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You may be familiar with coinsurance in the context of health insurance and workers’ compensation policies. In these cases, coinsurance means the insurance company and the patient share the costs of medical procedures.
However, coinsurance in business is different; it’s related to insurance coverage for a business’s property and assets. Here’s how coinsurance for businesses works.
Coinsurance clauses in small business insurance policies apply primarily to business property, including vehicles, buildings and office equipment. The coinsurance clause outlines the percentage of the property’s value that a policy owner must insure to receive full payment on a claim if a loss occurs.
With a coinsurance clause, the insurer knows you have adequate coverage if you must file an insurance claim. Coinsurance protects the insurance company’s ability to pay out claims for policy owners, assist with underwriting, and determine insurance premiums.
The insurer applies coinsurance percentage rates to business property or business income. This percentage depends on the property value covered under the policy owner’s plan, such as actual cash value and replacement cost value.
Coinsurance encourages companies to focus on business insurance risk management practices by sharing financial responsibility for potential losses with insurers.
Let’s say an insurer requires the amount of insurance you purchase on a property to be 80 percent of the property’s value to cover replacement costs adequately. For example, if your property is worth $100,000, you must insure it for at least $80,000.
In this example, the insurance limit would be 80 percent of the property’s value. If you fail to meet this required coverage and you file a claim on damaged property that exceeds the coverage limit, you’ll face a penalty to make up for the inadequate insurance (also known as the insurance shortfall).
Check your policy for the specific coinsurance percentage requirements associated with your property’s value and any penalties the insurer could impose.
When you’re reviewing policy options, it may seem like most property insurance possibilities involve coinsurance, in which each party shares a percentage of the claim. While this is a valid assumption, it’s not always the case.
Under a 100 percent coinsurance clause, the business owner must insure 100 percent of the property’s value. The policy’s premium costs are typically lower because the insurer doesn’t take on the same risk as it would with an 80 percent policy, in which the insurer pays out 20 percent if a claim is filed.
However, business owners should consider two things:
Choosing the right coinsurance coverage can significantly reduce your premium while protecting your business properly. You must strike a balance between the level of risk you potentially expose yourself to and the affordability of premiums.
A coinsurance penalty clause, often found on the insurance policy’s declaration page, penalizes the policy owner for not sufficiently insuring the property. These clauses require you to carry a specific amount of insurance based on the value of the covered property.
There are three ways policy owners can avoid coinsurance penalties:
Agreed value is often a higher-priced coverage option. Under this option, you and the insurer agree on the total value of all of your physical assets or property. The policy limits must equal the agreed-upon value.
Agreed value specifically requires a property value statement that you submit to the insurance company before the policy is issued or renewed. You must meet all of the stipulations defined in the policy to avoid a coinsurance penalty.
For example, if your coffee inventory stock would cost $2,000 to replace, you must insure it for at least 100 percent of the agreed value of $2,000 to avoid a shortfall and a coinsurance penalty if your inventory (commodity price) rises in value at the time of the loss.
This is the formula for agreed value:
Percentage of coinsurance x estimated net income and expenses for the time period specified by the insurer = Agreed value
Agreed value for business income insurance works similarly to agreed value in property insurance. However, in this case, since business income insurance replaces lost income, you must submit a business income worksheet listing your business’s projected revenues and expenses during a period specified by the insurance company. You must submit this information before the policy is issued or renewed each year.
Review your policy’s declaration page and contact your insurer or business insurance broker for specifics on the required accounting and documents.
Although the premium savings for this option are often minimal, value reporting accounting makes sense for companies with inventory levels that vary throughout the year. This means the policy amount and premium adjust according to the fluctuating inventory value.
Value reporting helps prevent overinsuring inventory that may decline in value at a certain point in the year. However, your small business must have highly accurate inventory value reporting to be paid out for a valid claim.
The insurer typically determines the premium based on this formula:
Value of the business ÷ $100 x insurer’s premium rates
Here are some key points to consider:
Work with your company accountant or insurance agent to see what coinsurance and property insurance plans and options best fit your small business. Read the details and specifics on your declarations page, and make sure you understand the costs associated with business insurance.
Coinsurance and deductibles are different. Coinsurance is a percentage of the cost sharing between the policy owner and the insurer. In contrast, a deductible is a predetermined amount listed in your policy. You’ll need to pay the deductible amount out of pocket before your insurer pays out any claims. Once you pay the deductible, coinsurance percentages apply to the remaining costs. For details, check your policy’s declaration page, call your insurance agent, or ask the insurer when you’re choosing business insurance.
These terms relate to health insurance. Coinsurance is the percentage of covered service costs you’re responsible for paying after your deductible. For example, if you have a 75 percent/25 percent plan, your insurer covers the first 75 percent of costs, and you pay the remainder until you reach your out-of-pocket maximum.
Copays, short for “copayments,” are charges you incur for health care services such as prescriptions, urgent care and emergency room visits. Unlike coinsurance, copays are fixed amounts. Copays may count toward your out-of-pocket maximum.
A waiver of coinsurance in your insurance policy removes your requirement to pay for a portion of a covered loss. With coinsurance, the costs of a claim are usually shared. However, if there is a waiver, your insurer will pay 100 percent of the costs for a covered event.
Mark Fairlie contributed to this article.