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IS YOUR COMPANY PROTECTED FROM ASSOCIATIONAL DISCRIMINATION CLAIMS?

By Business Protection Bulletin

Most employers are aware of the employee protections found in Title VII of the Civil Rights Act of 1964. Employers may not discriminate against employees on the basis of race, color, religion, sex, or national origin. Also, they may not retaliate against employees who have protested against an illegal employment practice or who participated in an investigation or other activities against the employer for an illegal practice.

Further, recent court decisions have applied Title VII’s protections to an employee’s association with another person whose characteristics fall under those protections. The U.S. Supreme Court held in 2006 that employers cannot discriminate against someone closely related to or associated with a person who is exercising protections under Title VII. Two federal courts earlier this year ruled that employers violated the law by discriminating based on association. One allegedly fired a white basketball coach because his wife was African-American; the other allegedly fired an employee whose coworker’s fiancé filed a complaint with the Equal Employment Opportunity Commission.

All employers are vulnerable to these types of accusations, even those who strive to obey the law. Employment Practices Liability insurance (EPLI) policies cover many types of losses resulting from employee claims. How will they respond to association discrimination claims?

EPLI policies vary somewhat from one insurance company to another, but most provide coverage for acts such as discrimination, wrongful termination, harassment, retaliation, and inappropriate employment conduct. A typical policy covers discrimination against an employee for termination of the employment relationship, demotion, failure to promote, denial of an employment benefit, or other adverse action based on a number of characteristics such as color, race, sex, ethnicity, age, and religion. It also covers retaliation claims if the employee engaged in a protected activity, the employee suffered an adverse action, and the protected activity caused the adverse action. Because they apply specifically to employees who have these characteristics or who perform protected activities, these policy provisions do not appear to cover actions against employees because of their association with others.

However, the policies usually also cover “inappropriate employment conduct.” Among the acts that might fall within this category are coercion, wrongful demotion, wrongful discipline, retaliatory treatment, and others. The definition of “inappropriate employment conduct” will be different from one policy to another. One insurance company might cover association discrimination while another might not. As such, employers should discuss specific terms of coverage with one of our insurance agents.

The policies might cover the employer, but not the employee alleged to have committed the act, if a court determines the employee deliberately acted illegally or with intent to harm the other employee. For example, if a court ruled that a supervisor was acting maliciously when he fired an employee for marrying someone of a different race, the insurance might pay for the employer’s defense and liability but not for that of the supervisor.

In this era where job cuts and lawsuits are common, employers face a real exposure to actions against them for the decisions they make. Lawsuits can be costly even if they are groundless; the costs of defending them can mount rapidly. EPLI provided by a financially solid company is an important part of every employer’s risk management program. EPLI, coupled with a well-executed loss prevention program, will help any employer survive employee accusations.

USE THESE TECHNIQUES TO TRANSFER LEGAL LIABILITY FOR YOUR PRODUCTS

By Employment Resources

Whether you’re a business bringing a new, exciting product to market or a 20-year-old firm selling the latest version of a successful product line, you face certain risks. Users of the product might suffer injuries or damage to their property. These accidents could stem from inappropriate use of the product, such as using a lawn mower to trim hedges. However, some products can be dangerous under normal use by untrained or inexperienced operators. Furthermore, vendors or contractors who sell or install a product might modify it or otherwise affect its performance. These changes can increase the chances that the product will cause injury or damage, and that can land the manufacturer in a courtroom. However, there are steps the firm can take to transfer the risks of financial loss from these incidents.

First, the manufacturer should require, as part of its contracts with contractors, that those parties name it as an additional insured on their Liability insurance policies. If the contractor is at least 1% liable for the accident, the endorsement gives the manufacturer rights to coverage under the policy for amounts necessary to settle a lawsuit. Perhaps more importantly, it covers the cost of defending the firm against the suit. These costs are often substantially higher than the cost of the settlement. The contracts should require the other party to give the manufacturer certificates of insurance showing that the Liability policies include this coverage.

Assume, however, that either the other party neglected to have the manufacturer added as an additional insured or for some reason the insurance company denied coverage under the endorsement. If the company pays for the settlement on behalf of its insured (the contractor), it has a legal right to try to recover its payment (subrogate) from the manufacturer or its insurance company. To prevent that from happening, the contract between the manufacturer and the other party should require the contractor to waive subrogation rights. The waiver of subrogation will bind the insurance company, preventing it from going after the manufacturer. The ISO Liability insurance policy implies that the insured can waive subrogation rights at any time before a loss occurs. However, if the manufacturer wants no doubt as to whether a waiver applies, it should require the other party to add a specific endorsement to its policy, waiving the insurance company’s subrogation rights.

One commonly used technique for transferring liability is requiring a contract to include an indemnity agreement, also known as a hold harmless agreement. Such an agreement will require the contractor to indemnify the manufacturer for the costs of any suits resulting from that party’s work for the manufacturer. For example, assume Contractor A installs a turbine made by Manufacturer B in a power plant and the turbine malfunctions, injuring several employees. Under this agreement, A would indemnify B for the costs of the ensuing lawsuits. Contractor A’s Liability insurance should provide coverage for this if it does not contain an absolute contractual liability exclusion. An experienced contract attorney can help develop the appropriate language for this agreement.

Because some of these techniques involve modification of insurance coverage, the manufacturer should consult our insurance agents. Some insurance companies might require the manufacturer to have these techniques in place before they will offer coverage, while others might accept the account without them but offer reduced premiums if they are in place.

Contractual arrangements are no substitute for providing a safe, quality product. However, since accidents are possible no matter how many precautions are taken, manufacturers are well advised to use these techniques to decrease the chance of financial loss.

AS GREEN CONSTRUCTION GROWS, SPECIALIZED INSURANCE BECOMES AVAILABLE

By Construction Insurance Bulletin

Weather patterns have become increasingly erratic during the past several years. Heat waves, droughts, mudslides, and increased hurricane activity have become the norm. In 2004, four major hurricanes pummeled Florida; the Gulf Coasts of Louisiana, Mississippi and Alabama are still recovering from 2005’s Hurricane Katrina and its ensuing floods. Between these disasters and increasing attention from politicians and the media, the problem of global climate change has become a major issue. As a result, the insurance industry has begun to devise new products and strategies.

Some insurers are beginning to offer specialized “Alternative Energy insurance” policies. For example, one company is writing policies to cover alternative energy system performance. This policy insures against the risk that a deficiency in the design of alternative energy technology will result in the under-performance of a facility. The company designed to help owner-operators of facilities meet the needs of lenders concerned about their investments. Another company has broadened its coverage for commercial buildings to include alternative energy systems. It also will insure against loss of income when alternative energy systems suffer damage and extra expenses when the building owner must buy power from the grid while the system undergoes repair.

At least one insurer offers special coverage to encourage commercial building owners to replace destroyed buildings with new ones using green technology. It gives the property owner several green technology options, including:

  • Non-toxic, low-odor paints and carpeting
  • Energy-efficient electrical systems
  • Interior lighting systems that meet independent energy efficiency standards
  • Water-efficient plumbing systems
  • Enhanced roofing and insulation materials to reduce heat loss

Anticipating less severe and less frequent losses, the same company offers rate credits to green building owners. It has found that most losses in traditional buildings are from electrical fires, heating and air conditioning system fires, and plumbing leaks. The company expects green technology to make these events less likely. Another insurer has introduced for commercial building owners a new policy that encourages green building. It features coverage for:

  • The increased cost of green building alternatives
  • The expense of re-engineering and re-certifying green buildings
  • Vegetative roofs
  • Additional time to restore operations so that building repairs can include green alternatives

Insurers are also educating their clients about the implications of climate change. Recognizing that courts could hold businesses liable for future environmental damage, insurers have worked with corporate boards and officers to encourage planet-friendly business practices. Their hope is that actions taken now will reduce the number and size of future liability insurance claims.

Although only a small number of insurers offer specialized policies for green construction now, the success of these products will encourage other companies to follow suit. Also, as green building technologies become widespread, the desire to attract and retain business will force insurers to compete with policies of their own. Insurance agents can identify companies that offer these coverages and make coverage recommendations to property owners. As businesses and households everywhere take steps to reduce their carbon footprints, make certain that your insurance coverage is keeping up with those steps.

PREPARE FOR PREMIUM AUDIT PROCESS BY FOLLOWING THESE EASY STEPS

By Construction Insurance Bulletin

Are you due for a Workers Compensation premium audit? Audits are how insurance rates are determined, and it’s possible that an audit will uncover information that can actually save you money. In any case, it pays to be prepared. These five tips can help you get ready.

  1. Let your broker know when there are changes in your staffing, payroll, or areas of operation. This is important not just at audit time but all the time. Your rates are based on variable rating information, including the number of employees, job classifications, the states in which you operate, etc. Updated information results in more accurate premium assessments.
  2. Get your records ready. Your auditor will need to see records such as federal and state tax returns, ledgers, checkbooks, contracts, and employee or contractor tax documents. If you prepare your records in advance, you’ll accelerate the audit process.
  3. Make sure you break out various types of compensation in your records. For example, to set your premium, your broker considers pay but not contributions to employee benefits packages and other perks, so it’s important to make sure your records are clear on the various types of compensation. Also make sure overtime pay is clearly defined since it’s classified as regular pay for Workers Compensation insurance purposes.
  4. Ensure that contractors have their own insurance. This is important not only from an audit standpoint but from a liability perspective as well. If an uninsured contractor has an accident while performing work on your behalf, you can be held liable. If an audit identifies contractors for whom you don’t have certificates of coverage, you can be charged for their premiums.
  5. Remain on hand to answer questions. As your auditor reviews your material, he or she might have questions or need additional data. If you’re available to provide answers, your audit will be completed more quickly.

By following these tips, you’ll be more prepared for your Workers Compensation premium audit. A fast, efficient audit process can save time for both you and your auditor, so it pays to be prepared.

CONTRACTORS: SECURE COVERAGE FOR POTENTIAL DAMAGE TO CUSTOMER’S PROPERTY

By Construction Insurance Bulletin

A plumbing contractor’s employee is soldering two lengths of pipe together when a fellow employee asks him to assist with another task for a moment. The first employee lays the soldering torch on a ceiling joist, forgetting that it is still hot. While he is away, the joist begins to smolder, then small licks of flame form and ignite combustible material in the ceiling. By the time someone notices, fire is consuming the ceiling. Firefighters’ efforts to extinguish the blaze causes water damage to portions of the building, and walls near the fire’s starting point suffer smoke damage.

The building owner will most likely hold the contractor responsible for the cost of repairing the damage. In turn, the contractor will look to his General Liability insurance policy to cover that cost. Will the insurance company pay for the repairs?

The Insurance Services Office’s Commercial General Liability Coverage Form states, “This insurance does not apply to … ‘property damage’ to … (t)hat particular part of real property on which you or any contractors or subcontractors working directly or indirectly on your behalf are performing operations, if the ‘property damage’ arises out of those operations … ” What does this mean, and how does it apply to an incident like this one? What does the form mean by the phrase, “that particular part”? Several courts have weighed in on this question.

A Tennessee court in 1975 ruled against an electrical contractor whose employee, while installing circuit breakers in a switchboard, caused a short circuit that destroyed the entire switchboard. The court said that the employee was performing operations on the switchboard, not just the individual circuit, and therefore liability coverage did not apply. Similarly, a Massachusetts court ruled against a cleaning contractor in 1989. The contractor was cleaning the bottom of an underground oil storage tank when an explosion occurred, destroying the entire tank. The contractor argued that the insurance should cover all of the damage except that to the bottom of the tank, but the court ruled that the entire tank was “that particular part” on which the contractor was performing operations.

Conversely, a Minnesota court granted coverage for a contractor that had been hired to clear trees and brush from a construction site but that also cut down trees on an adjoining property. The court said that, although the liability policy would not cover damage to property the contractor had been hired to work on, it did cover damage to the property of a third party. A New York court ruled in 1974 that a liability policy covered damage that occurred after the contractor had completed operations.

The courts have not established firm rules about what constitutes “that particular part” of property on which a contractor is performing operations. Case law will vary from one state to another. Because of this, contractors should discuss the exposure with one of our insurance agents. To reduce the chances of an uninsured loss occurring, an agent might recommend the purchase of a Builders Risk or Installation Floater policy. These policies cover property that the contractor is installing on a construction site while it’s in storage, in transit, on the job site, and during installation. They also usually cover property of others for which the contractor might be liable. Unlike the General Liability policy, there are no standard versions of these policies, so contractors must review them carefully and ask our agents questions about anything that is unclear.

The law of averages suggests that most contractors will accidentally damage a customer’s property at some point. Now is the time to make sure that there will be no insurance surprises when it happens.

WORKPLACE EYE SAFETY PROCEDURES ARE CRITICAL

By Workplace Safety

Each day, your eyes face a perilous world filled with hazardous objects. Consider this: One small flying object, a chemical splatter, or the wrong dust-sized particle and one or both of your eyes could be rendered useless. Although our eyelids provide some barrier from these harmful objects and materials, we have to be forewarned in order for the lids to close and protect them and sometimes, that is just not possible. According to the National Institute for Occupational Safety and Health (NIOSH), about 2,000 workers in the United States suffer a work-related eye injury requiring medical treatment each day. Thirty-three percent of these injuries are treated in the emergency room and 5% of them result in missed work. NIOSH has found that the vast majority of these injuries are the result of something as simple as a small object or particle striking or scratching the eye.

Although this type of injury does not always result in vision loss, the pain, expense, and inconvenience of the injuries lead many to wish they had taken the small precautions that could have prevented the injury. Often, the simple safety measures available that would have prevented the injury were ignored because the “It won’t happen to me” mentality was adopted. Taking the right steps toward keeping your eyes safe from painful injuries is easy as long as you know how to assess and minimize your exposure and wear proper safety equipment.

Assess Your Exposure

Your work area is the primary location for an eye-related injury. Luckily, it is a relatively easy space for you to clean and control. Monitor and clean your work area of any loose particles of sawdust, metal shards, or any other material. Keep any chemicals sealed and clean up spills immediately. Your workplace should have written instructions for maintaining your work area. Be sure to follow these instructions daily.

Select Proper Safety Equipment

There are many options for protective gear. Although some protect just your eyes, others can protect your entire face and head. These options include:

  • Goggles
  • Glasses
  • Helmets
  • Face shields

When you are working with chemicals that could splatter and cause chemical burns on your face, goggles or glasses will not offer enough protection. Instead, opt for a face shield. Helmets are useful when you have unpredictable elements like the sparks from welding. There are many different materials that protective lenses can be made of including:

  • Polycarbonate lenses
  • Glass lenses
  • Plastic lenses

Although each of these lenses is helpful in protecting against eye injury, Polycarbonate lenses are stronger and better able to stand up to heavy impact. However, they are more prone to scratching than glass, so be sure to store them properly.

CONSIDER CLOSE CALLS AS WARNING SIGNS FOR POTENTIAL ACCIDENTS

By Workplace Safety

How many close calls have you had at work? How many potential accidents have you seen that were within an inch of happening but by some lucky chance didn’t? Don’t get too comfortable with the fact that these close calls were incidents instead of accidents; instead consider that they were warnings.

When you view a close call as a warning, it can help you prevent actual workplace injuries. By being proactive, you not only save your employer money but you could also save your coworkers’ lives and limbs.

Common Causes of Close Calls:

  • Unclean floors with debris that can cause trips and falls. This could include chemical or grease spills, puddled water, ragged carpeting, chipped or uneven tiles, and tools left on the floor.
  • Employees rushing to finish a project in order to go home or meet a deadline and not observing precautions that might slow them down.
  • Lifting without wearing weight belts.
  • Not wearing safety gear like goggles and gloves.

Many of the above activities are the result of carelessness. Although you might not want to report the person responsible for careless action, it is vital to the safety of your entire workplace that you confront any offenders and, if necessary, report the incident.

If you see the unsafe action being perpetrated by an employee or group of employees, talk to them about your concerns. Be sure to do so in a neutral area and not while they are engaged in a dangerous activity. Do not put yourself at risk in order to talk to them and approach them as a concerned coworker, not as an outraged potential victim. If they continue to act in an unsafe manner or if you do not want to confront them, talk to a supervisor.

If the unsafe environment is out of your or another employee’s control and is, instead, a structural or procedural problem, do not work in the area until safety has been observed and the situation corrected. Your employer has an obligation to provide a safe workplace for you. If you have damaged safety gear, or if an area of your workplace has become unsafe, notify management and let them know you will be unable to continue working until the issue has been addressed.

The Bureau of Labor and Statistics recorded a total of 4 million nonfatal workplace accidents and injuries in 2007. That doesn’t consider the amount of close calls that might have gone unreported prior to the injuries. It’s more than possible that these accidents and illnesses could have been avoided if someone had been proactive after a close call.

OFFICE WORKERS: TAKE ACTION TO AVOID COMPUTER DESK DISCOMFORT

By Workplace Safety

In the past, office workers were frequently on the move — whether they were bending over to place documents in a filing cabinet, running off to a client meeting, walking to the storage closet to locate records or strolling to their office mailbox. But this old-school way of working is now ancient history.

In today’s high-tech, digital world, most office employees rarely need to leave their computer workstations at all. They can check their e-mail, access digital records and files, and talk to clients on the phone without ever leaving their desk. Unfortunately, spending inordinate amounts of time sitting stationary in front of a computer eventually will wreak havoc on your body.

When you think about it, it’s no wonder that office workers suffer from chronic aches and pains. It’s simply not natural for a body to sit in one position for hours on end. If you put your body through this kind of strain day after day, your body will begin to rebel in the form of stiff arms, throbbing wrists, sore shoulders, and an aching back. If you want to avoid desk aches and pains, follow these simple tips:

  1. Don’t ignore discomfort: If you begin to feel even a mild ache or minor numbness as you sit at your desk, it’s important to act on it right away. Try to figure out what is causing the discomfort and mend the problem. Although your soreness might seem insignificant now, it eventually could develop into chronic pain if you don’t heed your body’s warning signals.
  2. Get moving: Don’t sit in the same position for hours on end. Every hour or so, get up and move around to prevent blood circulation problems and muscle fatigue. Simply stand up and stretch or take a quick walk around the office to keep your blood flowing and your muscles active.
  3. Stay neutral: It’s important to keep your joints in a “neutral” position as you work at your computer desk. For example, if you hold your wrist at an odd angle as you type or move your computer mouse, you could develop chronic pain or even Carpal Tunnel Syndrome.
  4. Keep your workstation “ergonomically” correct: If you are experiencing discomfort at your desk, you might need to readjust your workstation. Raise, lower, or re-position your keyboard to keep your wrists neutral and your elbows close to the body. You might also want to consider buying a hand or wrist support for your keyboard and mousepad. Arrange your keyboard so that your forearms rest on the surface of your desk as you type. Your computer monitor should be at a level where your head rests squarely on your shoulders as you look at it. You might also need to raise or lower your chair to find the most comfortable position. Here are a few more tips for keeping your workstation ergonomically correct:
    • When using a keyboard or computer mouse, your hands should be even or slightly lower than your elbows. You might need to mount an adjustable keyboard tray mounted under the desktop to achieve this position.
    • Keep your hands in-line with your forearms as much as possible — do not bend them out, up, or down at the wrist.
    • Rest your elbows on your chair’s armrests and adjust them so the weight of your arms is supported by the armrests, not by your shoulders.
    • If your feet don’t sit flat on the floor, place a foot rest under your desk.
    • Keep the top of your monitor about eye level so you aren’t bending your neck up or too far down.
    • Sit upright so your head is above your shoulders. Don’t slouch forward.
    • Use a good adjustable chair and sit so the natural hollow stays in your lower back.
    • Position your monitor and keyboard in front of you, not to the side.
    • Don’t type with long fingernails. This can cause you to hold your wrists at an awkward angle.

HELP EMPLOYEES UNDERSTAND AND EMBRACE CONSUMER-DIRECTED HEALTH PLANS

By Employment Resources

When an employer invests the time and money in implementing a new benefits plan for employees, it wants the plan to be a success, attract employee participation and increase employee loyalty, and come in at the budgeted amount. Achieving these ends is easier with some plans than others, and consumer-directed health plans, in particular, can have a rough entry into a company’s benefits package. This might be because consumer-directed health plans are not as readily understood by employees as other types of health plans, or it might be because employees — rightly or not — suspect the plan is a cost-cutting measure for the employer rather than a benefits option that might meet their needs.

Employers can take steps when designing, implementing, and communicating a consumer-directed health plan to increase the likelihood that employees will embrace the plan enthusiastically — or at least give it serious consideration if choosing from a menu of plan options.

A study from Aetna shows how a thoughtful and strategic consumer-directed health plan implementation can have positive results. Aetna interviewed employers that had achieved significant success with their consumer-directed health plans — annualized cost trend rates 50% below average, and combined employer/employee savings of $15 million per 10,000 employees over a four-year period. These employers had four things in common concerning their consumer-directed health plan strategy:

  1. Fostered a culture of health care consumerism among all employees, beginning with senior executives.
  2. Implemented a focused employee communication and education campaign.
  3. Offered wellness programs and incentives for healthy behaviors, as well as 100% coverage for preventive care.
  4. Carefully constructed a benefits package that included appropriate levels of employee responsibility.

An issue brief from the Center for Studying Health System Change, in analyzing factors critical to consumer-directed health plan adoption, notes that these plans are complex, requiring employee understanding of the federal tax rules for the savings account component of the plan, including contribution caps and what medical expenses can be paid with health savings account funds. Consequently, consumer-directed health plans require extensive employee education. In fact, a study from Towers Perrin concluded that even a well-designed consumer-directed health plan is not likely to be effective unless it is combined with a thorough and continuous education strategy. The study found that people often misunderstand the risk associated with the savings account component of a consumer-directed health plan, because they confuse it with other forms of health care coverage. For example, they think the use-it-or-lose-it rule associated with flexible spending accounts applies, and don’t understand that their health savings account funds will roll over from year to year.

In looking back over the factors identified in the surveys cited above, the following — at a minimum — should be considered critical to consumer-directed health plan success:

  • Position the consumer-directed health plan as part of an overall health and wellness strategy. Cover preventive care generously, and provide incentives for employees to get and stay healthy.
  • Educate employees on the ways in which a consumer-directed health plan is similar to a traditional plan, and the ways in which it is different. Employees need to understand that although their health plan deductible will be higher, their financial risk is limited, and is offset to a degree by lower premium costs.
  • Show the company’s commitment to the consumer-directed health plan by engaging top management in plan buy-in and by making some type of company contribution to the account portion of the plan.
  • Communicate the plan on an ongoing basis. Publicize good experiences, and share cost-savings data.

Consumer-directed health plans can be a win-win for employers and employees, but for that to happen employees need to embrace the plan, and the consumer-oriented mindset that goes along with it.

WHAT CRITERIA DEFINE A HIGH-DEDUCTIBLE HEALTH PLAN?

By Employment Resources

Health Savings Accounts (HSAs), part of the consumer-directed approach to health care, provide a tax-favored way for individuals to save for and pay for medical expenses. HSAs also offer employers a way to better define their contribution for health care and transfer to employees more control over how health plan dollars are spent.

To add an HSA to a benefits menu, an employer must offer a high deductible health plan (HDHP). An individual must be covered by an HDHP to participate in an HSA.

The basic definition of an HDHP is this: A plan with a minimum deductible of $1,100 for individuals/$2,200 for families, and an out-of-pocket expense limit that does not exceed $5,600 for individuals/$11,200 for families (2008 limits). Previous guidance clarifies that “family coverage” means any coverage other than self-only.

Notice 2004-71 provides extensive guidance on what types of expenses are counted as out-of-pocket expenses, for purposes of determining whether the plan meets the requirement that such expenses not exceed the published limits. As would be expected, amounts paid to satisfy a deductible are counted, as are copayment and coinsurance amounts, even if they would not count against the deductible under the terms of the plan. In the case of cumulative embedded deductibles under family coverage, a plan would not qualify as an HDHP for families where the number of covered individuals is large enough that the cumulative deductible could exceed the $11,200 limit (such as for a family of six with a per person deductible of $2,000 and no cap or maximum family deductible). Notice 2004-71 lists certain types of expenses that are not counted toward the out-of-pocket expense limit:

  • Premiums
  • Amounts paid above the usual, customary, and reasonable (UCR).
  • Precertification penalties, including higher coinsurance amounts for out-of-network providers.
  • Amounts paid for services that are not covered benefits under the plan.
  • Amounts paid after the lifetime plan maximum is reached (the Notice cites as reasonable a plan with a $1 million lifetime benefit maximum).
  • Amounts paid after annual or lifetime limits on specific benefits are reached, so long as these limits are reasonable.

On this last bullet point, Notice 2004-71 states that restrictions or exclusions on specific benefits are reasonable only if “ … significant other benefits remain available under the plan in addition to … ” those subject to the restriction. This Notice provides an example of a plan (self-only coverage) with a $1,100 deductible (2008 minimum deductible) and 100% plan coverage thereafter, up to a $1 million lifetime maximum, and a $10,000 annual limit on benefits for any single condition. Because the annual single-condition limit is not reasonable, expenses incurred by an individual after meeting the deductible are counted toward the HDHP $5,600 out-of-pocket expense limitation (2008 individual out-of-pocket maximum).

A plan without an expressly stated limit on out-of-pocket expenses can still qualify as an HDHP, if the terms of the plan are such that the $5,600 individual/$11,200 family maximum cannot be exceeded. For example, a plan with a $2,000 deductible for self-only coverage that pays 100% of expenses after the deductible satisfies the maximum out-of-pocket requirement for HDHPs, even if it does not contain an express out-of-pocket maximum.