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Slowly Filling in the Blanks

January 2, 2019


IRS Releases Guidance on Qualified Transportation Fringe Benefits for Tax-Exempt Organizations

The Tax Cuts and Jobs Act (the “Act”), enacted in December 2017, eliminated the business deduction employers received for providing qualified transportation fringe benefits (“fringe benefits”) to their employees beginning January 1, 2018. The Act did not affect the employee exclusion, which enables the amount of qualified transportation fringe benefits provided by employers to be excluded from employee gross income up to specified monthly limits ($260 in 2018; $265 in 2019). Since the loss of the business tax deduction would not affect a tax-exempt organization, Congress included a provision in the Act that requires tax-exempt organizations to add the amount of these fringe benefits provided to their employees to its unrelated business taxable income (UBTI). However, the Act didn’t specify exactly how to calculate the disallowed deduction or UBTI amount, particularly for qualified parking expenses.

The Internal Revenue Service released Notice 2018-99 that fills in this gap by describing how to calculate the disallowed deduction amount for taxable organizations or UBTI for tax-exempt organizations. The Department of the Treasury and the IRS will eventually publish proposed regulations but, in the meantime, IRS Notice 2018-99 may be relied upon for fringe benefit amounts paid or incurred after December 31, 2017. Essentially, the calculation will depend upon whether the employer pays a third party for parking, or if the employer owns or leases a parking facility.

We believe the ultimate result is that employers will move away from or limit providing reserved parking spaces to employees for reasons that will become clear later in this article.

Employer Pays a Third Party for Parking Space 

If an employer pays a third party so their employees may park in the third party’s garage or lot, the disallowed deduction or UBTI amount is generally the total annual cost paid to the third party. Keep in mind that if the amount exceeds the monthly exclusion limit ($260 in 2018; $265 in 2019), the excess amount must also be treated as taxable compensation to the employee. Fortunately, this excess amount will not be included in the UBTI calculation.

Employer Owns or Leases All or Part of a Parking Facility

Until further guidance is released, employers may use any reasonable method to calculate the disallowed deduction or UBTI amount if the employer owns or leases a portion of a parking facility. The IRS specifically noted that “using the value of employee parking to determine expenses allocable to employee parking in a parking facility owned or leased by the taxpayer is not a reasonable method.”

If the employer owns or leases more than one parking facility in a single geographic location, the employer may aggregate the number of spaces in those parking facilities using this process. If the parking facilities are in multiple geographic areas, the employer cannot aggregate the spaces. For those who prefer firmer guidance, Notice 2018-99 provided steps an employer may follow to calculate that amount. Yes, this is really what the guidance says.

Step 1: Reserved Employee Spaces

The employer must first calculate the amount attributable for reserved employee spaces. This is done by determining the percentage of reserved employee spaces in relation to total parking spaces and multiplying that by the employer’s total parking expenses for the parking facility. “Total parking expenses” is defined in the Notice and does not include a deduction for depreciation or expenses paid for items near the parking facility, such as landscaping or lighting. The resulting amount is the disallowed deduction or the amount that will be added to a tax-exempt organization’s UBTI. The IRS will allow employers that have reserved employee spots until March 31, 2019 to change their parking arrangements to decrease or eliminate the number of reserved employee spots retroactive to January 1, 2018.

Step 2: Primary Use Test

The employer must next identify the remaining spaces and determine whether they are primarily used for the general public or for its employees. The IRS defines “primary use” as greater than 50% of actual or estimated usage during normal hours on a typical work day. If parking space usage significantly varies, the employer can use any reasonable method to determine the average usage. The portion of expenses not attributable to the general public’s use is the disallowed deduction or amount included in a tax-exempt organization’s UBTI.

Step 3: Reserved Non-Employee Spots

If the primary use of the employer’s remaining parking spaces is not for the general public, the employer must identify the number of spaces exclusively reserved for non-employees (such as “Customer Only” parking). Spaces reserved for partners, sole proprietors and 2% shareholders are also included in this category. If the employer has reserved non-employee spaces, it needs to determine the percentage of reserved non-employee spaces in relation to the remaining total spaces. That amount is multiplied by the employer’s remaining total parking expenses. This is the amount of the disallowed deduction or amount included in a tax-exempt organization’s UBTI.

Step 4: Determine Remaining Use and Allocable Expenses

If there are any leftover parking expenses left over, the employer must reasonably determine employee use (either actual or estimated usage) of the remaining spaces during normal work hours and the related expenses for those spaces. The amount of expenses attributable to employee use is the disallowed deduction or amount included in in a tax-exempt organization’s UBTI.

IRS Notice 2018-99 does provide some helpful examples of this four step process illustrating how the calculation works in different situations. If tax-exempt organizations have $1,000 or more of UBTI they will need to report using Form 990-T.  Those tax-exempt organizations with less than $1,000 in UBTI are not required to file and are not subject to the tax.

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Texas Federal Court Rules ACA Unconstitutional

December 18, 2018


Given the heavy media attention, you are probably aware that a Texas federal district court issued a decision on December 14, 2018, declaring the entire Affordable Care Act (ACA) unconstitutional. The final outcome will take a while, and the ACA remains in effect as this case moves through the appeals process. Employers (and their group health plans) should continue to comply with the ACA in the meantime.

2018 FORM 1094/1095 REPORTING.

Texas v. Azar

In its 2012 National Federation of Independent Businesses (NFIB) v. Sebelius decision that preserved most of the ACA as originally written,[1] the U.S. Supreme Court held that Congress had the authority to implement the individual mandate and its penalty under the taxing power given to it by the U.S. Constitution. The individual mandate penalty was reduced to zero effective January 1, 2019, by the Tax Cut and Jobs Act of 2017 triggering the Texas v. Azar lawsuit over the continuing constitutionality of the ACA. This case was ultimately joined by thirty-six states and the District of Columbia giving it a distinctive red versus blue feel.

In his decision, Judge O’Connor determined that the elimination of the individual mandate penalty meant the individual mandate itself could no longer be viewed as a valid exercise of Congress’ taxing power. Judge O’Connor also determined that the individual mandate was so essential to and inseparable from the ACA that this renders the entire ACA unconstitutional.

Predicting the Future

Judge O’Connor’s ruling did not include an injunction, meaning the ACA is still in effect pending the appeals process. This fact was verbally repeated by the Trump administration. It is probably foolish to attempt to predict the future of Texas v. Azar, but if we had to:

    1. The 5th Circuit – This is a coin flip, but the U.S. Court of Appeals for the 5th Circuit overrules the district court opinion. While the court agrees that the individual mandate is unconstitutional, the 5th Circuit is unable to conclude that the individual mandate cannot be severed from the rest of the ACA. Whatever the outcome, the side that comes up short appeals to the U.S. Supreme Court.
    2. Congress – If the 5th Circuit finds the ACA unconstitutional, lawmakers work in earnest to draft legislation preserving ACA protections that are popular with voters and to avoid massive disruption in the insurance industry. One of these bills will have enough bipartisan support to be enacted by Congress and signed into law by the President should the Supreme Court declare the ACA unconstitutional.
    3. The Supreme Court The U.S. Supreme Court agrees to hear the case and preserves the ACA again by holding that the individual mandate is severable from the remainder of the ACA and/or for other reasons. Remember, the appointments of Justices Gorsuch and Kavanaugh notwithstanding, the five justices who ruled in favor of the ACA in NFIB v. Sebelius in that 5-4 opinion are still present.

We’ll keep you updated as this progresses.

[1] If you’ll recall, the mandate for all states to participate in the Medicaid expansion was struck down.

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Retail Workers and Fatigue

December 17, 2018


During the holidays, many retail workers experience irregular and extended shifts and often take on additional workload due to reduced staff. This can lead to overexertion, stress and fatigue which ultimately can cause poor overall health in the population.

The National Institute for Occupational Safety and Health (NIOSH) looked at the retail sector and provided suggestions to reduce worker fatigue that can be implemented at the workplace. These include:

  • Allow for adequate rest breaks. Frequent breaks every 1 or 2 hours are more effective than one or two long breaks.
  • Allow at least 10 hours between shifts and try and avoid scheduling workers for an opening shift if they worked a closing shift the day before. Employees will have a better chance of getting 7-8 hours of sleep if they have adequate time off.
  • Schedule one or two days of rest for every five consecutive work days that are 8 – 10 hours long.
  • Provide anti-fatigue mats and/or chairs or stools for employees who stand for long periods of time.
  • Schedule strenuous and difficult work when employees are most alert. Fatigue related-incidents are at increased risk from 4am to 6am and then again in the middle of the afternoon.
  • Ensure adequate lighting, comfortable temperatures, ventilation and minimal exposure to noise in the workplace.
  • Offer healthy snacks or vending, access to cold water and refrigerators or microwaves for employees to bring healthy food from home.

For more information, visit NIOSH:

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Do the HIPAA Privacy and Security Rules Apply to My Organization?

November 27, 2018


This article is the second in a two-part series addressing whether and how the Privacy and Security Rules (the “Rules”) under the Health Insurance Portability and Accountability Act (HIPAA) apply to various legal entities. Part One addressed Covered Entities and appeared in our October 2018 newsletter. This article addresses Business Associates of Covered Entities that are self-insured group health plans.[1]

Quick Recap

Covered Entities are the key stakeholders in the delivery and payment of health care, but they frequently partner with other organizations for assistance. Many of these organizations will need to come into contact with Protected Health Information (PHI) to assist the Covered Entity. Remember, PHI is:

  • Information about a past, present, or future health condition, treatment for a health condition, or payment for the treatment of a health condition;
  • Identifiable to a specific individual;
  • Created and/or received by a Covered Entity or Business Associate acting on behalf of a Covered Entity; and
  • Maintained or transmitted in any form.

What’s a Business Associate?

In the group health plan context, HIPAA defines a Business Associate as a third party that requires PHI to perform some function or service on behalf of a group health plan. In other words, a third party that helps make your health plan go but needs PHI to do it. The third party might create, receive, store, or transmit[2] the PHI in this role, but it must be “PHI sticky” in at least one of those ways to be considered a Business Associate. Many of HIPAA’s Privacy and Security requirements apply directly to Business Associates.

Typical Business Associates for a Self-Insured Group Health Plan



Maybe So

  • Third party administrator (TPA) including pharmacy benefit manager
  • COBRA administrator (more about this below)
  • Broker/consulting firm
  • Actuaries
  • Record keepers (e.g. Iron Mountain or other third parties storing physical electronic records with PHI)
  • Other cloud service providers such as Google if Gmail is used as the email system
  • Plan sponsor/employer
  • Stop-loss carrier (more about this below)


  • External legal counsel
  • Accountants if will see PHI in connection with an audit or review





COBRA Administrators
If a COBRA administrator merely receives enrollment and disenrollment information from the employer (as plan sponsor), the information it receives is not PHI and the COBRA administrator is not technically a Business Associate of the group health plan. The nature and source of the information provided is easily blurred between the employer and group health plan, and it’s common for COBRA administrators to agree to be treated as Business Associates.

The Curious Case of Stop-Loss
The Rules indicate that stop-loss carriers are not Business Associates of a group health plan when the stop-loss policy insures the plan itself. The Rules are less clear about the more likely scenario where the stop-loss policy insures the employer/plan sponsor directly.  In practice, stop-loss carriers are often reluctant to be treated as Business Associates and are frequently excluded.  We recommend employers enter into robust non-disclosure agreements with stop-loss carriers not treated as Business Associates.

Business Associate Contracts

Your organization’s group health plan is required to enter into a contractual agreement with all of your Business Associates outlining how the Business Associate may use and disclose PHI, how it will secure PHI, and other rights and obligations the parties have under the Rules.[3] The Department of Health and Human Services (DHHS) has provided sample  business associate contract language. Among other items, the contract must include language addressing the parties’ responsibilities when unsecured PHI is improperly used or disclosed (a “breach”). Your organization has a limited amount of time to investigate and respond to a breach.

As a practical matter, it is the employer (as plan sponsor) who must secure the contract for all of the plan’s Business Associates, but Business Associates will often supply their version of this contract to the employer without being prompted. It is in each party’s best business interest to use a standardized contract for administrative ease rather than having to honor the commitments of contracts from different sources, so there is a natural tension between the parties who each favor their own contracts. The requirements for a Business Associate contract are pretty standard, but it is not unusual for the contract to be more favorable toward the drafting party or to include additional contractual terms beyond what the Rules require, so it is important to have this reviewed by your legal counsel.

Sometimes Business Associates contract with other organizations to perform one or more functions the Business Associate was hired to perform for the group health plan (“subcontractors” who are also PHI sticky), and there is no direct relationship between the health plan and the subcontractor. Your Business Associate must represent in the Business Associate contract that they have with your organization that it has a contract in place with its subcontractor that provides for all of the same protections under the Rules with respect to any PHI related to your health plan.

Example – A self-insured medical plan engages a TPA for claims administration and other services. One of these services is claims monitoring to reduce fraud, waste, and abuse.  The claims monitoring services are actually provided by a subsidiary of the TPA, and the medical plan does not have a direct contract with the claims monitoring subsidiary. The TPA is a Business Associate of the medical plan. The claims monitoring entity is a Business Associate of the TPA and should be addressed as a subcontractor within the Business Associate contract between the medical plan and the TPA.

Next Steps

You should always know who your Business Associates are and should make sure you have a list of all the current vendors who provide services related to your health plans. Of these vendors, which ones use PHI to perform a function on behalf of a group health plan?

These are your Business Associates, and you should maintain current Business Associate contracts with all of them. Don’t forget to make this an implementation step when adding a new vendor who will be a Business Associate to your health plan(s).

[1] In Part One, we addressed that insurance carriers are the Covered Entities for fully-insured group health plans and that employers/plan sponsors generally have few obligations under the Rules for those plans.

[2] A third party that only transmits PHI without accessing or storing it may qualify for an exception as a mere conduit of the information.

[3] A failure to enter into the contract does not mean the third party is not your Business Associate and just subjects you to potential penalties for non-compliance.

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Better Late Than Never

November 16, 2018


The Internal Revenue Service released Revenue Procedure 2018-57 today, which contains the 2019 cost-of-living adjustments for various employee benefit plans including employer sponsored health care flexible spending accounts, qualified transportation fringe benefits, and adoption assistance programs. The following provides a summary of the annual limits for these specific benefit programs along with a summary of the 2019 high deductible health plan and health savings accounts limits announced earlier this year.

Each of the limits described below are applicable for taxable years beginning in 2019. If you have any questions or need further details about the tax limits and how they will impact your employee benefit programs, please contact your account team.

Health Care Flexible Spending Accounts
Employees will be allowed to contribute up to $2,700 per plan year.

Qualified Transportation Fringe Benefit
The monthly dollar limit on employee contributions has increased to $265 per month for the value of transportation benefits provided to an employee for qualified parking. The combined transit pass and vanpooling expense limit will also increase to $265 per month.

Adoption Credit/Adoption Assistance Programs
In the case of an adoption of a child with special needs, the maximum credit allowed under Code Section 23 is increased to $14,080. The income threshold at which the credit begins to phase out is increased to $211,160. Similarly, the maximum amount that an employer can exclude under Code Section 137 from an employee’s income for adoption assistance benefits is increased to $14,080.

HDHP and Health Savings Account (HSA) Amounts
Earlier this year, the IRS released Revenue Procedure 2018-30 which included the 2019 minimum deductible and maximum out-of-pocket limits for high deductible health plans (HDHPs) and the maximum contribution levels for HSAs.

  • The minimum annual deductible for a plan to qualify as a HDHP will remain at $1,350 for self-only coverage and $2,700 for family coverage;
  • The maximum annual out-of-pocket limits allowable under an HDHP will increase to $6,750 for self-only coverage and $13,500 for family coverage; and
  • The 2018 maximum allowable annual contribution employees may make to their HSAs will increase to $3,500 for an individual with self-only coverage and increase to $7,000 for an individual with family coverage.

The HSA catch-up contribution limit for participants who are 55 or older on December 31, 2019, remains an additional $1,000 per year.

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Health Reimbursement Arrangements Poised for a Facelift

November 2, 2018


The President signed an Executive Order on October 12, 2017, directing the U.S. Departments of Labor, Treasury, and Health and Human Services (collectively, the “Agencies”) to consider rules expanding the availability and permitted uses for Health Reimbursement Arrangements (HRAs). The clear intent was to ultimately enable employers to offer HRAs to employees that can be used to purchase individual insurance policies. The Agencies issued a set of proposed regulations addressing this and related issues on October 23, 2018.

The Bottom Line
We’ll address the proposed rules in more depth under Some Details About Individual Insurance HRAs below, but the main takeaways are:

  1. Premiums – Employers will be able to offer HRAs to employees that can be used to pay for individual health insurance coverage premiums. These will be referred to as “Individual Insurance HRAs” in this article.
  2. Employer mandate – Individual Insurance HRAs can be used to avoid employer mandate penalties under the Affordable Care Act (ACA).
  3. It’s one or the other – An employer can offer traditional group health coverage to a class of employees or an Individual Insurance HRA, but not both.

So, When Exactly?
The proposed effective date is for plan years beginning on or after January 1, 2020. The comment period for the proposed regulations will last through the remainder of 2018. The proposed regulations cannot be relied upon as a safe harbor. The final regulations will probably not appear before mid-2019 and may not differ much from the details described below.

Some Details About Individual Insurance HRAs

Item Guidance


Employees (including former employees) and dependents who are enrolled in major medical coverage purchased in the individual insurance market[1]

Coverage for any part of a month for which a premium is due qualifies

Classes of Employees


Employers may divide their workforces into the following classes of employees:

  1. Full-time employees
  2. Part-time employees
  3. Seasonal employees
  4. Employees covered by a collective bargaining agreement
  5. Employees eligible for the employer’s traditional group health coverage, but who are in a waiting period
  6. Employees who are under age 25 at the beginning of the Individual Insurance HRA plan year
  7. Foreign employees working abroad with no U.S.-sourced income
  8. Employees primarily employed in the same insurance community rating area

If an Individual Insurance HRA is offered to a class, it must be offered on the same terms to all employees within the class[2] (benefit levels may only vary based on age and family size within a class)

If an employer offers an Individual Insurance HRA to a class of employees, it may not offer its traditional group health coverage to that class[3]

Note: There are no other permitted classes such as hourly versus salaried employees.

ACA and the Employer Mandate


An Individual Insurance HRA automatically qualifies as minimum essential coverage and is an “offer of coverage” for the purposes of satisfying the ACA’s employer mandate

An Individual Insurance HRA (with its individual major medical insurance policy) is automatically deemed to satisfy the ACA’s minimum value requirement

An Individual Insurance HRA is deemed “affordable coverage” if the difference between the monthly premium for the lowest cost available silver plan and 1/12th of the annual Individual Insurance HRA contribution is equal to or less than the applicable affordability safe harbor percentage.

Affordable Coverage Example

In 2020, an employer makes an annual contribution of $3,600 to an employee’s Individual Insurance HRA. The monthly premium for the lowest cost available silver plan is $400.

$400 – ($3,600/12) = $100/month

The Individual Insurance HRA is an affordable offer of coverage for the employee if $100/month is within an affordability safe harbor for that employee in 2020



Employees are required to substantiate enrollment in individual coverage (including for any dependents) each time a request for reimbursement is submitted

An employer may rely on the employee’s attestation of coverage or require reasonable proof of enrollment (such as an ID card)



Employees must be permitted to waive participation annually, although the Individual Insurance HRA may still be considered an offer of affordable, minimum value coverage by the employer
ERISA Status, etc.


The Individual Insurance HRA itself is an employer-sponsored group health plan

The individual insurance coverage reimbursed by the HRA will not be considered an ERISA plan offered by the employer so long as the employer does not sponsor it or play a role in its selection

Cafeteria Plan Option


An employer may allow employees to pay for any remaining premium for the individual insurance policy through the employer’s cafeteria plan, but this is not available for coverage purchased through the public insurance exchange
Notice Requirements


Employers must provide eligible employees with a notice describing the terms of the Individual Insurance HRA and the affect it may have on the employee’s eligibility for a subsidy in the public insurance marketplace

[1] This does not currently include short-term, limited duration insurance.

[2] An employer can offer an Individual Insurance HRA to some former employees within a class and not others so long as the terms are uniform.

[3] Employees are not treated as having been offered group health coverage while in a waiting period.

And for Good Measure…
The Agencies also created another category of HRA known as an “Excepted Benefit HRA” that may be offered on a standalone basis exempt from the ACA’s mandates if all of the following is true:

  • The employer offers traditional group health coverage to the employee (this means the employee cannot also be offered an Individual Coverage HRA);
  • The maximum annual reimbursement is $1,800 (indexed);
  • Reimbursements are limited to general medical expenses and premiums for COBRA, short-term limited duration insurance, and other excepted benefits coverage (this can include many types of non-major medical health coverage); and
  • The Excepted Benefit HRA is available on a uniform basis to all similarly situated employees.[4]

[4] This is based on HIPAA’s “similarly situated groups” rule and is not tied to the permitted classes of employees under the Individual Insurance HRA.

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Do the HIPAA Privacy and Security Rules Apply to My Organization?

October 22, 2018


This article is the first in a two-part series addressing whether and how the Privacy and Security Rules (the “Rules”) under the Health Insurance Portability and Accountability Act (HIPAA with one P and two As, always) apply to various legal entities. This article addresses Covered Entities. Part two will address Business Associates.

What’s a Covered Entity?

There are three types of Covered Entities under the Rules. We’ll describe all three below, although the remainder of this article focuses on the Rules as they relate to employer-provided group health plans.

  1. Health care providers that engage in certain types of electronic transactions – Health care providers generally include what you’d expect, such as hospitals, clinics, pharmacies, nursing homes, health care practices, individual health care professionals, etc.To be a Covered Entity, the health care provider has to engage in certain types of electronic transactions including determinations of eligibility, billing, payment, and the coordination of benefits. Even in the rare instance that a health care provider is not subject to the Rules, other federal and state law likely affects how the provider may access or use personal health information.
  2. Health care clearinghouses – These have nothing to do with sweepstakes prizes and usually operate invisibly in the background as a go-between health care providers and health plans. A health care clearinghouse receives health information from an entity and processes the health information into a format usable by another entity. The best example we can give you occurs when a health care provider transmits billing information to a third party, the third party reprices the claims and formats the information into a new data set, and transmits the data set to a third party administrator or insurance carrier enabling it to process and pay the claims. The third party repricing and formatting the billing information in this example is a health care clearinghouse.
  3. Health plans – A health plan is a plan that provides or pays for the cost of medical care. Simple, right?

Group Health Plans

There are many types of benefits that involve personal health information. A plan is only a Covered Entity under the Rules if it is a health plan that provides or pays for the cost of medical care. Covered Entity status transforms a lot of personal health information that may be held or used by or on behalf of the health plan into Protected Health Information.[1]

In a nutshell, Protected Health Information (PHI) is:

  • Information about a past, present, or future health condition, treatment for a health condition, or payment for the treatment of a health condition;
  • Identifiable to a specific individual;
  • Created and/or received by a Covered Entity or Business Associate acting on behalf of a Covered Entity; and
  • Maintained or transmitted in any form.

We’re focusing on employer-provided group health plans and will provide an overview of their obligations under “Group Health Plan Responsibilities Under the Rules” below.

Is it a Group Health Plan?



Maybe So

  • Medical
  • Prescription drug
  • Dental
  • Vision
  • Health FSAs
  • HRAs
  • EAPs (if not just a referral service)
  • AD&D
  • Business travel accident
  • Leave administration (e.g. FMLA)
  • Life
  • Stop-loss
  • Workers’ Compensation insurance
  • Onsite clinics
  • Long-term care
  • Wellness programs


[1] Even though a benefit plan may not be subject to the Rules, personal information created or used by the plan may still be protected under other federal or state law.  For example, leave administration and disability insurance are not generally subject to the Rules, but limitations under the Americans with Disabilities Act or other laws may apply.

A group health plan is exempt from the Rules if it covers less than 50 current and/or former employees and is self-administered by the employer without the assistance of a third party administrator or insurance carrier. This is hard to meet, but some small health flexible spending account (health FSA) or health reimbursement arrangement (HRA) plans may qualify.

Unlike ERISA, the Rules contain no exception for church or governmental plans.

What Did You Mean by “Maybe So?”

  • Onsite clinics – This feels like a trick. At first glance, you’d think an employer-provided onsite clinic might be a Covered Entity both as a health care provider and as a group health plan, but what seems obvious isn’t necessarily so.First, an onsite clinic might be operated in such a way that it doesn’t engage in any of the electronic transactions that would cause it to be a Covered Entity as a health care provider.  As a precaution, we recommend an employer seek the assistance of legal counsel before taking the position the Rules do not apply to its onsite clinic. Again, even though the Rules may not apply, personal information may still be protected by other federal or state law. Second, an onsite clinic that merely provides first aid-type services is not a health plan at all under the Rules. Third, an odd exception under the Rules seems to exclude onsite clinics that are health plans, even when the onsite clinic is integrated into other group health plan coverage (but see “It’s a bird, it’s a plane” below).
  • Long-term care – A long-term care policy is a group health plan unless it is limited to nursing home fixed indemnity coverage.
  • Wellness programs – Wellness programs can include programs that include medical care (e.g. biometric screenings and targeted health coaching) and those that do not (e.g. general education and activity challenges). If a wellness program does not include any medical care services, it is not subject to the Rules. In many instances, a wellness program will include both medical care and non-medical care services and/or be integrated into an employer’s medical plan (please see “It’s a bird, it’s a plane” below).

Does Self-Insured vs. Fully-Insured Matter?

It must, or we wouldn’t have a section addressing it, right? If a group health plan is self-insured, it is generally subject to all of the compliance obligations under the Rules. If a group health plan is fully-insured, many of the compliance obligations under the Rules belong to the insurance carrier if the plan (through its plan sponsor acting on the plan’s behalf) is “hands off” PHI.

  • “Hands Off” PHI – The plan sponsor does not create or receive PHI other than enrollment/disenrollment information or summary health information for the purposes of obtaining premium bids or modifying, amending, or terminating the plan. Many fully-insured group health plans qualify as “hands off” PHI.We can hear the howls of protest, but self-insured group health plans cannot qualify for “hands off” PHI relief under the Rules no matter how little the plan sponsor may be involved with their administration.
  • “Hands On” PHI – This applies if the plan sponsor is not “hands off” PHI and can access or receive specific information about claims information or payment.

We will provide an overview of the responsibilities for self-insured group health plans and fully-insured plans that are “hands off” or “hands on” PHI under “Group Health Plan Responsibilities Under the Rules” below.

It’s a Bird, it’s a Plane…

Sometimes, a legal entity may include parts that are subject to the Rules and others that are not. The Rules refer to this as a “hybrid entity” and examples include:

  • A welfare benefit “wrap plan” that incorporates both medical and non-medical care benefits such as medical, dental, vision, group term life, accidental death & dismemberment, business travel accident, and long-term disability benefits;
  • A standalone wellness program that includes both medical and non-medical care benefits such as biometric screenings, targeted health and nutritional counseling, general education, and step and/or healthy eating challenges; and
  • A Walgreen’s or CVS store that includes a pharmacy.

Left as is, the entire “hybrid entity” must comply with the Rules. However, the Rules allow a “hybrid entity” to separate itself for compliance purposes by designating which parts make up the Covered Entity and which do not. The Rules appear to only require this designation in the Covered Entity’s HIPAA Privacy and Security policies and procedures, but it wouldn’t be the worst idea ever to also include this in the corresponding plan document.[2]

Group Health Plan Responsibilities Under the Rules

A plan/plan sponsor can generally reduce its liability by limiting its contact with PHI. Many of the responsibilities in this section can be delegated to third parties, but the plan remains responsible for compliance with the Rules.

[2] The plan document will need to include certain HIPAA Privacy and Security language anyway, and the designation can go there.

Self-Insured Group Health Plan
and Fully-Insured Group Health Plan that is “Hands On” PHI[3]

  • €Appoint a HIPAA Privacy and Security officer (they can be different people in your organization)
  • €Identify the Covered Entity workforce (people in your organization that work with PHI to help administer your plan)
  • €Address all the administrative, physical and technological standards of the Security Rule
  • €Draft HIPAA Privacy and Security policies and procedures indicating how the plan complies with the Rules
  • €Train your Covered Entity workforce on your policies to safeguard PHI
  • €Identify all the plan’s Business Associates and enter into Business Associate Agreements with them
  • €Maintain a notice of privacy practices and distribute as required
  • €Create procedures to investigate potential breaches and address breach notification requirements
  • €Create a complaint process and designate a complaint contact
  • €Maintain processes for requesting restrictions, confidential communications and amendments to health information
  • €Amend plan document to comply with certain HIPAA Privacy and Security Rule requirements


Fully-Insured Group Health Plan that is “Hands Off” PHI

The plan may not:

  • Intimidate or retaliate against participants who exercise their rights under the Rules; or
  • €Require participants to waive their rights under the Rules
  • The plan has to comply with a limited number of safeguards under the Security Rule:[4]
  • €Appoint a HIPAA Security officer
  • €Perform a periodic risk analysis (this will document all PHI is in the hands of third parties such as the insurance carrier or a business associate and not the plan/plan sponsor)
  • €Document that the risk management procedures for PHI used by the insurance carrier are adopted by the plan and that the plan requires no additional measures to reduce risk
  • €Identify all the plan’s Business Associates, if any, and enter into Business Associate Agreements that comply with the HIPAA Security Rule requirements
  • €Amend plan document to comply with certain HIPAA Security Rule requirements

[3] We realize these are generally overlooked and likely present little risk.

[4] From a compliance perspective, the differences between the two types of plan are minor.

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Annual Creditable Coverage Notice Deadline Approaches

September 21, 2018


The annual deadline for the Creditable Coverage notice is arriving once again. The Centers for Medicare and Medicaid Services (CMS) requires employers offering prescription drug coverage to disclose to all Medicare Part D eligible individuals the creditable status of their plan by October 15th each year. Employers may use the model notices available here on CMS’s website.

It can be very difficult for employers to know exactly who should receive the notice as there are ways to become Part D eligible beyond attaining age 65. Many employers resolve this issue by including the notice in enrollment materials or providing separate mailings to all employees who participate in the employer-sponsored plan. We’ve previously discussed distributing the notice here.

If mailing the notice, first-class mail is generally preferred. A single notice may be sent to Part D eligible employees and their Part D eligible spouse or dependents. If the employer is aware a spouse or dependent resides at a different address, a separate notice must be sent to their address. When including with enrollment materials, the notice must be:

  • Prominently referenced; and
  • In a (minimum) 14-point font in a separate box, bolded or offset on the first page.
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September is Fruits & Veggies – More Matters Month

September 21, 2018


Most Americans know the importance of eating fruits and vegetables, but most still aren’t getting the daily recommended servings. The minimum requirement is 5 cups of fruits and vegetables a day. A cup is equal to one tennis ball-size piece of fruit or one cup of cooked or raw vegetables. Most individuals need to do some planning to ensure they are getting the minimum daily intake. Planning involves, purchasing, cleaning and preparing the fruit and vegetables. Keep a fruit and vegetable bowl in the refrigerator with a variety of ready-to-eat fruits and vegetables to snack on. Be sure to add a vegetable at meal time and double the portion so that fruits and vegetables make up one-half of you plate. For more ideas visit .

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Navigating the Wellness Program Rules for 2019

September 17, 2018


What a difference a year can make. Dealing with the various and differing wellness program requirements under HIPAA, the ADA, and GINA remains challenging, but we finally had a regulatory framework to work with for all three laws in 2017 and 2018. That was apparently too easy as a federal court determined that the Equal Employment Opportunity Commission (EEOC) hadn’t done enough to justify its ADA and GINA wellness incentive limit rules and ordered the EEOC to try again.  After the EEOC indicated it would be unable to complete revising its rules before 2021, the court issued an order vacating the existing ADA and GINA wellness incentive rules as of January 1, 2019.

So now what?
This leaves employers with a few options to consider heading into 2019:

  1. Leave existing wellness programs that comply with the current HIPAA, ADA, and GINA regulations alone without making any design changes;
  2. Modify existing wellness programs by eliminating or reducing incentives for activities that are subject to the ADA and/or GINA; or
  3. Determine whether to implement new wellness program activities with incentives that are subject to the ADA and/or GINA.

We recommend employers discuss their wellness program design with their legal counsel before choosing a course of action, but leaving an existing compliant wellness program alone seems to be a reasonable course of action for now for reasons we will discuss below. We also recommend employers carefully consider whether to implement new or additional programs that rely on the soon-to-be-vacated wellness incentive limits until further guidance is available.

Recap of the existing wellness incentive rules
The three sets of wellness rules have much in common, such as a general requirement that a wellness program be reasonably designed to improve health and/or prevent disease without being overly burdensome or a subterfuge for discrimination against participants. A key difference between them is when and how their wellness incentive rules apply.

  • HIPAA – Only “activity-only” and “outcome-based” wellness programs are subject to HIPAA’s incentive limits. An activity-only program requires participants to complete an activity related to their health status without actually requiring a specific health outcome. Examples include walking and healthy eating challenges. An outcome-based program requires participants to actually achieve or maintain a specific health outcome. Examples include requirements for participants to be tobacco free or achieve biometric targets. The cumulative amount of all incentives cannot exceed 30% of the total cost of coverage (employee + employer contribution) or 50% of the total cost of coverage provided the excess over 30% is used toward tobacco cessation incentives. A wellness program could utilize the entire 50% limit for tobacco incentives. If spouses and/or dependents may participate, the incentive may be based on the total cost of coverage for the enrolled tier such as employee + spouse instead of employee-only. A program must include reasonable alternatives to qualify for incentives if it is medically inadvisable or unreasonably difficult for a participant to participate in an activity-only program or if a participant fails to achieve a required outcome in an outcome-based program.
  • ADA – Wellness programs are subject to the ADA’s rules if the program includes questions that may relate to whether the participant has a disability, such as family medical history questions, or requires the participant to undergo a medical examination. Participation must be voluntary. Under the ADA’s wellness regulations, participation is considered voluntary if the cumulative amount of all incentives does not exceed 30% of the total cost of employee-only coverage. There are no reasonable alternative requirements, but reasonable accommodations must be provided to enable participants with disabilities to participate. For example, an accommodation may be required to enable hearing and/or visually impaired participants to complete a health risk assessment. An employer cannot limit or deny access to health plan coverage based upon participation which prevents an employer from using participation as a gateway to a richer plan design.
  • GINA – GINA prohibits the use of genetic information for health plan underwriting. In today’s wellness program context, GINA primarily impacts health risk assessments as family medical history questions are considered genetic information. Participation must be voluntary and occur after enrollment. Under GINA’s wellness regulations, a spouse’s completion of a health risk assessment is considered voluntary if the incentive does not exceed 30% of the total cost of employee-only coverage. The GINA regulations do not address permitted incentives for employees to complete health risk assessments as these are already covered by the ADA’s rules. No incentives may be offered for dependent children to participate.

We’ll provide an example of how the existing wellness incentive limits under HIPAA and the ADA work at the end of this article.

Because, because, because
The court in AARP v. EEOC held that the EEOC failed to sufficiently justify the use of a 30% incentive limit to satisfy the voluntary requirement under the ADA and GINA because it largely relied on the use of the 30% limit standard from HIPAA without sufficient explanation for why this should be considered “voluntary” or addressing the differences between the laws. However, the court didn’t say that the EEOC’s wellness incentive limits were inappropriate. Instead, it merely indicated that the EEOC hasn’t provided enough guidance to justify the 30% limit yet. The court also didn’t vacate any other provisions of the ADA and GINA wellness regulations, so the rest of the rules remain in effect. There hasn’t been any indication from the EEOC that it intends to back down, so the EEOC’s next attempt may simply rehash the 30% limit with additional support (i.e. the 30% standard is voluntary “because, because, because”).

Be careful what you wish for
Was this a victory for the AARP and potential plaintiffs contemplating suing their employers in 2019 over wellness programs? We’re not so sure.

Potential plaintiffs generally have to file a charge with the EEOC before filing a lawsuit under the ADA or GINA. The EEOC investigates the claim and issues a right to sue at the conclusion of the investigation. It seems unlikely the EEOC will find discrimination and intervene if a wellness program complies with the EEOC’s existing final regulations as drafted, particularly if the EEOC intends to stick with its wellness incentive rules and provide greater justification for them later. Plaintiffs might anticipate this and choose to request a right to sue before the EEOC’s investigation is completed. A lack of support from the EEOC isn’t fatal to a plaintiff’s claims of discrimination in court, but it certainly doesn’t help.

It’s also worth a mention that employer wellness programs were faring pretty well under the ADA in court before the final regulations were issued.[1] The court in AARP v. EEOC vacated the existing wellness incentive rules under the ADA and GINA and ordered the EEOC to try again, but it did not explicitly reject the incentive limits or find that they couldn’t be justified. There’s no basis to assume a wellness program that relies on those incentive limits will automatically lose in court.

In the meantime…
For these reasons, it seems reasonable for employers to stick with existing wellness programs that comply with the HIPAA, ADA, and GINA wellness rules as currently drafted until further guidance becomes available. That said, employers may consider tapping the brakes and not implementing any new or additional programs that rely on the soon-to-be vacated wellness incentive rules. There will be lawsuits and with the current uncertainty, employers may wish to avoid potential trouble they do not already have.

Example under the existing wellness incentive rules:
In the example below, assume the total cost of employee-only coverage is $5,000/year and only employees are eligible to participate in the wellness program.

Wellness Activity and Incentive HIPAA ADA
$250 incentive for completing a health risk assessment with health-related questions N/A
(participatory-only activity)
$250 counts toward
incentive limit
$250 incentive for participating in biometric screening without regard to results N/A
(participatory-only activity)
$250 counts toward
incentive limit
$1,200 annual surcharge for using tobacco based solely on employee attestation $1,200 counts toward
incentive limit*
Total permitted incentives


$1,500 (30% * $5,000) or up to $2,500 (50% * $5,000) if excess over $1,500 used for tobacco incentives $1,500 (30% * $5,000)
Total incentives used $1,200 = compliant $500 = compliant

*HIPAA’s reasonable alternative standard rules apply.

[1] Remember, only the wellness incentive rules have been vacated. The EEOC specifically rejected the bona fide benefit plan safe harbor relied upon in Seff v. Broward County and EEOC v. Flambeau in the preamble to its final ADA regulations and attempted to strip this approach out, so this probably remains unavailable today.

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Federal Agencies Release Final Regulations for Short-Term Limited Duration Insurance Coverage

August 8, 2018


The Departments of Labor, Health and Human Services, and Treasury recently released final regulations for short-term limited duration insurance policies (STLDI) that make several changes to the existing STLDI rules and also affect how these policies interact with other laws.  The final regulations become effective this Fall.  STLDI coverage is intended to provide individuals who experience short-term gaps in medical coverage with a cost-effective alternative to the more comprehensive and expensive coverage available through the public health insurance exchange (the “Marketplace”), COBRA, or through other coverage continuation laws.

Offering STLDI coverage to employees (or former employees) is not a viable employer strategy as the coverage will lose its STLDI protection under the final regulations.  Under the final regulations:

  • STLDI coverage is not required to meet the ACA’s plan design mandates, meaning it may have annual or lifetime dollar maximum limits, pre-existing condition exclusions, exclusions for ACA-mandated benefits, etc.
  • The permitted duration for an STLDI policy increases from 3 months to 364 days, and it may be renewed for up to 36 total months.
  • STLDI coverage does not qualify as minimum essential coverage (MEC) for the purposes of satisfying the ACA’s individual mandate tax penalty.  This penalty is charged when a taxpayer fails to maintain MEC for the tax year. The Tax Cut and Jobs Act of 2017 eliminates the penalty starting in 2019, so this issue will go away.
  • Insurance carriers are permitted to subject applicants to underwriting and may decline coverage.
  • A loss of STLDI coverage will not trigger mid-year election rights through the Marketplace.

Insurance carriers are not required to offer STLDI coverage.  Insurance carriers are required to provide a notice with the application materials to educate applicants about the limitations of these plans.  The final regulations also note that states can mandate additional limitations.


This alert was prepared by Marsh & McLennan Agency’s Employee Health & Benefits Compliance Center of Excellence.  The information contained herein is for general informational purposes only and does not constitute legal or tax advice regarding any specific situation. Any statements made are based solely on our experience as consultants. Marsh & McLennan Agency LLC shall have no obligation to update this publication and shall have no liability to you or any other party arising out of this publication or any matter contained herein.  The information provided in this alert is not intended to be, and shall not be construed to be, either the provision of legal advice or an offer to provide legal services, nor does it necessarily reflect the opinions of the agency, our lawyers or our clients. This is not legal advice. No client-lawyer relationship between you and our lawyers is or may be created by your use of this information. Rather, the content is intended as a general overview of the subject matter covered. This agency is not obligated to provide updates on the information presented herein. Those reading this alert are encouraged to seek direct counsel on legal questions. © 2018 Marsh & McLennan Agency LLC. All Rights Reserved.

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Artificial Intelligence is Disrupting the Insurance Industry

August 1, 2018


What exactly is artificial intelligence?

According to IBM, who has been doing research on the topic since the 1950s, artificial intelligence (AI) is simply “anything that makes machines act more intelligently”.­ This can be broken down further into two groups: applied or general. Applied AI is capable of doing only those tasks it has been designed for, such as driving/operating a car, or trading stocks. This is the most common type of AI, and has had a wide range of success in many applications. On the other hand, general AI is far more advanced and theoretical. Instead of seeing specialization in one task, “a machine [would be] able to perform any task a human can”. It would, in essence, be able to learn anything and apply it to any situation, to think and reason just like a human. This type of artificial intelligence, though generating much attention in the recent years, is still far from a reality.

Hand-in-hand with the concept of AI is the area of machine learning (ML). This is “a branch of artificial intelligence based on the idea that systems can learn from data, identify patterns and make decisions with minimal human intervention”. This technology is widely used today, mainly by industries who amass a large amount of data (e.g. financial services, government, health care, etc.). It is what gives a machine its ability to learn from the past, and make predictions/decisions for the future. The more it encounters, the smarter it becomes.

The financial services industry has been using artificial intelligence and machine learning for years. Referred to as FinTech, firms take advantage of AI’s power by providing sophisticated virtual customer service assistants, analyzing legal documents, and even making strategic trades on the stock market. Large firms such as JP Morgan Chase have adopted artificial intelligence to help analyze important documents, which in turn has reduced their time spent from 360,000 hours annually down to a matter of seconds.  With AI’s ability to streamline back-end operations and improve efficiency all around, one might wonder why other industries have been so late to the game. Insurance firms, for example, are only just beginning to experiment with the use of AI. Considering its resemblance to the financial industry, it seems odd that insurance is still lagging so far behind. There may be, however, two reasons why FinTech got a head start. For one, insurance is a very passive product. Whereas roughly 70 percent of insurance firms only hear from their customers once a year, financial institutions communicate with their clients almost 200 times annually. This frequent customer interaction, coupled with the heavy regulation following the economic crisis of 2008, created a need for change. It also created the perfect opportunity for disruption from startups and innovators. “From non-bank lending, because banks could no longer provide enough capital, to consumer friendly apps and efficient payment solutions” the introduction of FinTech was unsurprising. Given that the field has steadily grown over the years, and amassed $16.6B in investments for firms last year, AI’s possibilities should not be ignored. The question is: can other industries catch up?

For the insurance industry, AI and machine learning have thus far been used in pricing, handling claims and detecting fraud, though firms are only now learning of its endless possibilities. Lemonade, a new property insurance company out of New York, is pioneering the way for other carriers to automate their processes and implement artificial intelligence. They enlist the help of chatbots, which are computer programs able to analyze language and mimic conversations to interact with humans. The bots are able to speak to multiple customers at once and are available anytime of the day. This is a major advantage for businesses that rely on fast, effective customer service.

Lemonade’s chatbot, Maya, “sells inexpensive homeowners’ and renters’ insurance, and their claims bot, AI Jim…recently settled a claim in three seconds”. Maya is able to communicate directly with customers and help them navigate through the confusion of applying for coverage. Their website claims she will craft the perfect insurance for you, without the need for customer service representatives and underwriters. The appeal of having a computer execute such tasks is that it reduces the time spent, the hassles and the costs. It makes the processes far more seamless, instantaneous and trustworthy. Even though Lemonade is targeting a niche group (millennials), other insurance companies should not turn a blind eye; they could learn a lot from the company’s operations and values. “Lemonade is fast and transparent rather than slow and opaque”. Many people will be drawn to this refreshing view in a notoriously mundane industry.


With the ever-increasing use of social media and “smart” gadgets, AI machines now have access to a wealth of data. This is especially useful when analyzing a client’s risk and setting an appropriate premium. Underwriting, a somewhat lengthy and intricate process, has been presented with the opportunity for automation. A bot is able to “scan a customer’s social profile to gather information and find trends and patterns”. This ability to analyze social media posts and determine a person’s risk within seconds puts AI’s capabilities far beyond humans’, and at a far lower cost. When considering the vast amount of data generated from the Internet of Things (IoT), the accuracy and knowledge of these bots will be unparalleled. AI also provides the “mechanics to capture ‘tribal knowledge’, thereby providing a uniform assessment metric across the entire underwriting process”. Tribal knowledge is defined as information that is known only to the insiders of a particular group or organization, and is not common knowledge to outsiders. In the world of underwriting, this tribal knowledge could consist of emails, internal reports, presentations and evaluations, all of which can help better assess a group’s risk.

One would think gathering personal data from people would be met with overwhelming opposition, but surprisingly “62 percent of younger groups said they’d be happy for insurers to use third-party data…to lower prices”. While it is exciting that companies may no longer base their premiums on generalized assumptions, and look to individualized data instead, a concern for privacy is presented. Allowing limitless access to your personal data is both risky and invasive. What happens to our freedom of speech if we can no longer share photos from a night out, or post our thoughts online without the threat of increased insurance premiums? Additionally, think of the impact a data breach would have if you allow all of your personal information to be in the hands of one company. To make matters worse, there is no guarantee these companies would not sell your information to third parties, thereby increasing the risk of a data breach exponentially. Consumers need to weigh the pros and cons before allowing insurance companies access to such personal information. Since when does affordability outweigh privacy?

Claim Handling

Claims processing can be “a monotonous task susceptible to errors stemming from uniquely human factors”. Not only does AI reduce the amount of time spent on claims, it also reduces the probability of error. Imagine having a machine analyze a photo of damage and estimate repair costs within seconds. The entire burden of handling the claim would fall off of the insurer and customer. AI will eliminate the need for having multiple people work on the same claim, thus decreasing administrative costs and the frequency of errors. Kristof Terryn, COO of Zurich, has instituted a project to automate their claims processes. He declared that it “will trim $5 million from expenses…for the 39,000 hours of claims handler time now being done by computer”. Though this is an impressive reduction in costs, most of the value stems from increasing the accuracy of claims and virtually eliminating errors during the process. Other companies that have implemented automation “of their claims process have seen a significant reduction in processing times and [an increase in] quality”. The use of chatbots also reduces the need for interaction with customers during the process. Any questions customers may have could be directed to those bots, therefore allowing workers to focus on more important tasks. Thanks to artificial intelligence, insurance companies’ resources can be better allocated; they will no longer require the manpower needed in decades past.

Fraud Detection

With the implementation of AI and machine learning comes the ability to analyze data better and faster than any human ever could. These machines are able to identify patterns within a claim, look to historical data and “help to recognize fraudulent claims in the process”. This should be of utmost importance to not only insurance carriers, but to the insureds as well. According to the FBI, it is estimated that insurance fraud costs the United States $40 billion annually. This cost is passed along to the insureds in the form of increased premiums, roughly “$400 to $700 per year”. A startup firm in France called Shift Technology is using AI in their fraud prevention services. They have “already processed over 77 million claims… [and] have reached a 75 percent accuracy rate for detecting fraudulent insurance claims”.1Even IBM offers AI services to fight financial crimes.  It is evident that this application of AI will grow exponentially in the future and drastically help cut the cost of fraud.

All things considered, artificial intelligence is set to flip the insurance industry upside down. Automating monotonous processes, reducing fraud and increasing accuracy are major advantages of using the technology. Insurance, which as an industry is notorious for its antiquated processes and values, is being disrupted by this emergence of artificial intelligence and machine learning. Disruption happens when an existing market, industry, or technology is displaced and replaced with something new and more efficient/worthwhile. Accenture claims that “75 percent of insurance executives believe AI will provide significant industry changes in the next three years”. Despite the fact some insurers have started to embrace the change, many others are unaware of the impact it is having already. While there are many kinks left to be ironed out, the reality is that companies have two options- catch up or be left behind.


About the Author

Ashley Evans: Analytics intern at J.W. Terrill, and senior at Saint Louis University pursuing a bachelor’s degree in Finance; Dean’s List recipient for two consecutive semesters. Interested in continuing her education with a Master’s in Applied Financial Economics.


  1. “Artificial Intelligence.” IBM. July 25, 2016. Accessed July 18, 2018.
  2. Marr, Bernard. “What Is The Difference Between Artificial Intelligence And Machine Learning?” Forbes. September 15, 2017. Accessed July 18, 2018.
  3. “What Is AI?” IT PRO. June 11, 1970. Accessed July 18, 2018.
  4. “Machine Learning: What It Is and Why It Matters.” SAS. Accessed July 18, 2018.
  5. Alton, Liz. “How Financial Services Use AI To Serve Customer Needs.” Forbes, Forbes Magazine, 8 Sept. 2017,
  6. Kurani, Ravi. “InsurTech Is the New FinTech – or Is It? – Earlybird’s View – Medium.”Medium, Augmenting Humanity, 23 Aug. 2016,
  7. “The Global Fintech Report Q4 2017.” Corporate Innovation Trends, 2018, Ads&utm_medium=FintechReport&msclkid=4a5f3b8d528b149feb2660d5b3c03485.
  8. Team, Writer Profile Of “How Artificial Intelligence Is Changing the Insurance Business.” Medium. February 14, 2017. Accessed July 18, 2018.
  9. Sun, Alex. “How Chatbots Can Settle an Insurance Claim in 3 Seconds.” VentureBeat,VentureBeat, 28 May 2017,  settle-an-insurance-claim-in-3-seconds/.
  10. “Lemonade Renters & Home Insurance | Protect The Stuff You Love.” Lemonade. Accessed July 18, 2018.
  11. Fromm, Jeff. “How Startup Lemonade Is Redefining Insurance For Millennials.” Forbes. July 12, 2017. Accessed July 18, 2018.
  12. Moodie, Alison. “How Artificial Intelligence Could Help Make the Insurance Industry Trustworthy.” The Guardian. January 28, 2017. Accessed July 18, 2018.
  13. Morgan, Blake. “How Artificial Intelligence Will Impact The Insurance Industry.” Forbes. July 25, 2017. Accessed July 18, 2018.          intelligence-will-impact-the-insurance-industry/#1daeb20a6531.
  14. Kumar, Krishna. “AI’s Huge Potential for Underwriting.” Insurance Thought Leadership. December 17, 2015. Accessed July 18, 2018.
  15. “What Is Tribal Knowledge? Definition and Meaning.”   Accessed July 18, 2018.
  16. “Young Consumers Willing to Let Insurers Spy on Digital Data – If It Cuts Premiums.”     Insurance Journal. June 21, 2018. Accessed July 18, 2018.
  17. “Insurance Fraud Prevention Gets Help From Artificial Intelligence.” Samsung Business Insights. January 19, 2018. Accessed July 18, 2018.
  18. “AI and Insurance: Are Claims Jobs in Danger?” Carrier Management. March 14, 2017. Accessed July 18, 2018.
  19. “Insurance Fraud.” FBI. March 17, 2010. Accessed July 18, 2018.
  20. “RegTech and Cognitive Risk & Compliance | IBM.” IBM Cognitive Advantage Reports.             Accessed July 18, 2018.   markets/risk-compliance.
  21. Howard, Caroline. “Disruption Vs. Innovation: What’s The Difference?” Forbes. June 20, 2016. Accessed July 18, 2018.
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