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Frequently Asked Questions

Below are some of our frequently asked questions. If you have any other questions or concerns, please feel free to contact us.

  1. Obamacare Tax Credits What Are The Pay Back Requirements For Underestimating Annual Income
  2. What is the difference between Admitted Carriers and Non Admitted Carriers
  3. What happens if my insurance company becomes insolvent?
  4. What is the South Carolina Wind Pool
  5. If I buy a home in the Wind Pool, will I be able purchase wind insurance?
  6. What are the 3 Dangerous Myths About General Liability Insurance
  7. What is Wind Mitigation & Why should I care?
  8. What is " Blanket Additional Insured Endorsement
  9. what is Primary and Noncontributory
  10. What is Waiver of Subrogation
  11. What is Blanket Waiver of Subrogation
  12. What is yjr Workers Compensation Residual Market
Obamacare Tax Credits What Are The Pay Back Requirements For Underestimating Annual Income

When you apply for Obamacare through your health insurance exchange, you need to estimate what your family income for 2014 will be. If you estimate it will be below 400% of the federal poverty level for a family your size, you will be eligible to receive a subsidy to help pay your monthly insurance premiums. The amount of the premium assistance is based on your estimated income and the amount of your health insurance premiums. This premium assistance can be worth thousands of dollars per year.

But what happens if it turns out you underestimate your 2014 income? If you already benefited form premium assistance payments, you’ll have to pay them back to the IRS when you file your 2014 income taxes. The amount you’ll have to pay back depends on your 2014 family income. If your 2014 income is below 400% of the federal poverty level, there is a cap on the amount you’ll have to pay back, even if you received more in assistance than the amount of the cap. However, at higher income levels, you’ll have to pay back the entire amount you received, which could be a lot.

The following chart shows how much individuals and families will be required to pay back.

Income, based on federal poverty level

 

Annual Household Income for an Individual

 

Individual Payback of Obamacare Premium Assistance

Annual Household Income for a Family of Four

 

Family Payback of Obamacare Premium Assistance

Less than 200%

 

Under $22,980

 

Capped at $300

 

Under $47,100

 

Capped at $600

At or above 200% to 300%

 

$22,980 – $34,470

 

Capped at $750

 

$47,100 - $70,650

 

Capped at $1,500

At or above 300% to 400%

 

$34,470-$45,960

Capped at $1,250

$70,650 – $94,200

 

Capped at $2,500

Greater than 400%

 

$45,961 and higher

Full amount received

$94,201 and higher

Full amount received

Example: Ernest, a 45-year-old single self-employed writer who lives in San Francisco, obtained health coverage through the California health insurance exchange (covered.ca). He estimated that his 2014 income would be $30,000. Based on his age and income, he qualified for a premium assistance of $216 per month, or $2,592. However, it turns out that Ernest had a better year than he thought he would: He actually earned $40,000 in 2014. Based on this income, he was actually entitled to premium assistance of only $109 per month, or $1,308. He received $1,284 more in assistance than he should have. However, he only has to pay back $1,250 because this is the cap for people at his income level. Had his income been $46,000 or more, he would have to pay back the entire $2,592.

One way to avoid having to pay back all or part of your Obamacare premium assistance is to report to your health exchange any changes in your income during the year. The exchange can adjust downward the amount of premium assistance you receive for the remainder of the year.

Another way to avoid having to repay all or part your premium assistance is to elect to have all or part of your premium assistance sent to you as a tax refund when you file your tax return, instead of paid in advance to your health insurer during the year. In other words, you pay the entire amount out of your own pocket during the year, and then you are reimbursed by the amount of premium assistance you qualify for.

For details, see your health insurance exchange. Links to your state exchange are at healthcare.gov.

 



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What is the difference between Admitted Carriers and Non Admitted Carriers

Definitions

Whether an insurance company is classified as "admitted" varies by state. To qualify as an admitted provider in a particular state, an insurance company must file an application with that state's insurance commissioner and be approved. Approval as an admitted company requires compliance with state insurance requirements, including the filing and approval of rates. A non-admitted carrier is simply an insurance provider operating in a state without going through the submission and approval process required for admitted companies.

Benefits of Admitted Companies

One of the main benefits of an admitted insurance company from a policyholder's standpoint is that the provider's liabilities are backed by the finances of the admitting state. If an admitted insurance company goes bankrupt, the state will use money from a special fund to help pay off policyholders. For example, in South Carolina , admitted providers are part of the South Carolina Insurance Guaranty Association, which pays claims up to $300,000 if the carrier becomes insolvent. Another advantage of admitted companies is that their rates are usually more reasonable, as these must be approved by the state insurance commissioner.

Benefits of Non-Admitted Carriers

Non-admitted companies can often provide insurance coverage that admitted carriers can't, because of their unrestricted rate structure. Admitted companies often can't charge high enough premiums to safely insure high-risk events, but non-admitted providers have no such restriction. As a result, non-admitted companies are usually the only ones available to offer specialty insurance such as professional liability insurance or earthquake coverage.

Considerations

The choice between insurance companies often comes down to the financial strengths of the individual providers, rather than their status as admitted or non-admitted. Ratings company A.M. Best scores insurance carriers, with the highest ratings of A++ and A+ reserved for those with the greatest financial strength and claims-paying ability. These should be your primary concerns as a policyholder. Your ultimate choice of companies may be restricted based on the type of insurance you need, but you should always seek a high-quality provider, regardless of whether the company is admitted or non-admitted

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What happens if my insurance company becomes insolvent?
The South Carolina Property & Casualty lnsurance Guaranty Association (SCPCIGA) has been set up by the legislature to help protect you. Not all insurance companies and types of insurance are covered, but generally, homeowners , automobile, workers’ compensation and other property and casualty lines are covered

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What is the South Carolina Wind Pool

In 1972, The South Carolina Wind and Hail Underwriting Association (SCWHUA) was established to ensure that residents living on the beach areas of South Carolina would have a means of purchasing wind/hail insurance on their beach homes. Most standard insurance companies had quit providing such coverage.

Commercial buildings located in the beach areas are also eligible for coverage

 

Why was the Wind Pool expanded in 2007?

Since the mid-90s, the insurance industry has become increasingly reluctant to provide wind insurance in the coastal counties of South Carolina due to the hurricane threat. The situation became so bad in 2004-2006 that some residents could not obtain wind insurance and those who could found themselves paying very high premiums. The SC Department of Insurance was being pressured to take some action and the expansion of the Wind Pool was the result.

 

Where is the Wind Pool area?

You can log onto www.scwind.com and click on the Check Eligibility heading. Simply type in the address of your home. You will be told if the home is in Zone 1 or Zone 2 or not in the wind pool area. Zone 1 is the original Wind Pool area and Zone 2 is the expanded Wind Pool area. To see a map of the Wind Pool, click on Territory Expansion and select from the county maps listed. The orange area is Zone 1 and the yellow area, Zone 2. North of Charleston, the boundary is generally Hwy 17N. A written description of the Wind Pool boundaries can be found in the same Territory Expansion section under “Territory Expansion order signed by Director Richardson, May 23, 2007”, starting on page 2 under “Conclusion”.



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If I buy a home in the Wind Pool, will I be able purchase wind insurance?

Yes, most independent agencies, like Roe & Associates, sell the wind policy offered by SCHWUA and can offer the regular homeowners policy (excluding wind) through major national insurance companies. And some insurance companies will offer wind coverage in designated wind Zones

 

Can condominiums be insured through the wind pool?

Yes, the Wind Pool insures individual condominium units for the unit owner and also insures the condominium building for the Condominium Regime.

 

Is there a waiting period before a Wind Pool policy takes effect?

Yes, there is a 16 day waiting period starting when SCHWUA receives the application, photo, and payment of premium. Independent agents have the ability to transmit this information electronically. The waiting period may be waived when there is a property closing that involves a mortgage company, bank, or savings and loan. The loan must be for a term of at least 10 years.

 

I am building a home in the Wind Pool area. Can I get a Wind Pool policy while the home is under construction?

Yes, SCWHUA insures houses under construction

 

Are the Wind Pool premiums higher than those charged by regular insurance companies?

Yes, the premiums are usually higher. SCWHUA charges higher premiums because SCWHUA is considered the market of last resort, the place you go to get wind coverage when you cannot obtain it through other markets.

 

What coverages are available on a Wind Pool policy?

The Wind Pool allows you to insure your home and personal property located in the home. It also offers Loss of Use coverage and Increased Cost of Construction (ICC) insurance. For a commercial property, the building and contents may be insured plus Loss of Business Income insurance is available

 

Is there a maximum limit of insurance available?

The maximum limits for ALL coverages (building, contents, loss of use, and ICC) for a residential property is $1,300,000. For all other properties (commercial), the limit is $2,500,000.

 

What deductibles are offered by the Wind Pool?

SCWHUA offers deductibles of 2%, 3%, 4%, 5% and 10%. The deductible is a percent of the amount of insurance on the dwelling and a percent of the amount of insurance on the contents. The deductibles apply separately to building and contents. For example, a house insured for $200,000 with $50,000 contents with a 3% deductible would have a dwelling deductible of $6,000 plus a contents deductible of $1,500.

 

Is replacement cost coverage available?

Dwelling replacement cost coverage is available only if the dwelling is your primary residence and was built after 1950, and you have flood insurance policy covering the dwelling. Replacement cost coverage for contents is not available.

 

Does this Wind Pool policy provide hurricane insurance?

Well, there is no such thing as “hurricane insurance”. The wind damage done by a hurricane is covered by a Wind Pool policy. Any damage done by the flooding associated with a hurricane, like the hurricane surge, is NOT covered by the Wind Pool policy. You must purchase a separate flood insurance policy offered by the National Flood Insurance program and available through independent insurance agencies. And yes, Roe & Associates,  does sell flood insurance.

 

Does the Wind Pool automatically renew policies?

No. Your agent must request that the policy be rewritten and submit the full payment of premium each year. Approximately 90 days in advance of expiration, the Wind Pool distributes pre-printed applications to be used for renewing policies. Your agent will contact you regarding the renewal of your policy


 



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What are the 3 Dangerous Myths About General Liability Insurance

MYTH #1: GENERAL LIABILITY COVERS FINANCIAL LOSSES DUE TO PROFESSIONAL MISTAKES.

FACT: General liability policies cover bodily injuries and property damage. They don’t, however, cover financial losses caused by failing to deliver a certain service i.e. a professional service. General liability insures products or a completed operation: actions that are performed once and then done (the job is obviously completed right then and there). Professional services refer to mishaps due to opinions, services, solutions or recommendations provided during the course of business. It could take years for a professional service’s “error” to show up in a product.

For example, let’s say your client was a building designer. If it was later determined that a design error led to financial losses (e.g. the building proved to be structurally unsound), this wouldn’t be covered under a general liability policy. The design would fall under the category of professional service.

Professional liability will insure against professional service mistakes. A policy can also extend to contingent bodily injuries and property damage.

MYTH #2: ADDING SUB-CONTRACTORS TO A GENERAL LIABILITY POLICY COVERS THEM TOO.

FACT: You can add as many sub-contractors as you want to a general policy – but you’ll run into the same problem as Myth #1. A general liability policy will not cover a sub-contractor’s professional services. Make sure each sub-contractor has their own insurance because your clients are liable for any work performed by them.

MYTH #3: GENERAL LIABILITY COVERS WORKERS ANYWHERE.

FACT: General liability policies are not designed to cover intangible data or published private information exposed by a data breach. In a recent coverage disrupted between Sony Corporation and Zurich Insurance Company, a New York trial court ruled that Zurich American Insurance Co. has no duty to defend Sony Corp. of America under the General Liability (GL) policy for a matter involving a data breach of the Sony Playstation Network. The court ruled acts by third-party hackers do not constitute “oral or written publication in any manner of the material that violates a person’s right of privacy” in the Coverage B (personal and advertising injury coverage) under the policy.

The fact is most clients overestimate the protection provided by their general liability policies. Talk to an experienced wholesaler – such as Burns & Wilcox – about professional liability to ensure your clients avoid any gaps in their coverage.

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What is Wind Mitigation & Why should I care?

Wind Mitigation is the addition of tested and approved materials to a dwelling to withstand the sheer forces of strong wind and rain.  In 2006, many wind mitigation measures were entered into the building codes to reduce widespread catastrophic losses. These measures reduce your client's insurance premiums by hundreds of dollars a year!  You can request a Wind Mitigation inspection on homes built before 2006.  When you are about to have your inspections, reach out to me and I will provide the necessary forms for the inspector to fill out as they move through the home.   

  

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What is " Blanket Additional Insured Endorsement

Policy endorsement used to add coverage for additional insureds by name—for example, mortgage holders or lessors. There are a number of different forms intended to address various situations, some of which afford very restrictive coverage to additional insureds. (Rather than naming each additional insured, a blanket additional insured endorsement sometimes is available.)



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what is Primary and Noncontributory

This term is commonly used in contract insurance requirements to stipulate the order in which multiple policies triggered by the same loss are to respond. For example, a contractor may be required to provide liability insurance that is primary and noncontributory. This means that the contractor's policy must pay before other applicable policies (primary) and without seeking contribution from other policies that also claim to be primary (noncontributory).



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What is Waiver of Subrogation

prohibits the insurer from attempting to seek restitution from a third party who causes any kind of loss to the insured. This type of arrangement is allowable under certain circumstances where the insured could be held liable for a claim that is paid.



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What is Blanket Waiver of Subrogation

This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV – COMMERCIAL GENERAL LIABILITY CONDITIONS) is deleted and replaced by the following: We waive any right of recovery we may have against any person or organization against whom you have agreed to waive such right of recovery in a written contract or agreement because of payments we make for injury or damage arising out of your ongoing operations or “your work” done under a contract with that person or organization and included in the “products-completed operations hazard



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What is yjr Workers Compensation Residual Market
Residual Market There are some employers that, for a number of reasons—such as new business, poor loss experience, or the inherently dangerous nature of their work—cannot find a voluntary market carrier willing to provide them with workers compensation insurance. To ensure that all employers have a means of meeting their statutory obligations, states have created markets of last resort—residual markets. In essence, the residual market is a safety net for these employers. There are several ways to provide a residual market. Some states establish state funds. Another option is to establish a joint underwriting association (JUA). However, most states have established a Workers Compensation Insurance Plan (WCIP, assigned risk Plan, or Plan). The WCIP is the basic instrument, adopted pursuant to statute and/or regulatory authority of the state, through which eligible employers otherwise unable to obtain necessary insurance coverage can secure workers compensation insurance.

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Roe & Associates, Inc.
7089 Rivers Ave | North Charleston, SC 29406
| Ph: 843.740.1723
| Fx: 843.740.0178
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