Tag Archives: Coverage

Hospitality Industry Insurance Risks: Restaurant Operators Face "Financial Hit" From New Health Insurance Benefit Programs That Take Effect In 2014

Under the Patient Protection and Affordable Care Act, companies with 50 or more full-time eligible workers must either provide basic coverage by Jan. 1, 2014, or face fines of $2,000 per employee. A full-time employee is defined as one averaging 30 or more hours per week over a 60-day period.

“We will have a financial hit,” said CEO Victor Ansara. “We first thought it was going to be $300,000, but maybe only $100,000 to $200,000. We just don’t know how many of our employees in their 20s, who are pretty healthy, will want coverage.”

Farmington Hills-based Ansara Restaurant Group, which operates 22 Red Robin outlets and five other restaurants in Michigan and northern Ohio, is bracing financially to expand its health insurance benefit program by as many as 665 full-time workers to accommodate expected federal health care reform.

The first 30 employees are excluded from the penalty. For example, an employer with 75 employees would pay the penalty for 45 workers, or $90,000.

Eligible employees that reject insurance coverage by their employer would have to pay a $95 tax, or 1 percent of income, whichever is greater, in 2014. The tax rises to $325 in 2015 and to a maximum of $695, or 2 percent of income, in 2016. Family coverage taxes would be about three times higher in those years. The penalty is estimated to raise $6.9 billion in 2016, said the Congressional Budget Office.

Ansara said his company covers about 130 management staff with various plans from Blue Cross Blue Shield of Michigan and Blue Care Network. Only about 35 of its estimated 350 eligible hourly workers have opted for the coverage, he said.

“It is very difficult to plan when we don’t know what our health care costs are going to be in 2014,” he said. “To comply with the regulation, we have to offer coverage to all full-time eligible employees.”

Of Ansara’s 2,300 employees, up to 700 hourly workers could become eligible for health insurance coverage, he said.

For more: http://www.crainsdetroit.com/article/20121021/SUB01/310219956/red-robin-group-among-restaurants-bracing-for-health-insurance-reform#

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Filed under Health, Insurance, Labor Issues, Liability, Management And Ownership, Risk Management

Hospitality Industry Insurance Risks: "Employment Practices Liability Insurance" May Contain "Exclusions For Intentional Acts" That May Deny Coverage To Hotel Executives In "Disparated Treatment And Sexual Harassment" Cases

“…a panel of arbitrators found that (the executive)  “was well acquainted with the company’s policy on sexual harassment and other acts of inappropriate conduct.”  They further found that (the executive)  “did not comply with the policy on sexual harassment and that his refusal was willful.” 

“…attorneys should remind their clients to carefully review their existing EPLI policies and to understand all exclusions that may apply, as well as to be mindful of such exclusions when negotiating the purchase of a new EPLI policy…”

Exclusions typically found in EPLI policies include exclusions for Fair Labor Standards Act claims, National Labor Relations Board decisions, ERISA matters, costs of complying with accommodations mandated by the Americans with Disabilities Act, and claims arising out of facts or circumstances known to the employer before the effective date of the policy.  Another possible exclusion is for intentional acts.  This exclusion generally is intended to eliminate coverage if an employer acts with “wonton, willful, reckless, or intentional disregard for any laws.” This exclusion is a carryover from other policies traditionally offered, including commercial general liability policies and workers compensation policies.

The question that arises is whether an intentional acts exclusion precludes coverage for disparate treatment or sexual harassment claims.  By their very nature, disparate treatment and sexual harassment require some type of intentional conduct.  If the intentional acts exclusion is interpreted broadly enough, an allegation of disparate treatment or sexual harassment may provide the insurer grounds for denying coverage under the policy.

For more:  http://www.lexology.com/library/detail.aspx?g=54d3b2ac-48f1-497b-ac65-ee0e32826815

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Filed under Claims, Employment Practices Liability, Insurance, Labor Issues, Liability, Management And Ownership, Risk Management