Uncle Sam Steps In State and federal governments save the day with insurance assistance for entrepreneurs.
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You're having a dispute with your insurance companyregarding a claim.The insurance company refuses to pay you a dime,you think you're entitled, and you've reached an impasse.Whom do you call for help--a lawyer or your state insurancecommissioner?
Asking your state insurance commission for help is free to youand any other resident across the United States, and the commissionhas the power to mediate on your behalf. That's usually enoughpressure to get your agent to cooperate. It can also fine yourinsurance company for wrongdoing or, as a last resort, take awayits license to sell insurance in your state.
But the commission has no power to mandate how much you shouldbe paid for your claim--it can only make a yes-or-no decision aboutwhether your policy covers the situation for which you've madea claim. If your dispute is over the monetary amount of your claim,a lawyer might be more helpful than the commission.
"It really depends on the problem," says DavidLangenbacher, deputy commissioner for Consumer Services and MarketConduct with the California State Insurance Department."We're successful in resolving many things, and if wecan't, you still have the option of seeking the advice of anattorney."
Claire Tristram is a business and technology writer in SanJose, California.
New York's Experiment
Last January, the city of New York launched a two-year pilotproject to help small businesses with two to 50 employees offertheir staff members health insurance. The Small Business HealthInsurance Program works as a purchasing alliance--it allowsbusinesses to pool together, which makes them eligible for lessexpensive benefit plans from insurers. Program rates range fromabout $100 for individual employees to $235 for family coverage.New York City small-business owners can purchase the plan throughtheir insurance broker, just like any other policy.
The program could be a win-win situation for both entrepreneursand the city of New York. Entrepreneurs win with reduced premiumsfor their employees.The city wins, too, by reducing the financialburden of uninsured people using public hospital emergency rooms aswalk-in clinics. But there are drawbacks, too: Employers who signup must cover all their employees, and members of the plan can onlyuse the services of three public hospitals, rather than choosingtheir own health-care providers. If the program succeeds, expect tosee far more municipalities following the Big Apple's lead.
Capitol News
Six years ago, when President Bill Clinton signed the Family andMedical Leave Act into law, small-business owners everywherebreathed a sigh of relief:While the law required businesses toprovide employees with up to 12 weeks for family and medical leaveeach year, businesses with fewer than 50 employees were exempt fromthe provision.
During the State of the Union address in January, however, thepresident pledged to extend the law's provisions to smallbusinesses, too.Although at press time there was no active drive inCongress to pursue the president's pledge, it's probablystill a good idea to contact your congressional representative ifyou have concerns about how lifting the exemption on smallbusinesses would affect you.
That's not to say that Congress hasn't been busy withinsurance-related issues: A wave of legislation is currently beingdebated in both houses that seeks to protect patients' byregulating HMOs. The legislation includes bills that allow patientsdirect access to specialists without getting permission from theirHMO, mandatory minimum lengths of stay in hospitals for certainprocedures, and outside review for patients challenging denial ofcare, among other things. To track these bills, log on to theTHOMAS site, run by the Library of Congress at http://thomas.loc.gov, and enter asearch for the keyword "insurance."
