They also decided they wouldn’t cover the damaged garage doors even though they were obviously part of the structure and built according to Zone 1 code. Same thing for the sheetrock enclosing the inside staircase as required by building code. They said all they would pay for is if the stairs themselves were damaged.

    It seems as though these folks make up the rules as they go along figuring if they decline 50 percent of the claims and only 5 percent of the policy holders take them to court, they will be ahead of the game—risk management at its best.

    The systemic problem here in Eastern North Carolina is that insurance carriers and FEMA require licensed contractor estimates, which is problematic in two ways for a poor rural area.

    First, the North Carolina process to become a licensed contractor is too onerous for most of the locals and it involves travelling to Raleigh for “classes”, consequently, contractors keep contract increments just below the “license required” level.

    The second is “water seeks its own level” and the amount of contractors able to have food with their meals in Eastern NC is based on “normal times” and a disaster that virtually affects everyone is simply way beyond their capacity to recover. We’re still waiting for contractor calls to be returned and written estimates.

    This means you had better be pretty much self-sufficient when it comes to essential repairs or you’ll be waiting a very long time for things to get back to normal, in many cases well beyond the claim filing limits for carriers.

    I could go on and on, but I do need to tell you about the conversation with our agent last week. She passed on the following facts:

    1. She said FEMA states in their policy that even if we sue them and the court finds in our favor we can’t collect our court costs. Who wrote this nonsense—Eric Holder?
    1. If we install cabinets or sheetrock in an out-building, then it is “living space” and not covered unless it has a separate policy with an elevation certificate.
    1. Only one detached out-building/garage is covered.
    1. If you have power going to an out-building, it isn’t covered and needs its own policy and elevation certificate.

    After that discussion, I was left with the thought—why didn’t you tell me all this stuff BEFORE we wrote the policies?

    In summary, we are not too pleased with either the commercial carriers, the agency system, or the government. The errors of omission were significant and a rational man presented with all the implications and small-print connections to other policies would have acted much differently.

    I believe our story isn’t an anomaly in eastern North Carolina, so we’ve copied the North Carolina Insurance Commissioner, the Consumer Protection Agency, and the County Compass who always has our back in eastern North Carolina.

    Stay tuned for our SBA/FEMA adventure, which is still playing out.

    Editor’s note: Readers may e-mail the couple at trawlerphil@earthlink.net.